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A  SYSTEM 


OF 


LEGAL  MEDICINE 

BY 

ALLAN   McLANE  HAMILTON,  M.  D. 

CONSULTING  PHYSICIAN  TO  THE  INSANE   ASYLUMS  OF  NEW-YORK  CITY,  ETC.,  ETC. 

AND 

LAWRENCE  GODKIN,  ESQ, 


OF    THE   NEW-YORK  BAR 


WITH  THE  COLLABORATION  OF 


PROF.  JAMES  F.  BABCOCK,  LEWIS  BALCH,  M.  D., 

JUDGE    S.    E.    BALDWIN,    LOUIS   E.    BINSSE,    ESQ.., 

C.  F.  BISHOP,  ESQ..,  A.  T.  BRISTOW,  M.  D.,  B.  F.  CARDOZO,  ESQ., 

C.  G.  CHADDOOC,  M.  D.,  A.    F.  CURRIER.  M.  D.,  C.   L.    DANA,   M.  D.,  GEO. 

RYERSON  FOWLER,  M.  D.,  W.T.GIBB,  M.  D.,  W.  S.  HAINES,  M.  D.,  F.  A.  HARRIS,  M.D., 

W.  B.  HORNBLOWER,  ESQ. ,  CHAS.  JEWETT,  M.  D. ,  P.  C.  KNAPP,  M.  D. ,  R.  C.  McMURTRIE, 

ESQ.,  C.  K.  MILLS,  M.  D.,  J.  E.  PARSONS,  ESQ.,  C.  E.  PELLEW,  E.  M., 

JUDGE  C.  E.  PRATT,  W.  A.  PURRINGTON,  ESQ.,  B.  SACHS,  M.  D., 

F.  R.  STURGIS,  M.  D.,  BRANDRETH  SYMONDS,  M.  D., 

V.  C.  VAUGHAN,  M.  D. 


ILLUSTRATED 


VOLUME  I 


NEW-YORK 

E.  B.  TREAT,  5  COOPER  UNION 

1895 


Copyright,  "by 

E.  B.  Treat,  New  York. 

1894. 


All  rights  reserved. 


o 


i 


PEEFACE 


In  presenting  these  volumes  the  Editor  realizes  the  serious- 
ness of  the  work  that  has  engaged  his  attention  for  a  number  of 
months,  and  trusts  that  the  production  of  an  encyclopaedic  book 
of  reference  of  convenient  arrangement,  containing  special  arti- 
cles written  by  authorities  in  their  respective  branches,  will 
commend  itself  to  the  many  thinking  physicians  and  lawyers 
into  whose  hands  it  may  fall.  It  has  been  his  aim  to  make  it 
in  every  sense  an  original  embodiment  of  the  most  advanced 
knowledge  of  the  subject,  free  from  the  redundancies  which  are 
apt  to  fill  the  pages  of  many  technical  works  of  this  character. 
To  those  who  expect  a  collection  of  statistics  and  references 
it  will  doubtless  prOve  a  disappointment,  but  there  is  no  diffi- 
culty in  obtaining  such  material  elsewhere. 

An  experience  of  almost  a  quarter  of  a  century  has  con- 
vinced the  Editor  that  both  medical  and  legal  practitioners, 
in  the  preparation  of  their  cases,  need  just  such  information 
as  they  will  here  find  in  a  concise  and  easily  accessible  form, 
and  it  is  hoped  that  the  lawyer  and  the  doctor  who  go  into 
court  will,  without  much  effort,  obtain  the  needed  aid. 

The  legal  contributors  who  have  so  kindly  helped  the  Editor 
have  been  requested  to  prepare  special  articles  upon  subjects 
which  most  frequently  arise  in  court,  and  are  usually  neglected 
in  treatises  upon  medical  jurisprudence,  or,  at  best,  are  but 
superficially  noticed. 

It  is  hoped  that  the  reader  will  enjoy  the  Editor's  satisfac- 
tion in  the  presentation  of  much  experimental  work  and  new 


s  PREFACE. 

materia]  which  is  inseparable  from  advanced  forensic  medicine. 
It  would  be  unfair  to  single  out  examples  of  snch  research,  but 
the  painstaking  and  thorough  experiments  in  regard  to  the 
effect  of  gunshot  wounds,  the  inquiries  relative  to  the  impor- 
tance  of  Mood-stains,  and  the  novel  and  significant  investiga- 
tions in  regard  to  ptomaine  poisoning  in  the  first  volume,  may- 
be cited  as  examples  of  the  general  industry  and  progressive 
methods  of  the  contributors  generally;  and  the  new  material 
relative  to  railway  neuroses,  aphasia,  and  medical  and  surgical 
malpractice,  in  the  second  volume,  is  an  earnest  of  what  the 
writers  upon  these  subjects  and  the  others  have  done. 

The  thanks  of  the  Editor  are  due  to  Dr.  Hebbert,  lately  asso- 
ciated witli  Mr.  Bond,  the  Coroner  of  London,  England,  who 
has,  in  conjunction  with  Dr.  F.  A.  Harris,  presented  for  the  first 
time  in  a  book  of  medical  jurisprudence  the  records  of  the 
W 1 1  it  .'chapel  murder  cases,  and  the  deductions  therefrom,  which 
must  in  future  play  a  great  part  in  the  determination  of  the 
identity  of  the  dead  body. 

It  has  been  the  aim  of  the  Editor  and  his  associates  to  be  as 
impartial  as  possible  in  their  treatment  of  the  different  subjects, 
and  it  is  expected  that  this  work  will  further  the  rights  of  the 
people  and  the  prisoner  as  well,  and  be  in  every  way  a  safe  and 
useful  guide. 

Allan  McLane  Hamilton. 


LIST   OF   CONTRIBUTORS. 


VOLUME  I. 


JAMES  F.  BABCOCK,  formerly  Professor  of  Chemistry  in  the  Mas- 
sachusetts College  of  Pharmacy,  and  in  the  Boston  University,  and 
State  Assayer  of  Massachusetts. 

LEWIS  BALCH,  Ph.D.,  M.D.,  Professor  of  Medical  Jurisprudence, 
Albany  Medical  College;  Consulting  Surgeon  to  St.  Peter's  Hos- 
pital ;  Surgeon  to  the  Child's  Hospital ;  Secretary  of  the  New  York 
State  Board  of  Health ;  Health  Officer  of  Albany. 

CORTLANDT  FIELD  BISHOP,  Esq.,  of  the  New  York  Bar. 

A.  T.  BRISTOW,  A.B.,  M.D.,  Demonstrator' of  Anatomy  to  the  Long 
Island  College  Hospital  Medical  School ;  Surgeon  to  the  Long  Island 
College  Hospital,  Brooklyn,  N.  Y. ;  etc.,  etc. 

BENJAMIN  N.  CARDOZO,  Esq.,  of  the  New  York  Bar. 

W.  TRAVIS  QIBB,  M.D.,  Examining  Physician  to  the  New  York  Society 
for  the  Prevention  of  Cruelty  to  Children;  Instructor  in  Gynaecology, 
Medical  Department,  New  York  University ;  Assistant  in  Gynecol- 
ogy, New  York  Polyclinic. 

WALTER  S.  HAINES,  A.M.,  M.D.,  Professor  of  Chemistry  and  Toxi- 
cology in  Rush  Medical  College,  Chicago;  Toxicologist  to  the  Presby- 
terian Hospital,  Chicago;  Consulting  Chemist  to  the  Health  Depart- 
ment of  the  City  of  Chicago;  Fellow  of  the  Chemical  Society,  Lon- 
don ;  etc.,  etc. 

9 


10  LIST  OF  CONTRIBUTORS. 

ALLAN  McLANE  HAMILTON,  M.D.,  Consulting  Physician  to  the  In- 
sane Asylums  of  New  York  City;  Consulting  Neurologist  to  the  Hos- 
pital for  Ruptured  and  ('rippled,  and  to  the  Hospital  for  Nervous 
Diseases;  author  of  a  "Treatise  upon  Medical  Jurisprudence,  espe- 
cially with  reference  to  Injuries  and  Diseases  of  the  Nervous  System," 
"  Types  of  Insanity,"  "Nervous  Diseases,  Their  Description  and  Treat- 
ment," articles  upon  Epilepsy  in  Wood's  Handbook  and  Pepper's 
•■System  of  Medicine." 

FRANCIS  A.  HARRIS,  M.D.,  formerly  Instructor  of  Medical  Jurispru- 
dence in  the  Harvard  Medical  School;  Medical  Examiner  of  Suffolk 
Co.,  Mass. 

R.  C.  McMURTRIE,  Esq.,  of  the  Philadelphia  Bar. 

C.  E.  PELLEW,  Ph.D.,  Demonstrator  in  Physics  and  Chemistry  at  the 
College  of  Physicians  and  Surgeons,  Medical  Department  of  Columbia 
College ;  Fellow  of  the  New  York  Academy  of  Sciences ;  author  of 
"Laboratory  Schemes  in  Medical  Chemistry"  and  a  "Practical  Man- 
ual of  Medical  and  Physiological  Chemistry." 

WILLIAM  A.  PURRINGTON,  Esq.,  of  New  York,  formerly  Counsel  of 
the  New  York  County  Medical  Society. 

BRANDRETH  SYMONDS,  A.M.,  M.D.,  is  the  Senior  Examining  Phy- 
sician of  the  Mutual  Life  Insurance  Co.  for  New  York  City. 

VICTOR  C.  VAUGHAN,  A.M.,  Ph.D.,  M.D.,  Dean  of  the  Medical  Fac- 
ulty, and  Professor  of  Hygiene  and  Physiological  Chemistry  in  Mich- 
igan University ;  member  of  the  Michigan  State  Board  of  Health ; 
member  of  the  American  Association  of  Physicians ;  member  of  the 
German  Chemical  Society ;  honorary  member  of  the  French  Society 
of  Hygiene ;  etc.,  etc. 


CONTENTS  OF  VOLUME  L 


PAGE 

Preface 7 

Introduction 17 

LAWRENCE  GODKIN,  Esq. 

Medico-Legal  Inspections  and  Post-Mortem  Examinations  ....     25 

algernon  t.  bristow,  a.b.,  m.d. 

Death  in  its  Medico-Legal  Aspects „ 57 

FRANCIS  A.  HARRIS,  M.D. 

Blood  and  Other  Stains — Hair 139 

Prof.  JAMES  F.  BABCOCK. 

Identity  of  the  Living 191 

ALLAN  McLANE  HAMILTON,  M.D. 

Identity  and  Survivorship 213 

BENJAMIN  N.  CARDOZO,  Esq. 

Homicide  and  Wounds 243 

LEWIS  BALCH,  M.D.,  Ph.D. 

Poisoning  by  Inorganic  Substances 321 

CHARLES  E.  PELLEW,  Ph.D. 

Poisoning  by  Alkaloids  and  Organic  Substances 415 

walter  s.  haines,  a.m.,  m.d. 

The  Toxicologic  Importance  of  Ptomaines  and  other  Putre- 
factive Products 475 

VICTOR  C.  VAUGHAN,  Ph.D.,  M.D. 

11 


L2  CONTENTS  OF   rOLUME  I. 

PAGB 

The  Medical  Jurisprudence  of  Life  Insurance 493» 

BRANDRETH   SYMONDS,  A.M.,  M.D. 

Accident  Insurance 583; 

CORTLANDT  FIELD  BISHOP,  Esq. 

The  Obligation  of  the  Insured  and  the  Insurer 591 

R.  C.  McMURTRIE,  Esq. 

Of  Certain  Legal  Relations  of  Physicians  and  Surgeons  to 
their  Patients  and  One  Another 595 

WILLIAM  A.  PURRINGTON,  Esq. 

Indecent  Assault  upon  Children 64i> 

W.  TRAVIS  GIBB,  M.D. 


LIST  OF  ILLUSTKATICOTS. 


VOLUME   I. 


PLATES. 

PAGE 

I.   Internal  Surface  of  Stomach  of  a  Child  poisoned  by  Arsenic . . 

Frontispiece 
II.   Dissection  of  the  Heart 45 

III.  Death  by  Burning,  showing  Vesicles  and  Contortions  of 

Limbs 133 

IV.  Arborescent  Marking  produced  by  Lightning-Stroke 135 

V.   Absorption  Spectra  of  Blood 145 

VI.   Human  Blood-Corpuscles « 153 

VII.   Effects  of  Vitriol 285 

VIII.   Color  Reactions  of  Alkaloids 415 


WOOD-CUTS  AND   HALF-TONE  ENGRAVINGS. 

Fig.  1.  Method  of  Saw-Cutting  for  Removal  of  Calvarium 38 

Fig.  2.   Line  of  External  Incision  of  Heart « 45 

Fig.  3.   Exposure  of  Interior  of  Heart 45 

Fig.  4.   Skull  of  European 62 

Fig.  5.   Skull  of  Australian 62 

Fig.  6.   Pelvis  of  Man 63 

Fig.  7.   Pelvis  of  Woman •  64 

Fig.  8.   Inferior  Maxilla  of  New-born,  showing  Union  of  Rudimen- 
tary Processes 65 

13 


PAGE 


14  LIST  OF  ILLUSTRATIONS. 

Fig.    9.  The  Microspectroscope 143 

Pig.  10.   Zeiss's  Microspectroscope 143 

Fig.  11.   Cells  for  the  Microspectroscope 144 

Fig.  12.  Haemoglobin  Crystals 148 

Fig.  13.   Blood-Corpuscles  from  the  Mammalia  and  the  Ovipara  ...   151 

Fig.  14.   Blood  Drops  and  Spatters I55 

Fig.  15.   Hsamin  Crystals 163 

Fig.  1G.   Blood-clot  and  Various  Spores 170 

Fig.  17.   Microscopical  Appearance  of  Materials  found  Associated 

with  Blood !71 

Fig.  18.  Eye-piece  Micrometer - 172 

Fig.  19.   Diagram  representing  the  Comparative  Sizes  of  the  Red 

Blood-Corpuscles  of  Various  Animals 175 

Fig.  20.   Epithelium  from  the  Vagina 180 

Fig.  21.   Microscopical  Appearance  of  Spermatozoa 185 

Figs.  22-35.  Microscopical    Appearance    of    Hairs    from  Various 

Sources,  and  Vegetable  and  other  Fibers 188 

Figs.  36,  37.   Illustrating  Change  through  the  Effect  of  Disease 194 

Fig.  38.   Growth  of  Hair,  with  reference  to  Race  Type 197 

Fig.  39.   Schematic  Figure  showing  the  Different  Thumb  Tip  Types 

of  Galton  and  the  Disposition  of  the  Papillary  Lines . . .   205 
Fig.  40.   Impression  of  the  Right  Thumb— Schematic.    (Testut.) . . .   205 

Fig.  41.   Causse's  Method  for  Identifying  Footprints 206 

Figs.  42-50.  Noses  Classified  according  to  Bridge  and  Base.     (Ber- 

tillon.) 209 

Figs.  51-59.   Classification  of  Foreheads.     (Bertillon.) 210 

Fig.  60.   Some  Classifications  of  the  Form  of  the  Ear.     (Bertillon.)  211 
Figs.  61-64.   Powder  Tattoo-Marks  made  by  Revolver  at  Various 

Distances 255,  256 

Fig.  65.   Mrs.  Billings's  Skull.     Point  of  Entrance  of  Ball 265 

Fig.  66.   Mrs.  Billings's  Skull.     Hole  made  by  Piece  of  Bone,  being 

driven  outward  backward 265 

Fig.  67.  Inside  View  of  Mrs.  Billings's  Skull,  showing  left  petrous 

portion  gone,  and  on  the  right  side  the  place  where  the 

ball  lodged 265 

Figs.  68,  69.   Experiment  on  Skull— Sixth  Shot 266 

Fig.  70.  Inside  View  of  Skull— Sixth  Shot 266 


LIST  OF  ILLUSTRATIONS.  15 

PAGE 

Fig.  71.   Blood-clot  from  Right  Middle  Meningeal  Artery,  effused 

between  Bone  and  Dura-Mater.    (Mechaniesvilie  Case.) . .  268 

Fig.  72.   Front  View  of  Heart  and  Lungs 307 

Fig.  73.   The  Liver 309 

Fig.  74.   The  Stomach  and  Small  Intestines 313 

Fig.  75.   Ordinary  Reduction-Tube,  with  Charcoal  Splinter 373 

Fig.  76.   Special  Reduction-Tube,  when  Flux  is  used,  drawn  out  after 

Mixture  is  inserted 373 

Fig.  77.   Marsh's  Apparatus „ . . .  375 

Fig.  78.   Ignition-Tube,  for  Berzelius-Marsh  Test 376 

Fig.  79.   Arsenic  Deposits  in  the  Berzelius-Marsh  Test 377 

Fig.  80.   Crystals  of  Morphine  from  Stomach.     Magnified  18  diam- 
eters    445 

Fig.  81.   Crystals  of  Strychnine  Chromate.   Magnified  80  diameters .  455 
Fig.  82.   Crystals  of  Strychnine  from  Stomach.    Magnified  12  diam- 
eters   456 

Fig.  83.   Strychnine  from  Stomach.    Magnified  40  diameters 457 


INTRODUCTION. 


Medical  jurisprudence,  or  legal  medicine,  may  be  denned  as  the 
science  which  applies  the  principles  and  practice  of  the  different  branches 
of  medicine  to  the  elucidation,  in  judicial  proceedings,  and  subject  to 
legal  rules  and  forms,  of  questions  relating  to  the  cause  or  time  of  death, 
conception  and  birth,  or  the  cause  or  effect  upon  the  legal  status  of  indi- 
viduals of  mental  or  physical  disease  or  injuries. 

The  questions  which  are  included  in  this  definition  have  been  divided 
into  five  classes,  the  first  of  which  includes  inquiries  arising  out  of  the, 
relations  of  sex,  as  impotence  and  sterility,  pregnancy,  legitimacy,  and 
rape ;  the  second,  injuries  inflicted  on  the  living  organism,  as  infanticide, 
wounds,  poison,  injuries,  and  death  from  violence;  the  third,  questions 
arising  out  of  disqualifying  diseases,  as  the  different  forms  of  mental 
alienation ;  the  fourth,  those  arising  out  of  deceptive  practices,  as  feigned 
diseases;  fifth,  questions  of  a  miscellaneous  nature,  as  age,  identity,  pre- 
sumption of  seniority,  and  life  assurance. 

Of  course  the  means  or  instrumentalities  by  winch  the  principles  and 
practice  of  medicine  are  applied  to  the  elucidation  of  questions  of  law- 
are  the  utterances  of  persons  skilled  in  medicine,  to  wit,  of  physicians, 
surgeons,  and  chemists.  These  utterances,  whether  oral  or  written,  are 
made  use  of  in  courts  of  justice,  subject  to  certain  rules  which  have 
been  adopted  as  best  calculated  to  correct  or  assist  the  infirmities  of  the 
human  character,  mind,  and  memory. 

In  a  general  way  the  evidence  given  by  medical  and  chemical  experts 
has  been  classed  as  "opinion"  evidence — that  is  to  say,  as  evidence 
which  consists  in  the  expert  giving  the  conclusions  which  he.  as  a  sci- 
entific man,  draws  from  certain  facts  which  have  been,  or  are  supposed 
to  have  been,  proved.  But  owing  to  the  progress  of  the  science  of  medi- 
cine, and  as  the  result  of  the  modern  scientific  methods  of  investigation 
with  accurate  results,  medicine  and  chemistry  have  become  more  worthy 
to  be  classed  as  exact  sciences,  and  much  of  the  testimony  of  physicians 
which  formerly  might  rightly  have  been  classed  as  pure  matter  of  opinion 
is  now  as  much  a  statement  of  matter  of  fact  as  a  statement  of  the  law 
of  gravity,  or  the  fact  that  the  earth  moves  around  the  sun.  And  while 
it  is  to  a  large  extent  still  true — as  was  laid  down  in  a  case  in  New  York 
which  established  the  proposition  that  the  law  does  nol  recognize  any 
particular  class  or  school  of  practitioners  as  qualified  experts  to  the 
exclusion  of  other  classes  or  schools — that  medicine  is  no!  an  exact 
science  in  which  truths  have  become  established  and  fixed,  but  that,  on 
the  contrary,  it  has  been  characterized  in  a  greater  degree  by  fluctuation 
of  opinion  as  to  its  principles  and  the  mode  of  practice  than  perhaps  any 

17 


1  s  I  NTH  01)  UCTIOK. 

other  pursuit,  and  has  been  distinguished  by  the  constant  promulgation 
and  explosion  of  theories,  and  that  the  popular  axiom  that  doctors  differ 
is  as  true  now  as  it  ever  was,  still,  on  the  other  hand,  there  has  been,  ever 
since  the  discovery  of  the  circulation  of  the  blood,  a  steady  progression 
in  medicine  toward  the  establishment  of  an  increasing  collection  of 
fundamental  and  precise  scientific  facts,  which  are  almost  as  reliable,  as 
premises,  as  any  of  the  facts  in  nature  of  which  courts  have  for  many 
years  taken  judicial  notice  without  proof.  This  is  especially  true  of 
that  division  of  medicine  which  is  known  as  patholog}^  as  distinguished 
from  therapeutics,  and  in  which  the  modern  scientific  school  of  medicine 
lias  made  such  wonderful  discoveries,  by  means  of  methods  of  demon- 
stration and  proof  which  have  raised  the  results  out  of  the  domain  of 
controversy. 

Nor  is  the  complaint  which  Bacon  made  in  the  seventeenth  century — 
that  the  science  of  medicine  had  departed  from  the  true  path  trod  by 
Hippocrates,  who  used  to  set  down  a  narrative  of  the  special  cases  of  his 
patients,  and  how  they  proceeded,  and  how  they  were  judged  by  recovery 
or  death— any  longer  applicable;  for  to-day  a  large  part  of  the  science 
of  medicine  consists,  like  the  profession  of  the  law,  in  studying  and 
reporting  new  cases  and  decisions  for  the  direction  of  future  judgments. 
It  is  his  learning  and  experience,  drawn  from  the  "myriad  of  single 
instances,"  which  qualify  the  medical  expert  and  gives  his  opinion,  in 
the  specific  instance  in  issue,  gravity  and  weight.  In  the  actual  practice 
of  medicine  it  is  still  true,  as  of  old,  that  the  physician  is  judged  to  a 
great  degree  by  the  recovery  or  not  of  his  patient,  either  of  which  results 
may  be  due  to  a  hundred  causes  other  than  the  skill  or  ability  or  incom- 
petence of  the  physician;  but  in  forensic  medicine  the  expert  is  judged 
l>\  the  knowledge  and  learning  evinced  in  his  testimony,  and  not  by  the 
result  of  the  trial.  And  in  these  days  of  criticism  and  belittling  of 
expert  testimony  on  the  grounds  that  it  consists  of  bought  opinion,  it  is 
well  to  hear  in  mind  the  remark  of  that  prince  of  practical  philosophers, 
Dr.  Johnson,  who,  when  Sir  James  Johnston  said  that  he  paid  no  atten- 
tion to  arguments  of  counsel  at  the  bar  of  the  House  of  Commons  be- 
cause they  were  paid  for  speaking,  replied :  "Nay,  sir,  argument  is  argu- 
ment. You  cannot  help  paying  regard  to  their  arguments  if  they  are 
good."  And  so  in  the  case  of  expert  testimony,  if  the  opinion  or  argu- 
ment of  the  expert  appears  sound  and  weighty,  and  to  be  based  on  sound 
premises,  it  is  no  answer  to  the  impression  hf  may  make  upon  the  minds 
of  the  hearers  that  the  expert  was  paid  for  testifying. 

_  Although  the  principles  of  medical  science  were  applied  to  the  deter- 
mination of  certain  legal  questions  by  the  Greeks  and  Romans,  there  is 
nowhere  any  authoritative  mention  of  such  a  procedure  in  actual  trials. 
There  is  some  doubt  whether  in  Roman  criminal  trials  the  accused  was 
himself  allowed  to  call  any  witnesses  in  his  own  behalf  except  as  to 
his  general  character.  Mr.  Trollope.  in  his  Life  of  Cicero,  savs  that  he 
was  not.  There  does  not  seem  to  be  any  allusion  either  in  the  Digest  or 
the  Theodosian  Code  to  insanity,  or  any  form  of  mental  alienation,  as  a 
defense  to  prosecution  for  crime;  but  we  know  that  the  subject  was  fully 
recognized  under  the  system  of  Roman  jurisprudence,  and  that  insane 
persons  were  regarded  as  having  no  intelligent  wiU,  and  as  therefore 
being  incapable  of  having  rights  or  responsibilities,  and  that  their  per- 
sons and  property  were  placed,  after  due  investigation  bv  magistrates. 


IXTB  OD  UCTION.  j 9 

under  the  custody  of  curators.  It  is  very  probable  that  in  such  proceed- 
ings expert  testimony  was  relied  upon  to  some  extent  at  least.  In  Rome, 
under  both  the  republic  and  empire,  and  elsewhere  in  Europe  during  the 
middle  ages,  human  suffering  produced  by  physical  torture  was  relied 
upon  in  criminal  procedure  to  extort  confessions  or  other  evidence  which 
might  be  used  against  the  prisoner,  and  during  all  these  dark  ages  of  the 
criminal  law  we  hear  but  little  of  medicine  as  an  adjunct  to,  or  a  miti- 
gator  of,  its  enforcement.  Torture  played  a  prominent  part  in  Roman 
criminal  procedure,  particularly  in  the  preliminary  investigation  after 
the  arrest  of  the  accused.  Slaves  were  tortured  when  their  masters  were 
suspected  of  offenses,  and  the  accused  himself  might  be  tortured  repeat- 
edly when  the  evidence  against  him  was  particularly  strong.  It  is  worthy 
•of  note  here  that  the  Roman  law  was  especially  severe  upon  the  crime  of 
poisoning,  and  extended  its  provisions  to  every  one,  "qui  venemum  necandi 
Jiominis  causa  fecerit,  vel  vendiderit"  and  that  the  crime  of  rape  was  spe- 
cially provided  for,  and  was  not  included  under  the  "Lex  Julia  de  AdiiJ- 
terns,"  which  apparently  was  intended  to  cover  every  other  sort  and 
description  of  sexual  crime.  But  the  crime  of  murder  or  attempted  mur- 
der by  poison  has  always  been  regarded  with  special  abhorrence  in  ancient 
systems  of  law.  By  the  Statute  22  Hen.  VIII.  it  was  provided  that  will- 
ful poisoners  should  be  boiled  to  death  ;  and  in  the  trial  of  Richard  Wat- 
son for  poisoning  in  1615  Lord  Coke  declared  that  "  of  all  felonies  murder 
is  the  most  horrible  ;  of  all  murders,  poisoning  the  most  detestable ;  and 
of  all  poisoning,  the  lingering  poisoning."     (State  Trials,  vol.  ii.,  p.  91.) 

The  idea  of  preliminary  torture  of  the  accused  with  a  view  to  extract- 
ing from  him  a  confession,  or  evidence  that  can  be  used  against  him,  is 
preserved,  although  of  course  in  a  very  much  modified  and  milder  form. 
in  the  French  system  of  criminal  procedure.  In  France  the  juge  d'instruc- 
tion,  who  in  some  respects  corresponds  to  our  committing  magistrate, 
may  put  the  prisoner  in  solitary  confinement  for  an  indefinite  time,  and 
during  the  time  question  him  in  secret  as  often  as  he  desires.  This 
secret  interrogation  may  be  carried  on  without  giving  the  accused  any 
information  as  to  the  nature  of  the  evidence  against  him,  and  every  art 
of  verbal  torture — in  addition  to  the  solitary  confinement — calculated 
to  extort,  from  him  a  confession  may  be  used  against  the  unfortunate 
prisoner. 

The  system  of  trial  by  ordeal  which  existed,  particularly  in  England, 
in  the  middle  ages,  and  even  up  to  the  sixteenth  century,  may  have  suf- 
ficient interest  to  the  student  of  legal  medicine  to  deserve  a  passing 
mention.  In  England,  under  this  system,  if  an  accused  person  could  not 
get  a  sufficient  number  of  satisfactory  "compurgators,"  or  persons  who 
would  swear  to  their  belief  in  his  innocence,  he  was  put  to  the  ordeal. 
This  ordeal  might  be  of  various  descriptions.  It  sometimes  consisted  in 
compelling  the  accused  to  handle  red-hot  irons,  or  plunge  parts  of  his 
body  into  boiling  water,  and  if  the  skin  showed  any  mark  of  burn  or 
scalding,  he  was  guilty.  Another  form  of  the  ordeal  was  to  throw  the 
accused  into  water,  and  if  he  sank  he  was  innocent,  ami  if  lie  floated  he 
was  guilty.  These  ordeals,  whatever  might  be  their  nature,  were  simply 
tests  of  human  endurance  of  such  a  kind  that  only  a  reversal  of  some 
law  of  nature  could  enable  the  victim  to  successfully  supporl    them. 

The  real  beginning  of  the  science  of  forensic  medicine  is  generally 
ascribed  to  the  publication  in  1.353,  by  the  Emperor  Charles  V.  of  Ger- 


j,)  IXTltOnUCTWN. 

many,  of  the  Constituo  Criminalis  Carolina,  or  Caroline  Code,  in  which  it 
was  directed  that  the  opinion  of  medical  men  should  be  taken  in  cases 
where  death  was  alleged  to  have  occurred  by  violence,  and  suspicion 
existed  of  a  criminal  agency.  But  it  was  not  until  the  seventeenth 
century  that  we  began  to  have  authentic  recorded  instances  of  the  em- 
plovim-nt  of  forensic  medicine  in  England,  and  in  some  of  the  English 
state  trials  of  that  time  we  find  cases  in  which  medical  men  were  called 
upon  to  testify  in  criminal  trials;  but  in  a  large  class  of  inquiries  which 
are  to-day  the  subject  of  medical  examination  and  testimony,  medical 
men  were  not  consulted.  For  instance,  we  know  that  in  applications 
for  postponement  of  the  sentence  of  death  on  account  of  pregnancy,  in 
prosecutions  for  rape,  and  in  applications  for  a  decree  of  nullity  on  the 
ground  of  incapacity  to  consummate  the  marriage  contract,  it  was  the 
practice  to  impanel  a  jury  of  matrons  to  examine  and  report  to  the  court. 
In  the  trial  for  murder  of  Jane  Norkott,  in  1628,  there  is  a  curious  in- 
stance of  the  disinterment  of  a  body  for  a  second  inquest  thirty  days  after 
the  first  inquest  had  been  held.  At  the  first  inquest  the  coroner's  jury 
rendered  a  verdict  of  suicide.  It  was  shown  upon  the  trial  that  when 
the  body  of  Jane  Norkott  was  disinterred  for  the  second  inquest,  one  of 
the  persons  accused  of  her  murder  touched  the  dead  body,  "  whereupon 
the  brow  of  the  dead,  which  before  was  of  a  livid  and  carrion  color,  be- 
gan to  have  a  dew  or  gentle  sweat  arise  on  it,  which  increased  by  degrees 
till  the  sweat  ran  down  in  drops  on  the  face,  the  brow  turned  to  a  lively 
and  fresh  color,  and  the  deceased  opened  one  of  her  eyes  and  shut  it 
again ;  and  this  opening  the  eye  was  done  three  several  times ;  she  like- 
wise thrust  out  the  ring  or  marriage  finger  three  times  and  pulled  it  in 
again,  and  the  finger  dropped  blood  on  the  grave."  (14  State  Trials, 
1342 .) 

In  1665  occurred  the  trial  of  the  Suffolk  witches,  Rose  Cullender  and 
Amy  Duny,  on  a  charge  of  bewitching  children,  in  which  we  find  one 
of  the  most  enlightened  and  distinguished  physicians  of  the  time,  Sir 
Thomas  Browne,  author  of  the  Beligio  Medici,  testifying  to  his  belief  in 
witchcraft,  and  it  was  largely  upon  his  testimony  that  the  unfortunate 
women  were  -convicted  and  hung.  As  an  illustration  of  the  value  of 
the  best  medical  testimony  in  England  in  that  day,  it  is  worth  while  to 
quote  Dr.  Browne's  testimony  in  court,  delivered  after  an  examination 
of  the  two  accused  women  and  the  aunt  of  the  children  alleged  to  have 
been  bewitched.  It  seemed  that  Rose  Cullender  and  Amy  Duny  had 
quarreled  with  the  parents  of  the  children;  that  the  children  subse- 
quently had  fits  and  threw  up  crooked  pins  and  a  twopenny  nail  with  a 
broad  head,  and  that  thereupon  a  bee  brought  the  nail  and  forced  it  into 
the  child's  mouth ;  and  the  two  children  declared  that  the  prisoners  were 
tormenting  them,  and  that  they  saw  their  apparitions.  There  was  other 
evidence,  but  the  foregoing  was  the  most  weighty.  After  hearing  the 
evidence  and  making  his  examination,  Dr.  Browne,  having  been  called 
on  for  his  opinion,  stated  to  the  court  that  "  he  was  clearly  of  opinion 
that  the  persons  were  bewitched,  and  said  that  in  Denmark  there  had 
been  lately  a  great  discovery  of  witches,  who  used  the  very  same  way  of 
afflicting  persons  by  conveying  pins  into  them,  and  crooked  as  these  pins 
were,  with  needles  and  nails.  And  his  opinion  was  that  the  devil  in  such 
cases  did  work  upon  the  bodies  of  men  and  women  upon  a  natural  foun- 
dation (that  is)  to  stir  up  and  excite  such  humours  superabounding  in 


INTBOD  UCTIOX.  9 1 

their  bodies  to  a  great  extent,  whereby  he  did  in  an  extraordinary  man- 
ner afflict  them  with  such  distempers  as  their  bodies  were  most  subject 
to,  as  particularly  appeared  in  these  children;  for  he  conceived  that 
these  swooning  fits  were  natural,  and  nothing  else  but  that  they  call  the 
mother,  but  only  heightened  to  a  great  excess  by  the  subtlety  of  the 
devil  cooperating  with  the  malice  of  those  we  term  witches,  at  whose 
instance  he  doth  these  villainies." 

In  his  Iieligio  Medici  (part  i.,  sec.  30)  Dr.  Browne  emphatically  affirms 
his  belief  in  witches,  and  describes  those  who  do  not  believe  in  them  as 
"  a  sort  not  of  Infidels,  but  Atheists."  In  charging  the  jury  in  the  case 
just  alluded  to,  Chief -Justice  Hale  said  "  that  there  were  such  creatures 
as  witches  he  had  110  doubt  at  all." 

In  the  early  part  of  the  eighteenth  century  we  have  what  is  probably 
the  first  recorded  instance  of  a  criminal  trial  in  which  the  result  de- 
pended largely  upon  the  conflicting  evidence  of  medical  experts.  The 
case  was  that  of  Spencer  Cowper,  an  Englishman  of  high  position,  who 
was  accused  of  the  murder  of  a  Quakeress,  Sarah  Stout  by  name.  Miss 
Stout's  body  was  found  one  morning  in  a  mill  stream.  There  was  evi- 
dence to  show  that  the  last  person  who  had  been  with  her  on  the  night 
before  was  Cowper.  He  was  tried  for  her  murder,  and  a  considerable 
number  of  physicians  were  called  by  the  prosecution  and  defense  to 
establish  or  controvert,  among  others,  this  proposition :  that  "  it  is  con- 
trary to  nature  that  any  persons  that  drown  themselves  should  float  upon 
the  water ;  we  have  sufficient  evidence  that  it  is  a  thing  that  never  was ; 
if  persons  come  alive  into  the  water,  then  they  sink ;  if  dead,  then  they 
swim."  Witnesses  were  also  called  to  prove  the  proposition  that  water 
must  be  found  in  the  stomach  of  a  person  who  died  of  drowning,  and 
that  its  absence  was  inconsistent  with  death  so  caused.  The  case  was 
prosecuted  and  defended  with  great  energy  and  vigor,  and  resulted  in 
Cowper's  acquittal.  Baron  Hatsell,  who  presided  at  the  trial,  made  some 
remarks  upon  medical  testimony  in  the  course  of  his  charge  to  the  jury, 
which  have  a  decided  resemblance  to  some  of  the  reflections  which  are 
made  to-day  by  judges  charging  the  jury  upon  the  merits  of  the  same 
kind  of  evidence.  Baron  Hatsell  said :  "  You  have  heard  also  what  the 
doctors  and  surgeons  said  on  the  one  side  and  the  other  concerning  the 
swimming  and  sinking  of  dead  bodies  in  the  water;  but  I  can  find  no 
certainty  in  it,  and  I  leave  it  to  your  consideration.  The  doctors  and 
surgeons  have  talked  a  great  deal  to  this  purpose,  and  of  the  water  going 
into  the  lungs  or  the  thorax;  but  unless  you  have  more  skill  in  anatomy 
than  I,  you  will  not  be  much  edified  by  it."     (13  State  Trials,  1188.) 

In  another  criminal  trial  somewhat  later  we  find  a  very  curious  result 
of  the  denial  to  the  prisoner  of  the  assistance  of  counsel  in  trials  for 
felony.  At  the  trial  of  Lord  Ferrars,  the  prisoner  set  up  the  defense 
of  insanity,  and  was  obliged  himself  to  examine  the  witnesses  whom  he 
called  to  support  this  plea. 

In  the  nineteenth  century  the  development  of  the  science  of  forensic 
medicine  has  been  rapid  and  important,  and  a  quantity  of  literature  lias 
appeared  upon  the  subject,  Some  of  the  best  known  names  of  contrib- 
utors to  the  science  are  those  of  Orfila  and  Tardieu  in  France,  Casper  in 
Germany,  Christison,  Tavlor,  Guy,  and  Ogston  in  England,  and  Beck. 
Reese,  Wharton  and  Stille,  and  Wormley  in  the  United  States.  The 
increasing  complexity  of  modern  life  resulting  as  it  has  in  a  marked  in- 


22  INTRODUCTION. 

crease  in  the  quantity  and  variety  of  litigation,  the  rapid  strides  in  the 
direction  of  accurate  knowledge  and  means  of  scientific  investigation 
which  have  been  made  in  medicine,  surgery,  and  chemistry,  and  the 
tendency  to  a  relaxation  of  the  strictness  of  the  old  common-law  rules  of 
evidence,  have  all  contributed  to  activity  in  the  domain  of  forensic  medi- 
cine  and  lo  the  enlargement  of  the  field  of  its  application. 

Recurring  to  the  definition  of  medical  jurisprudence  which  has  been 
given,  it  is  obvious  in  the  first  place  that  a  wide  field  of  science  may  be 
covered  by  the  terms  "principles  and  practice  of  medicine."  Anat- 
omy, physiology,  medicine,  surgery,  chemistry,  and  physics,  all  come  to  a 
greater  or  less 'extent  within  the  province  of  the  science  of  medicine,  and 
they  are  all  constantly  called  upon  to  contribute  to  the  elucidation  of 
legal  questions  affecting  life,  liberty,  and  property.  It  may  be  said  that 
the  progress  which  has  been  made  in  the  application  of  the  sciences  of 
toxicology  and  pathology  in  courts  of  law  has  greatly  increased  the  dif- 
ficulty of  successfully  concealing  the  crime  of  death  by  poisoning. 

Nor  is  the  category  of  the  kind  of  judicial  proceedings  in  which  the 
assistance  of  the  trained  medical  witness  is  invoked  less  varied  than  the 
nature  of  the  subjects  covered  by  the  science  of  medical  jurisprudence. 
Tin'  determination  of  the  capacity  of  testators  to  make  wills,  of  contract- 
ing parties  to  contract,  and  in  the  marriage  relation  to  consummate  the 
contract,  the  decision  of  property  rights  depending  upon  questions  of 
legitimacy,  survivorship,  age,  and  identity,  mental  capacity  to  take  and 
hold  property,  are  all  familiar  instances  on  the  civil  side  of  the  law  of  the 
daily  application  of  the  science  of  medical  jurisprudence  to  assist  courts 
and  juries  in  arriving  at  just  conclusions  in  regard  to  property  rights; 
while  in  the  criminal  branch  of  the  law,  the  increasing  frequency  with 
which  mental  alienation  is  interposed  as  a  defense  to  prosecution  for 
crimes  of  violence,  the  necessity  of  the  ascertainment  of  the  causes,  and 
probable  means  or  instrument,  of  death  or  injury,  and  the  duration  and 
effect  of  such  injuries,  and  questions  arising  out  of  what  is  known  as- 
hypnotism,  which  has  already  more  than  once  been  interposed  in  France 
as  a  defense  to  criminal  prosecutions — all  furnish  a  class  of  cases  in 
which  the  testimony  of  the  medical  expert  is  indispensable.  It  is  to  be 
noted,  however,  that  the  statute  law  of  many  of  the  States  has  interposed 
a  wise  and  salutary  check  upon  possible  forms  of  abuse  of  the  confiden- 
tial relation  which  must  of  necessity  exist  between  physician  and  patient, 
by  prohibiting  the  disclosure  by  a  physician  of  communications  made 
by,  or  information  received  from,  the  patient  while  in  attendance  upon 
him  in  a  professional  capacity.  This  topic  will  be  fully  treated  in  a 
subsequent  article.  It  is  an  instance  of  a  class  of  cases  in  which  expert 
testimony  is  limited  or  excluded  on  the  same  well-founded  grounds  of 
public  policy  which  has  caused  the  enactment  of  laws  prohibiting  the 
disclosure  of  confidential  communications  made  by  clients  to  their  attor- 
neys, and  persons  to  their  spiritual  advisers. 

Under  the  systems  of  legal  procedure  which  obtain  in  England  and 
the  United  States,  the  contesting  parties  to  the  proceeding  select  their 
own  experts  and  pay  them.  That  this  system  has  in  some  cases  led  to 
abuse,  and  that  it  has,  particularly  in  the  last  few  years,  had  a  tendency 
to  throw  discredit  upon  all  medical  expert  testimony,  cannot  be  doubted. 
The  spectacle  which  is  now  constantly  witnessed  in  our  courts,  of  equally 
qualified  experts  called  on  different  sides  of  a  case  flatly  contradict- 


INTRODUCTION.  23 

ing  each  other,  must  of  necessity  cast  doubt  either  upon  the  reliability 
of  medical  opinion,  or  else  upon  the  standing  of  medicine  as  an  exact 
science.  But  as  the  real  object  of  all  judicial  proceedings  is  the  ascer- 
tainment of  truth  and  the  doing  of  justice,  the  important  question  is 
whether  our  system  conduces  to  these  ends  to  a  greater  or  less  extent 
than  the  system  in  vogue  elsewhere.  As  regards  this  question  there  is 
much  room  for  discussion  and  difference  of  opinion.  But  that  there  is  a 
growing  restiveness  on  the  part  of  judges,  juries,  and  experts  themselves 
under  the  faults  and  defects  of  our  system,  and  a  casting  about  for  some 
better  solution  of  the  problem,  is  undoubted.  A  very  brief  statement  of 
how  it  is  managed  in  France  and  Germany,  where  the  English  and 
American  system  of  common  law  procedure  does  not  exist,  may  be  not 
without  interest. 

In  France  the  court  may  order  an  investigation  and  report  {expertise) 
by  experts  whenever  it  deems  it  advisable.  If  the  parties  cannot  agree 
upon  the  experts  the  court  appoints  them.  They  are  at  least  three  in 
number,  and  are  generally,  though  not  necessarily,  selected  from  a  list 
of  specialists  termed  experts  assermewtis.  The  order  directing  the  inves- 
tigation contains  a  statement  of  its  precise  object,  and  appoints  a  referee, 
or  jiige  commissaire.  Barristers,  or  avocats,  are  not  allowed  to  appear 
before  the  experts,  but  the  parties  are  represented  before  them  by  solic- 
itors (drones),  and  sometimes  by  persons  specially  skilled  in  the  matter 
of  the  investigation.  The  report  must  be  signed  by  all  three  of  the  ex- 
perts'; and  if  there  be  a  dissent,  the  dissenting  opinion  and  the  reasons 
for  it  are  set  forth  in  the  bod}'  of  the  report.  The  judges,  however,  are 
not  at  all  bound  by  the  report  if  it  is  opposed  to  their  convictions.  ("Si 
leur  conviction  sy  oppose."     Code  de  Procedure  Civile,  titre  quatorzieme.) 

In  Germany  since  1870,  under  the  Code  of  Civil  Procedure  for  the  Ger- 
man Empire,  after  the  issues  are  framed  upon  which  expert  testimony  is 
sought,  the  parties  may  agree  upon  the  experts,  and  the  court  appoints 
those  agreed  upon,  but  it  may  confine  the  parties  to  a  given  number  of 
experts.  Sometimes  the  court  submits  to  the  parties  the  names  of  a 
number  of  experts,  and  allows  each  side  to  object  to  a  certain  number  of 
them,  and  then  appoints  those  remaining.  There  exists  in  Germany 
a  class  of  officially  appointed  experts  on  certain  subjects,  and  in  trials 
which  concern  these  subjects  such  experts  have  the  preference  in  appoint- 
ment, unless  there  exists  some  special  reason  why  they  should  not  be 
appointed.  In  Prussia,  for  instance,  it  is  said  to  have  been  the  custom 
to  appoint  as  experts  a  physician  and  surgeon  for  every  county.  In 
addition  there  was  a  medical  college  in  each  province  to  which  an  appeal 
lay  if  the  experts  disagreed  or  the  parties  desired  it.  In  addition  to 
this  there  was  an  appellate  medical  commission  for  the  whole  kingdom. 
(Rogers,  Expert  Testimony,  §  41.)  But  in  Germany,  as  in  France,  the  court 
is  not  constrained  to  follow  the  expert  opinions,  and  if  it  is  not  satisfied 
with  them  it  may  order  a  new  expert  opinion  from  the  same  or  from 
other  experts. 

The  plans  for  reform  in  the  American  system  of  calling  expert  wit- 
nesses have  generally  been  in  the  direction  of  establishing  a  class  of 
official  experts;  and  the  trouble  with  most  of  the  plans  is  that  they  con- 
travene one  or  all  of  the  three  fundamental  ideas  of  our  system  of  crim- 
inal trial,  to  wit,  that  the  judge  ah  me  is  to  be  the  judge  of  the  law,  that 
the  jury  alone  are  to  pass  on  the  facts,  and  that  the  accused  shall  be 


24  INTRODUCTION. 

allowed  to  produce  any  relevant  and  competent  evidence  in  his  own 
behalf.  The  plan  suggested  by  Sir  James  Fitzjames  Stephen  at  the  end 
of  the  first  volume  of  his  History  of  the  Criminal  Law  of  England,  would 
Beem  to  meel  the  situation,  although  it  is  one  which  requires  a  very  high 
standard  of  medical  honor  and  knowledge.  It  seems  that  under  this 
plan,  which  has  been  for  some  time  in  operation  at  Leeds  in  England, 
medical  men  refuse  to  testify  unless  before  doing  so  they  can  meet  in 
conference  with  the  expert  witnesses  to  be  called  on  the  other  side  of  the 
case,  and  have  an  interchange  of  views.  And  it  is  stated  that  the  result 
is  that  at  Leeds  medical  witnesses  are  hardly  ever  cross-examined  at  all, 
and  it  is  by  no  means  uncommon  to  have  them  called  on  one  side  only. 
It  such  a  system  could  be  adopted  by  the  profession  in  America  it  would 

1 1  immense  service  in  raising  the  standard  of  expert  testimony,  and 

Increasing  the  reliance  placed  upon  it  by  the  courts  and  juries. 

The  adoption  by  the  medical  profession  of  some  such  plan  as  this,  is, 
in  the  opinion  of  the  writer  of  this  brief  and  inadequate  introduction  to 
the  great  science  which  is  treated  in  the  following  pages,  the  proper 
solution  of  the  difficulty.  And  not  its  least  merit  lies  in  the  fact  that  it 
may  thus  be  brought  about  by  the  members  of  the  profession  taking  the 
matter  into  their  own  hands,  and  dealing  with  it  upon  the  lofty  and  dis- 
interested plane  upon  which  the  medical  profession  should  be  moving  on 
to  the  great  future  which,  as  an  instrumentality  for  the  attainment  of 
righteousness  and  justice,  as  well  as  the  retarder  of  death  and  the  alle- 
\  iator  of  human  suffering,  is  surely  before  it. 

Lawrence  Godkin. 


MEDICO-LEGAL  INSPECTIONS  AND  POST-MORTEM 

EXAMINATIONS. 


BY 
A.    T.    BRISTOW,    A.B.,    M.D. 


A  post-mortem  examination  as  ordinarily  undertaken  is  made  for  the 
purpose  of  determining  the  cause  of  death  where  this  is  the  result  of 
disease,  to  observe  the  resulting  pathological  changes,  their  nature,  and 
extent,  together  with  the  organs  implicated. 

The  inquiry  concerns  the  physician  himself.  The  friends  of  the 
deceased  are  disposed  to  accept  the  results  of  the  examination  without 
question,  and  with  the  signing  of  the  death  certificate  the  function  and 
responsibility  of  the  examiner  cease.  In  the  case  of  a  medico-legal  in- 
spection the  responsibility  of  the  examiner  is  much  increased.  On  his 
report  and  testimony  may  depend  the  issue  of  a  civil  damage  suit,  or, 
more  important  still,  the  arrest  of  a  freeman,  his  prolonged  imprisonment, 
indictment,  and  trial.  The  liberty  of  the  citizen  and  the  vindication  of 
the  law  alike  demand  that  the  examiner  should  proceed  with  the  utmost 
circumspection,  to  the  end  that  the  guilty  may  not  escape  njr  the  inno- 
cent suffer.  It  is  to  be  remembered  that  when  prosecution  follows  as  a 
result  of  the  inspection  the  examiner  must  expect  that  his  methods  will 
be  subjected  to  the  minutest  scrutiny,  and  bear  the  test  of  hostile  criti- 
cism from  the  acutest  minds  the  defense  can  summon.  Loose  and  inac- 
curate methods,  hasty  observations,  deductions  rashly  drawn,  may  bring 
confusion  on  the  medical  witness  and  involve  in  ruin  a  righteous  prosecu- 
tion. On  the  other  hand,  it  is  to  be  observed  that  although  the  prose- 
cuting officer  may  demand  a  victim,  justice  calls  for  the  criminal.  Not 
seldom  it  may  be  the  duty  of  the  medical  witness  to  stand  between  the 
unfortunate  and  an  ambitious  or  too  zealous  prosecutor,  carried  away  by 
the  ardor  of  battle,  the  hope  of  future  gain  or  preferment.  In  such  a 
case  too  often  the  prosecution  is  degraded  into  an  intellectual  contest 
between  the  counsel  for  the  defendant  and  the  prosecuting  officer,  becom- 
ing a  sort  of  prize-fight,  in  which  the  stake  fought  for  is  a  conviction,  a 
victory  for  the  prosecution  which  may  lead  to  professional  distinction, 
possibly  political  preferment.  When  such  motives  prevail,  it  is  not 
strange  if  the  medical  witness,  especially  when  retained  by  the  prosecu- 
tion, enters  upon  his  investigations  with  a  biased  mind.  Such  an  attitude 
is  not  conducive  to  that  judicial  spirit  which  the  task  of  a  medical  exam- 
iner requires.  It  maybe  objected  that  it  is  the  function  of  the  examiner 
simply  to  determine  certain  facts  and  report  accordingly,  it  being  for  the 

25 


26  A    SYSTEM   OF  LEGAL  MEDICINE. 

jury  to  judge  of  their  significance.  It  may  be  observed,  in  reply,  that 
there  are  many  instances  where  the  jury  must  be  guided  solely  by  the 
inferences  of  expert  witnesses,  amended  and  clarified  by  proper  cross- 
examination  and  comparison.  It  is  this  very  lack  of  the  judicial  spirit 
which  lias  brought  the  opinions  of  the  expert  witness  into  well-deserved 
discredit.  Be  is  too  apt  to  regard  the  ease  from  the  point  of  view  of  the 
side  thai  employs  him,  and  so  looks  rather  for  what  he  hopes  or  wishes 
to  find  than  at  the  tacts  as  they  really  are. 

Thai  medical  witnesses  should  be  entirely  free  from  bias  is  expecting 
too  much,  perhaps,  under  the  present  system;  but  it  is  certainly  their 
duty,  as  honest  and  true  men,  as  far  as  in  them  lies  to  divest  themselves 
of  every  feeling  which  is  likely  to  give  their  minds  a  slant.  The  medical 
witness  should  therefore  be  on  his  guard,  and  with  his  natural  desire  to 
serve  those  who  have  employed  him  yet  keep  his  judgment  unclouded. 
It  is  quite  possible  to  be  mistaken  with  regard  to  even  natural  appear- 
ances. The  writer  has  seen  the  petechia?  of  the  early  stage  of  decompo- 
sition mistaken  for  the  marks  left  by  contusions.  It  is  unnecessary  to 
point  out  the  possible  consequences  of  such  an  error.  Because  of  similar 
blunders,  payments  on  policies  of  life  insurance  have  been  refused,  and 
criminal  prosecutions  instituted  involving  the  innocent  in  ruinous  ex- 
pense, perhaps  even  jeopardizing  human  life. 

Post-mortem  examinations  made  for  forensic  purposes  may  be  classi- 
fied as  follows: 

1.  Before  burial:  (a)  examination  made  soon  after  death,  before  de- 
composition has  set  in;  (&)  when  decomposition  is  far  advanced. 

2.  After  burial :  (a)  before  the  soft  parts  have  lost  their  identity ;  (&)  at 
a  more  remote  period,  when  the  bones  only  are  left,  the  soft  parts  having 
either  disappeared  altogether  or  been  merged  in  an  undistinguishable 
mass. 

In  all  medico-legal  examinations  the  examiner  should  be  accompanied 
by  at  least  one  other  physician  not  only  as  an  assistant,  but  also  as  a 
witness.  It  shall  be  his  duty  to  write  out  an  accurate  and  full  account 
of  the  proceedings  of  the  examiner  at  his  dictation,  with  the  findings,  to- 
gether with  a  description  of  the  methods  employed.  The  journal  should 
be  kept  in  ink,  and  signed  and  sworn  to  by  both  the  examiner  and  his 
assistant,  also  by  any  other  physician  who  may  be  present,  It  is  impor- 
tant that  every  organ  should  be  examined,  not  excluding  the  spinal  cord 
and  the  ribs,  especially  the  first  and  second.  A  full  and  complete  exam- 
ination should  be  the  rule  in  every  case,  to  which  there  should  be  no 
exception.  Ogston  relates  a  case  in  which,  owing  to  the  fact  that  the 
examination  of  the  spinal  cord  was  omitted,  the  prosecution  failed  to 
convict.  The  case  was  as  follows:  Two  men  having  quarreled,  one  of 
them  in  the  struggle  which  followed  strangled  his  opponent  by  twisting 
his  neckcloth  violently.  In  the  subsequent  trial  the  defense  claimed 
thai  th.-  deceased  lost  his  life  from  spinal  hemorrhage,  and  the  cord  not 
having  been  examined,  the  prosecution  was  unable  to  disprove  the  claim 
of  the  defense,  and  lost.  It  is  important  to  examine  the  ribs,  not  neglect- 
ing the  first  ami  second.  In  an  autopsy  held  bv  Dr.  Van  Cott  at  the- 
Brooklyn  City  Hospital  on  the  body  of  a  man  who  died  from  injuries 
received  from  falling  into  the  hold  of  a  ship,  the  writer  saw  a  quantity 
or  blood  m  the  left  pleural  cavity,  which  had  come  from  a  wound  in  the 
lett  subclavian  vein,  made  evidently  by  a  sharp  spicule  of  bone  from  a 


MEDICO-LEGAL  INSPECTIONS— POST-MOETEM  EXAMINATIONS.     27 

fractured  first  rib.     So  too  the  lamina?  and  bodies  of  the  vertebrae  should 
be  examined.     The  inspection  cannot  be  too  minute  or  precise. 

It  is  always  a  very  great  advantage  for  the  medical  examiner  to  be 
able  to  make  the  inspection  and  autopsy  at  the  place  of  death,  and,  if 
possible,  before  the  body  has  been  interfered  with  or  moved  from  the  spot 
where  it  lay  when  discovered.  There  are  many  facts  connected  with  the 
position  of  the  corpse,  its  distance  from  a  bed,  door,  or  stairway,  which 
might  be  of  the  utmost  importance  as  bearing  on  the  cause  of  death,  yet 
which  would  almost  certainly  escape  the  lay  witness.  Such  details  as 
these  would  be  estimated  at  their  true  value  by  the  medical  examiner, 
and  noted  accordingly. 

It  will  be  seen  that  the  role  of  examiner  is  thus  extended  beyond  the 
mere  making  of  an  autopsy.  It  is  certainly  high  time  that  the  important 
data  which  may  be  obtained  from  a  proper  examination  of  the  premises 
should  no  longer  be  left  to  the  bungling  of  ignorant  persons.  At  pres- 
ent, the  court  has  to  depend  on  the  testimony  of  policemen  and  excited 
neighbors  for  what  is  in  many  cases  vital  evidence,  and  then  falls  back 
on  the  much-abused  hypothetical  question,  which  the  medical  examiner 
is  required  to  answer  categorically.  It  is  certain  that  some  change  should 
be  brought  about  in  the  nature  of  the  judicial  proceedings  at  present  in 
vogue  on  the  discovery  of  a  homicide  or  supposed  suicide,  and  known 
as  a  "  coroner's  inquest."  The  reform  ought  to  commence  at  the  very 
beginning,  starting  from  the  moment  when  the  corpse  is  discovered.  On 
the  arrival  of  the  officer,  he  should  first  satisfy  himself  that  life  is  extinct. 
A  physician  will  usually  have  been  summoned,  so  that  he  will  not  have 
to  depend  on  his  own  judgment  to  determine  this  important  point.  This 
done,  he  should  close  the  room  and  permit  no  one  to  enter.  In  cases  of 
suspension,  the  body  should  always  be  cut  down  at  once;  nor  is  this  so 
unnecessary  a  direction  as  may  at  first  sight  appear.  Instances  have  not 
been  wanting  where  an  absurd  fear  of  interfering  with  the  coroner  has 
prevented  this,  although  life  was  not  entirely  extinct.  A  life  may  thus 
have  been  sacrificed  which  might  have  been  saved.  Under  all  other 
circumstances  it  is  better  that  the  body  be  not  in  any  respect  disturbed, 
nor  should  any  article  of  furniture,  wearing-apparel,  household  utensils. 
or  weapons  be  moved  from  the  position  where  first  discovered.  If  evi- 
dences of  a  struggle  are  apparent  in  other  apartments,  not  only  should 
the  room  be  closed  where  the  body  was  discovered,  but  also  the  whole 
house,  and  left  in  charge  of  an  officer,  the  inmates  being  either  confined 
to  their  rooms  or  allowed  to  remove  to  other  quarters.  At  all  events, 
they  should  not  be  permitted  to  roam  about  the  premises  unhindered,  at 
full  liberty  to  commit  any  indiscretion,  or,  if  necessary,  make  prepara- 
tions to  conceal  evidences  of  crime.  The  coroner's  office  having  been 
notified,  a  duly  authorized  medical  examiner  should  at  once  go  to  the 
house,  and  with  his  assistant,  and  possibly  a  representative  of  the  law- 
officer,  make  the  necessary  medico-legal  inspection  of  the  body  and  its 
environment.  After  the  autopsy,  and  on  the  written  permission  of  the 
examiner,  the  body  may  be  properly  cared  for,  but  under  no  circum- 
stances should  the  use  of  any  embalming  fluid  be  permitted.  Such  fur- 
ther arrangements  may  then  be  made  as  cleanliness  and  necessity  may 
require.  The  inmates  may  be  allowed  such  liberty  in  the  house  as  may 
seem  advisable  to  the  law-officer.  They  shall,  if  they  desire,  be  allowed 
the  privilege  of  accompanying  the  medical  inspector  in  his  search,  either 


28  A   SYSTEM  OF  LEGAL  MEDICINE. 

in  person  or  by  representative,  but  shall  not  be  allowed  to  remove  articles 
of  wearing-apparel  or  other  articles  until. written  permission  has  been 
obtained  from  the  medical  inspector.  Such  a  proceeding  as  this  may 
seem  unnecessarily  harsh,  yet  it  will  not  only  prevent  guilty  inmates 
from  removing  evidences  of  their  crime,  but  will  also  protect  the  inno- 
eent  I  iv  deterring  them  from  the  commission  of  actions  which  might 
render  them  liable  t<>  suspicion.  Had  such  regulations  been  carried  out 
in  the  Borden  house  after  the  discovery  of  the  bodies,  is  it  likely  that 
Lizzie  Borden  would  have  been  put  on  trial  for  her  life?  She  certainly 
would  not  have  been  permitted  to  destroy  clothing  as  she  did,  innocently 
enough,  perhaps.  Yet  this  error  of  judgment  was  one  of  the  strongest 
inducements  to  the  State  to  hold  her  for  trial.  It  certainly  was  one  of 
the  strongest  points  against  her. 

Such  ill-considered  acts  are  to  be  expected  from  persons  laboring 
under  great  excitement,  as  must  be  the  case  where  relatives  or  even 
strangers  have  been  found  struck  down  by  the  hand  of  violence.  Pru- 
dence is  not  to  be  expected  under  such  circumstances,  and  the  innocent 
may  not  only  do  things  unwittingly  which  may  destroy  evidence,  but 
also  lie  the  means  of  entangling  them  in  the  meshes  of  the  law. 

It  may  be  said  of  such  a  procedure  that  it  would  be  impracticable  in 
rural  districts  and  in  lonely  situations ;  but  there  is  no  hamlet  without 
its  village  constable  and  justice  of  the  peace.  The  latter,  in  the  absence 
of  the  regularly  appointed  examiner,  might  delegate  the  office  to  the 
village  practitioner,  whose  observations  would  be  far  more  likely  to  be 
of  service  to  the  court  than  those  of  the  constable  or  the  casual  neighbor. 
Other  processes  of  law  are  carried  out  in  remote  districts,  and  there  is 
no  reason  why  so  important  a  function  as  a  medico-legal  inspection 
should  not  be  likewise  conducted  in  an  orderly  and  precise  manner.  In 
mosl  States  the  law  makes  no  provision  for  such  a  procedure.  In  one 
State,  however  (Massachusetts),  the  medical  examiner  is  a  regular  official 
appointed  by  the  State,  and  this  is  a  step  in  the  right  direction.  It  is  to 
lie  hoped,  however,  that  a  more  enlightened  practice  may  ultimately 
prevail,  and  that  the  prosecuting  officer  will  not  have  to  depend  on  the 
testimony  of  ignorant  persons  and  laymen  for  the  preparation  of  what  is 
often  the  most  important  part  of  the  case. 

It  is  rare  at  present  for  the  medical  examiner  to  have  an  opportunity 
to  inspect  the  body  and  its  surroundings  before  both  have  undergone 

interfere] and  change.     If,  however,  he  has  been  so  fortunate  as  to 

have  forest  ailed  this,  on  his  arrival  at  the  place  of  death  he  should  first 
note  accurately  the  position  of  the  body,  whether  on  face,  side,  or  back. 
The  position  of  the  limbs  should  also  be  observed,  especially  that  of  the 
arms  and  hands.  If  there  is  a  weapon  in  either  hand,  the  position  of  the 
fingers  with  regard  to  the  handle  of  the  weapon  should  be  carefully 
m. ted.  as,  for  instance,  whether  tightly  clinched  upon  or  only  loosely 
surrounding  it.  The  nails  of  the  corpse  should  be  carefully  'inspected 
for  shreds  of  skin,  which  in  a  struggle  may  have  been  scratched  from 
the  assailant.  If  found,  they  should  be  carefully  preserved  for  future 
examination.  So,  too,  the  hands,  when  clinched,  should  be  opened  and 
examined  for  tufts  of  hair  or  fragments  of  clothing.  These  inspections 
should  be  completed  before  the  removal  of  the  body  from  its  original 
position  A  rough  diagram  of  the  room,  which  any  intelligent  man 
could  make,  will  be  of  material  assistance.     On  this  may  be  plotted  the 


MEDICO-LEGAL  INSPECTIONS— POST-MORTEM  EXAMINATIONS.     29 

position  of  the  body,  together  with  that  of  every  article  of  furniture  in 
the  room,  and  any  weapon  or  weapons  which  may  be  discovered.  Nor 
is  it  necessary  to  be  a  surveyor  to  do  this  with  sufficient  accuracy  for  the 
purpose.  A  tape-measure  used  with  ordinary  intelligence  will  give  the 
required  measurements,  and  these  can  be  recorded  on  a  rude  diagram. 
Such  a  sketch  shows  at  a  glance  the  position  of  the  body  with  regard  to 
every  article  of  furniture  in  the  room,  together  with  the  distances.  If  a 
weapon  is  found  in  the  room,  its  distance  from  the  corpse  can  be  indi- 
cated in  like  maimer.  If  any  blood-stains  are  found  on  the  floor,  whether 
in  the  room  or  without,  their  distance  from  the  corpse  should  be  noted, 
and  if  on  the  wall,  their  height.  It  is  also  of  importance  to  notice  the 
character  of  the  stains,  as,  for  instance,  whether  produced  by  the  spouting 
of  an  artery  or  smeared  on  the  wall  or  floor  by  hands  or  feet.  With  re- 
gard to  the  furniture  in  the  room,  the  position  of  each  piece  should  be 
noted,  and  whether  disposed  in  an  orderly  manner  or  overturned.  The 
bed  should  be  examined  with  reference  to  the  condition  of  the  bedclothes, 
whether  stained,  in  disorder,  or  undisturbed.  The  minutest  detail  is 
worth  mentioning,  for  until  the  entire  case  is  made  up  it  is  impossible  to 
be  sure  that  any  fact  is  trivial  and  of  no  importance.  It  is,  besides,  ex- 
tremely difficult  to  supply  a  link  which  may  be  essential  to  the  evidence 
after  all  traces  of  the  act  of  violence  have  been  effaced  from  the  spot. 

With  reference  to  the  importance  of  noting  the  position  of  the  body, 
as  regards  the  different  articles  of  furniture  in  the  room,  the  following 
case  may  be  cited  from  Christison.  The  deceased  died  from  poisoning 
by  hydrocyanic  acid.  The  question  arose  whether  it  was  self -admin- 
istered or  not.  The  body  was  found  in  bed,  covered  in  an  orderly  man- 
ner with  the  bedclothes,  while  the  vial  which  had  contained  the  acid, 
together  with  a  tumbler  from  which  it  had  been  drained,  was  in  a  dis- 
tant part  of  the  room.  The  whole  case  turned  on  the  following  point, 
as  to  whether  a  person,  taking  the  poison  with  suicidal  intent,  could 
afterward  set  the  tumbler  and  vial  deliberately  where  found,  then  go 
over  to  the  bed  and  draw  the  bedclothes  up,  before  being  overtaken  by 
death.  Here  it  was  evidently  of  the  utmost  importance  that  the  distance 
between  the  body  and  the  vial  and  tumbler  should  be  accurately  known. 
So,  too,  in  rapidly  fatal  wounds  accompanied  by  violent  hemorrhage,  a 
knife  or  other  cuttiug  instrument  may  be  found  at  a  distance  from  the 
corpse,  possibly  in  another  room  or  part  of  the  house.  Irrespective  of 
the  nature  and  direction  of  the  wounds,  it  may  be  asked  whether  it  was 
possible  for  the  deceased  to  traverse  the  distance  between  the  spot  where 
the  weapon  was  discovered  and  that  where  the  body  lay,  before  death 
ensued.  If  the  medical  witnesses  answer  no,  it  is  evident  that  the  death 
was  not  self-inflicted.  When  the  body  has  been  discovered  in  the  open 
air,  similar,  though  less  precise,  observations  are  still  possible.  Accidents 
of  weather  may,  of  course,  obscure  or  entirely  obliterate  much  that  would 
prove  useful  in  the  way  of  evidence  ;  still,  the  vicinity  should  be  carefully 
examined,  especially  for  traces  of  a  struggle.  If  found,  the  distance 
should  be  measured  from  the  spot  where  the  body  lay  to  the  farthest 
point  where  traces  of  a  struggle  are  visible.  If  the  body  be  that  of  a 
woman,  the  condition  of  the  underclothes  should  be  examined,  and  par- 
ticular search  made  for  seminal  stains.  Rape  followed  by  murder  is  more 
apt  to  be  perpetrated  in  secluded  localities  than  near  or  in  a  dwelling, 
and  therefore  the  evidence  of  such  a  crime  should  be  looked  for  with 


30  A   SYSTEM  OF  LEGAL  MEDICINE. 

care.     Often  after  an  unsuccessful  attempt  at  rape  murder  may  be  com- 
mit i.-tl.  either  as  a  result  of  the  violence  used  or  with  the  object  of  con- 

cealment.  .      . 

The  foregoing  remarks  apply  to  the  preliminary  examination  of  the 
premises  in  which  the  body  was  discovered.  Reasons  have  been  given 
why  it  is  besl  for  the  medical  examiner  to  make  this  a  part  of  his  duty. 
Afterward  he  will  proceed  to  the  actual  inspection  of  the  body  itself. 
The  external  inspection  should  always  include  an  examination  of  the 
clothes.  Bnllet-holes  in  clothing  should  be  inspected  to  determine  the 
condition  of  the  edges  of  the  rents,  for  if  these  are  burned,  it  is  evident 
tli.it  the  shot  was  fired  at  very  close  range.  The  cuts  made  by  a  knife  or 
other  sharp  instrument  should  be  counted  and  described.  They  may 
be  afterward  compared  with  the  body  wounds.  Where  the  cuts  in  the 
clothes  exceed  those  in  the  body,  this  fact  is  in  itself  a  presumption 
against  suicide,  as  self-inflicted  wounds  are  not  likely  to  miss  their  mark. 
The  special  examination  of  the  clothing  for  seminal  stains  will  be  referred 
to  and  described  in  the  article  on  Blood  and  Other  Stains. 

The  actual  examination  of  the  body  consists  of  two  stages,  the  external 
examination  and  the  internal.  Let  it  not  be  supposed  that  the  autopsy 
proper,  the  dissection  of  the  body,  and  the  inspection  of  the  viscera  form 
the  most  important  or  only  important  part  of  a  medico-legal  examina- 
tion. It  is  often  of  the  greatest  importance  to  determine  the  identity  of 
(lie  c< >rpse,  and  this  is  frequently  a  most  difficult  task.  Nothing  woidd  seem 
to  be  easier  than  for  a  wife,  brother,  or  sister  to  recognize  the  body  of  a 
deceased  husband  or  near  relative;  yet  there  is  hardly  a  body  found, 
where  the  necessity  arises  for  identification,  which  is  not  claimed  by 
several  different  people.  Nor  are  these  false  recognitions  caused  alto- 
gether by  putrefactive  changes,  for  the  most  extraordinary  mistakes  of 
recognition  have  been  made  before  putrefaction  has  had  time  to  occur. 
No  doubt  such  errors  are  due  in  part  to  the  changed  appearance  of  the 
body  after  death;  but  there  is  also,  in  the  natural  desire  of  friends  to 
recover  the  body  of  a  near  relative  missing  and  supposed  to  be  dead,  an 
incentive  to  exaggerate  the  importance  of  slight  points  of  resemblance, 
and  to  overlook  points  of  marked  dissimilarity.  In  no  other  way  can  we 
account  for  the  mistakes  of  this  sort  which  are  being  constantly  made. 
The  recognition  of  the  corpse  must  depend,  however,  mainly  on  the  ex- 
ternal examination,  together  with  such  corroborative  evidence  as  may 
be  afforded  by  the  clothing  and  other  property  found  on  the  body.  In 
this  connection,  it  may  be  both  useful  and  interesting  to  give  several 
recent  instances  of  mistaken  identity  which  have  come  to  the  writer's 
notice.  On  September  3,  1893,  there  appeared  the  following  account 
in  the  New  York  Herald  of  the  case  of  Marcus  A.  Quinn:  ''He  was 
entered  as  dead  in  the  books  of  the  morgue,  and  at  the  Bureau  of  Vital 
Statistics.  A  body  was  buried  as  his  in  consecrated  ground  in  Calvary 
Cemetery,  and  yet"  on  Tuesday  (August  29th)  he  was  found  alive  in  the 
hospital  of  the  almshouse.  Quinn  was  employed  as  messenger  and 
teacher  in  the  office  of  the  warden  of  the  almshouse  on  BlaekwelFs 
Island.  His  wife,  however,  lived  in  the  city,  and  Quinn  was  in  the  habit 
of  visiting  her  every  five  or  six  days.  He  came  to  the  city  on  leave  of 
absence  August  5th.  Having  been  long  away  from  his  friends,  he  re- 
ceived a  warm  welcome,  and  it  is  said  drank  too  freely,  and  afterward 
wandered  about  aimlessly.     His  wife,  hearing  of  his  vagaries  through  a 


MEDICO-LEGAL  INSPECTIONS— POST-MORTEM  EXAMINATIONS.     31 

relative,  became  alarmed  as  time  passed  and  lie  did  not  call  upon  her. 
She  finally  sent  to  Black  well's  Island,  and  learned  that  he  was  not  there, 
but  had  been  away  for  a  number  of  days,  and  there  was  no  clew  to  his 
whereabouts.  She  then  went  to  police-headquarters  on  August  18th,  and 
saw  the  following  report,  filed  August  11th:  'The  body  of  a  man  was 
found  off  Pier  9,  East  River ;  about  fifty  years  old,  five  feet  nine  inches 
tall,  weighing  about  one  hundred  and  fifty  pounds ;  gray  hair  and  mus- 
tache, and  beard  about  a  week's  growth ;  gray  eyes ;  mixed  black-and- 
brown  ribbed  vest,  blue-and-brown  striped  trousers,  white  shirt,  leather 
belt  about  the  waist,  black  Prince  Albert  coat ;  in  the  water  about  five 
hours.'  To  Mrs.  Quinn  this  description  seemed  to  tally  with  that  of  her 
missing  husband  in  every  particular.  She  arrived  at  the  morgue  the 
following  morning  armed  with  a  tintype.  The  body  had  been  buried  in 
Hart's  Island,  but  the  photograph  taken  before  burial  left  no  room  for 
doubt  in  the  mind  of  the  wife.  The  pictures  were  compared  and  carefully 
scrutinized  by  the  authorities  at  the  morgue,  and  the  policeman  stationed 
there  said,  'You  could  not  tell  one  from  the  other.'  Mrs.  Quinn  wanted 
to  make  sure.  She  went  to  Hart's  Island  on  Monday,  where  the  body 
was  disinterred  for  her,  and  not  only  she,  but  her  eldest  son  Matthew 
and  a  friend,  positively  identified  the  body  as  that  of  her  husband.  In 
a  sealed  coffin  the  body  was  taken  back  to  the  morgue,  while  the  supposed 
widow  went  to  the  office  of  the  Prudential  Insurance  Company,  from 
whence  an  agent  was  sent  to  adjust  the  claim.  To  him  the  evidence 
seemed  so  complete  that  Quinn  was  dead  that  the  claim,  $165,  was  paid 
in  full.  The  funeral  followed,  which  the  widow  and  her  three  sons 
attended,  together  with  a  friend.  Even  the  clothing  on  the  dead  man 
was  burned,  so  positive  was  the  identification.  Shortly  after  the  funeral 
her  eldest  son,  who  was  employed  on  the  island  steamer,  walked  in  and 
told  her  that  he  had  seen  her  husband  in  the  hospital,  and  that  she  had 
buried  the  wrong  man.  It  appeared  that  in  his  adventures  about  the 
city  the  man  had  contracted  pneumonia,  and  had  finally  brought  up  in 
the  hospital  on  August  29th." 

With  regard  to  the  insurance  money,  it  may  be  added  that  the  woman 
paid  it  back  at  once,  receiving  a  receipt  in  full  from  the  company.  Indeed, 
the  small  amount  of  the  money,  and  the  fact  that  the  bulk  of  it  must  have 
been  spent  on  the  funeral,  preclude  the  idea  of  a  fraudulent  identification. 
Here  was  a  case  where  a  bod}-  was  positively  identified  by  five  persons, 
including  the  wife,  as  that  of  her  husband.  Not  only  were  the  city  officials 
satisfied  of  the  validity  of  the  recognition,  but  the  insurance  company 
also.  The  photographs  were  compared  by  certainly  ten  persons,  and 
declared  to  be  those  of  the  same  individual.  Yet  all  were  mistaken. 
Another  case  equally  singular  happened  about  the  same  time.  It  occurred 
in  connection  with  the  Halliday  murder  in  this  State.  The  bodies  of  two 
women  found  in  the  Halliday  barn  were  first  identified  as  those  of  Halli- 
■day's  daughter  and  granddaughter,  although  not  without  some  difference 
of  opinion  on  the  part  of  the  relatives,  as  the  two  sons  of  Halliday  denied 
that  the  bodies  were  those  of  their  sister  and  niece,  while  other  relatives 
were  just  as  positive  that  they  were.  Within  twenty-four  hours  the  bodies 
were  identified  again  as  those  of  a  certain  Margaret  M'Quillan  and  her 
daughter,  by  a  second  set  of  relatives  equally  positive.  All  this  happened 
before  decomposition  had  become  sufficiently  far  advanced  to  account  for 
the  errors. 


.,.,  A   SYSTEM  OF  LEGAL  MEDICINE. 

( lases  like  these,  where  the  nearest  relatives  of  an  individual  have  been 
mistaken  in  the  identity  of  a  corpse,  should  sufficiently  emphasize  the 
care  which  it  is  requisite  for  the  medical  examiner  to  exercise  in  that  part 
of  the  externa]  examination  which  is  intended  to  establish  or  confirm  the 
question  of  the  identity  of  the  corpse.  To  this  end,  after  noting  the  ap- 
pearance of  the  body  with  regard  to  blood-stains,  extraneous  dirt,  etc., 
it  should  be  carefully  washed.  This  is  necessary  not  only  to  facilitate 
the  inspection  for  the  purpose  of  establishing  identity,  but  also  to  pre- 
vent the  drawing  of  erroneous  conclusions  from  superficial  appearances. 
Strange  as  it  may  seem,  the  stains  produced  by  ingrained  dirt  have  been 
mistaken  for  the  marks  of  commencing  decomposition,  also  for  contu- 
sions. The  external  examination  should  commence  with  the  head,  and 
be  completed  in  an  orderly  manner.  The  special  external  details  neces- 
sary tor  establishing  identity  are  treated  of  in  another  article.  If  the 
identity  of  the  body  is  beyond  dispute,  many  of  the  detailsof  the  exter- 
nal examination,  as  far  as  this  relates  to  identification,  may  in  the  discre- 
tion of  the  examiner  be  omitted,  always  bearing  in  mind,  however,  the 
tact  that  certain  questions  may  be  settled  at  this  time  which,  arising 
later,  when  decomposition  has  advanced,  cannot  be  answered.  It  is 
better  in  a  doubtful  case  to  be  over-particular  than  to  regret  an  omission 
when  it  is  too  late  to  remedy  it. 

The  body  should  now  be  examined  for  contusions,  recent  fractures, 
and  external  wounds.  The  region  of  the  scalp  should  be  particularly 
observed,  for  extensive  ecchymoses  are  frequently  found  in  this  locality, 
especially  on  the  lateral  and  posterior  surface  of  the  head,  and  not  neces- 
sarily associated  with  fracture  of  the  skull.  Sometimes  they  cannot  be 
seen  until  the  scalp  has  been  retracted,  previous  to  the  removal  of  the 
calvarium.  If  this  is  done  at  this  juncture  for  the  purpose  of  determin- 
ing the  existence  of  a  suspected  ecchymosis,  the  brain  should  be  left  in 
situ.  In  general,  it  is  better  to  defer  the  removal  of  the  calvarium 
until  the  examiner  is  ready  to  proceed  with  the  inspection  of  the  brain. 
The  region  of  the  neck  should  always  be  examined  for  finger-marks  and 
the  lividities  produced  by  throttling.  Other  evidences  of  violence  about 
the  neck,  such  as  the  circular  or  oblique  marks  left  by  a  cord,  are  to  be 
noted  and  described ;  if  multiple,  this  fact  should  be  particularly  men- 
tioned. Some  writers  regard  this  as  proof  that  death  was  homicidal  and 
not  self-inflicted.  When  wounds  of  the  neck  are  present,  their  direction 
should  be  carefully  observed,  also  their  extent  and  number.  Suicidal 
wounds  made  by  a  right-handed  person  run  from  left  to  right,  while 
homicidal  wounds  take  the  opposite  direction.  The  so-called  tentative 
wounds  of  the  suicide  are  to  be  noted. 

As  the  court  must  depend  upon  the  medical  examiner  for  a  de- 
scription of  the  wounds,  their  nature,  direction,  etc.,  the  matter  is  here 
briefly  mentioned.  In  making  the  external  examination  of  wounds, 
the  most  important  question  with  regard  to  determining  the  manner 
of  their  infliction  is  that  of  direction.  In  describing  a  wound  this  is 
the  first  and  most  important  detail.  With  a  view  of  determining  the 
character  of  the  weapon,  the  peculiarities  of  the  wound  are  next  to 
be  described,  whether  incised,  lacerated,  or  contused.  With  regard  to 
wounds  with  clean-cut  edges,  the  examiner  is  cautioned  against  hastily 
calling  them  incised,  particularly  when  on  the  scalp,  where  a  blow  from 
a  bludgeon  may  produce  a  wound  having  all  the  characteristics  of  that 
inflicted  by  a  cutting  instrument.     In  penetrating  wounds  extreme  care 


MEDICO- LEGAL  INSPECTIONS— POST-MORTEM  EXAMINATIONS.     \y,\ 

should  be  exercised  iu  the  use  of  the  probe,  lest  the  examiner  be  accused 
of  producing,  for  instance,  a  puncture  of  the  intestine,  or  some  other 
such  injury.  It  is  to  be  kept  in  mind  that  the  lawyers  for  the  defense 
will  look  not  for  a  probable  but  for  any  possible  circum stance,  no  mat- 
ter how  remote,  which  may  exculpate  their  client  or  throw  doubt  on  his 
conviction.  It  is  better,  therefore,  to  use  the  probe  simply  to  determine 
the  direction  of  a  wound,  and  leave  the  question  of  extent  to  a  subsequent 
dissection  to  decide.  Of  course  the  dimensions  of  all  external  wounds 
require  mention.  In  mentioning  their  situation  the  measurements  should 
always  be  taken  from  fixed  bony  points. 

The  question  whether  a  wound  has  been  inflicted  before  or  after 
death  is  more  fully  treated  in  another  article.  It  is  sufficient  to 
suggest  here  that  the  edges  of  wounds  be  examined  for  retraction, 
ecchymosis,  swelling,  and  the  depths  for  clotted  blood.  These  circum- 
stances all  point  to  a  wound  inflicted  during  life.  If  pus  be  found, 
or  other  evidences  of  inflammation,  this  should  be  mentioned,  as  it  is 
evident  that  the  person  must  have  survived  the  infliction  of  the  wound 
some  time.  The  examiner  should  not  be  content  with  a  superficial  de- 
scription of  a  wound.  He  should  state  exactly  what  vessels  have  been 
divided,  what  large  nerves  and  other  important  structures.  Foreign 
bodies  should  always  be  looked  for,  and  if  found,  their  location  stated. 
The  hands,  especially  on  their  palmar  surfaces,  should  be  examined  for 
cuts.  In  cases  of  homicide  there  are  almost  always  marks  of  injury  in 
this  situation,  particularly  if  the  assault  has  been  committed  with  a  cutting 
instilment.  The  external  examination  of  the  body  may  be  completed 
by  an  inspection  of  the  natural  orifices.  The  mouth  and  pharynx  should 
be  examined  for  the  evidences  of  the  action  of  corrosive  poisons,  such  as 
the  mineral  acids  or  oxalic  acid.  In  cases  where  death  has  resulted  from 
strangulation  the  mouth  and  nostrils  are  often  filled  with  a  bloody  froth, 
the  tongue  and  lips  swollen.  These  appearances  are  to  be  noted.  Some- 
times, also,  evidences  of  disease  may  be  seen  in  this  locality,  as,  for  in- 
stance, the  scars  of  syphilitic  ulcers,  or  possibly  the  mucous  patches  of 
active  disease.  So,  too,  the  scarred  tongue  of  epilepsy  may  be  made  to 
tell  its  story.  The  pharynx  should  be  inspected  for  foreign  bodies,  and 
such  portions  of  the  upper  air-passage  as  are  accessible  to  external  ex- 
amination. The  more  complete  inspection  of  the  larynx  and  trachea 
must  be  deferred  until  the  internal  examination  of  the  body.  The  ex- 
ternal auditory  meatus  on  each  side  is  to  be  inspected  for  traces  of  hem- 
orrhage ;  so  with  the  nasal  passages. 

The  information  which  is  to  be  gained  from  an  examination  of  the 
male  genitalia  is  not  usually  of  much  importance,  other  than  as  bearing 
on  the  subject  of  identity.  In  the  case  of  a  female,  the  examination  of 
the  vagina  and  external  genitalia  is  of  great  importance.  The  lacerations 
and  injuries  which  are  inflicted  on  these  parts  in  criminal  assaults  are 
often  very  great,  and  cannot  easily  be  overlooked.  In  the  case  of  women 
who  have  borne  children,  or  who  have  been  accustomed  to  sexual  inter- 
course, an  assault  may  have  been  perpetrated  without  the  infliction  of 
any  injury  on  the  genitalia.  In  such  a  case  the  vaginal  mucus  may  be 
withdrawn  on  a  piece  of  surgeon's  gauze  and  preserved  in  a  test-tube  for 
subsequent  examination  by  the  microscope.  In  this  way  the  crime  of 
rape  may  be  detected,  which  otherwise  might  have  escaped  notice  from 
the  uninjured  condition  of  the  pudenda. 

It  is  often  of  importance1  to  be  able  to  determine  the  length  of  time 


;;4  I    SYSTEM   OF  LEGAL   MEDLCINE. 

which  has  elapsed  since  death.     To  facilitate  such  an  estimate,  we  may 
divide  bhe  period  after  death  into  three  divisions:  first,  that  period  dur- 
ing which  the  body  is  cooling,  but  prior  to  the  inception  of  rigidity; 
second,  the  period  of  rigidity;  third,  when  rigidity  has  disappeared  and 
putrefaction  has  commenced.     It  is  not  possible  to  draw  any  distinct 
boundaries  between  these  different  epochs,  because  there  are  many  cir- 
cumstances which  modify  both  the  time  of  their  inception  and  their 
duration.     These  will  be  treated  of  in  another  chapter.     With  regard  to 
temperature,  it  maybe  stated  that  if  a  body  has  an  external  temperature 
of  80    P.  or  over,  death  has  occurred,  probably,  within  four  hours.     In 
deaths  from  certain  diseases,  such  as  cholera,  hydrophobia,  tetanus,  in 
strychnine  poisoning,  the  temperature  rises  after  death.     The  latter  case 
is  the  only  one  likely  to  be  a  cause  of  error  to  the  medical  jurist.     For 
the  purpose  of  taking  the  temperature  of  the  dead  body,  any  surf ace- 
thermometer  maybe  used,  such  as  Seguin's  or  that  of  Immisch.     The 
instrument  is  placed  on  the  abdomen,  and  a  reading  is  taken  after  it  has 
been  in  position  at  least  fifteen  minutes.     The  rigidity  which  occurs  after 
death,  the  so-called  rigor  mortis,  does  not  as  a  rule  come  on  until  from 
two  to  three  hours  after  death,  and  in  previously  healthy  persons  dying 
smith  nly,  not  for  some  hours  later.     In  such  a  case  as  the  last  mentioned, 
which  is  that  most  likely  to  come  under  the  notice  of  the  medical  jurist, 
if  rigor  mortis  be  well  marked  death  has  almost  certainly  occurred  at 
least  six  hours  previously,  and  possibly  twelve  hours  may  have  elapsed 
since  death  occurred.     In  the  temperate  zone  putrefactive  changes  do 
not  appear,  unless  under  exceptional  circumstances,  until  the  end  of  the 
second  day  after  decease.     In  death  from  septic  disease  putrefaction 
commences  much  earlier,  but  these  cases  are  not  of  that  class  in  which  it 
is  necessary  to  estimate  the  period  which  has  elapsed  since  death.     Such 
a  necessity  arises  usually  where  the  person  deceased  has  previously  been 
in  perfect  health,  and  has  perished  by  violence.     This  consideration  will 
enable  the  medical  examiner  to  make  reasonable  and  fairly  positive  as- 
sertions with  regard  to  the  inferences  to  be  drawn  from  the  appearance 
of  putrefactive  changes  in  such  cases,  unless  the  post-mortem  examina- 
tion reveals  pathological  conditions  which  compel  him  to  make  reserva- 
tions.    Thus  it  can  be  said  that  if  a  body  show  the  characteristic  dis- 
coloration of  the  abdomen  together  with  lividity  of  the  dependent  parts, 
death  has  occurred  at  least  forty-eight  hours  previously,  if  the  season  be 
summer;    while  in  the  winter  from  seventy-two  to  one  hundred  and 
twenty  hours  will  elapse  before  the  appearance  of  the  characteristic  dis- 
colorations.     As  all  such  questions  as  these  are  likely  to  come  up  in  a 
medico-legal  inquiry,  it  has  been  thought  best  to  refer  to  them  in  con- 
nection with  the  external  examination  of  the  body.     They  will  be  found 
in  another  chapter,  where  they  are  treated  at  length. 

In  the  inspection  of  the  body  for  injuries  such  as  contusions,  etc., 
there  is  one  precaution  to  be  observed:  the  petechia?  of  decomposition 
should  not  be  mistaken  for  the  extravasations  of  contusions.  A  curious 
instance  in  which  this  error  was  committed  lately  came  to  the  writer's 
notice.  A  young  man  of  dissipated  habits  in  a  fit  of  despondencv  com- 
mitted suicide  by  taking  laudanum.  The  ambulance  surgeon  who  was 
called  to  the  case  found  him  dead  on  arrival,  and  after  examining  the 
body  returned  to  the  hospital.  The  friends  of  the  young  man  lived  in  a 
distant  city,  and  after  the  coroner's  inquest  the  body  was  sent  to  them. 


MEDICO-LEGAL  INSPECTIONS— POST-MORTEM  EXAMINATIONS.     35 

Some  days  thereafter  an  indignant  communication  came  to  the  hospital, 
in  which  it  was  charged  that  the  young-  man  had  been  the  victim  of  foul 
play,  owing  to  the  fact  that  the  body  was  "covered  with  bruises  when 
received."  As  a  matter  of  fact,  there  was  no  truth  in  the  suspicious  of 
the  relatives.  It  appears  that  they  were  quite  ignorant  of  the  vicious 
habits  of  the  deceased,  and  had  mistaken  the  petechia?  of  decomposition 
for  contusions.  There  were,  however,  a  number  of  witnesses  to  the  cir- 
cumstances of  the  young  man's  death,  and  the  mistake  resulted  in  no 
harm.  It  is  easy  to  see,  however,  how  very  serious  might  be  the  results 
of  such  a  blunder.  To  make  the  distinction  between  the  ecchymoses  re- 
sulting from  violence  and  the  lividities  of  decomposition  is  not  difficult. 
In  the  first  place,  the  ecchymosis  is  a  true  hemorrhage,  which  the  lividity 
is  not ;  therefore  an  incision  into  the  former  will  either  be  followed  by  the 
•escape  of  the  effused  blood,  or,  what  is  more  common,  a  subcutaneous  clot 
wdl  be  found.  Post-mortem  lividities  are  disjdaced  by  pressure  of  the 
fingers ;  ecchymoses  are  not.  That  an  actual  hemorrhage  ever  occurs  after 
incision  must  be  quite  exceptional,  and  can  only  happen  when  for  some 
reason  the  blood  retains  its  fluidity  long  after  death.  In  the  post-mortem 
lividity,  the  incision  is  not  followed  by  the  escape  of  blood,  nor  is  there 
.any  clot  present.  The  position  of  the  spots  is  significant.  When  of  post- 
mortem origin,  they  are  found  on  the  most  dependent  portions  of  the 
body,  such  as  the  calves  of  the  legs,  the  posterior  parts  of  the  arms.  The 
sides  of  the  chest  posteriorly  are  almost  always  the  seat  of  these  post- 
mortem discolorations,  which,  as  they  extend  downward,  coalesce  until 
the  back  presents  the  appearance  of  a  uniform  suggillation.  The  time  at 
which  the  discoloration  appears  is  of  some  importance,  post-mortem  spots 
not  appearing  until  an  interval  of  some  hours  after  death.  No  exact 
time  can  be  fixed,  however,  for  their  appearance,  as  this  varies  according 
to  climate,  season,  cause  of  death,  as  well  as  for  other  reasons  at  present 
unknown.  Of  course,  if  the  injury  which  caused  the  discoloration  oc- 
curred some  time  before  death,  swelling  may  lie  found  in  the  vicinity, 
and  the  ecchymotic  spot  will  be  elevated  above  the  surrounding  surface 
— something  which  never  happens  in  a  post-mortem  spot.  So  also  the 
color  of  the  ecchymosis  may  be  characteristic,  if  time  sufficient  shall  have 
elapsed  before  death  for  the  familiar  changes  to  occur.  No  such  changes 
take  place  in  the  petechia  of  decomposition.  When  decomposition  is 
far  advanced,  the  difficulty  of  distinguishing  between  the  ecchymosis  and 
the  spots  of  decomposition  increases  greatly.  It  is  impossible  to  say  a1 
what  period  it  becomes  impossible  to  make  the  distinction.  This  is  ;i 
matter  which  must  be  left  to  the  discretion  of  the  examiner.  It  is  very 
doubtful  whether  such  a  distinction  should  be  attempted  after  the  skin 
is  far  advanced  in  decomposition. 

Internal  Examination The  technique  of  an  autopsy  is  very  differ- 
ent from  that  of  a  dissection.  The  broad  and  vigorous  sweep  of  Hie  ki Life 
with  which  the  incisions  are  made  to  expose  the  viscera  is  very  differenl 
from  the  cuts  of  the  dissecting-scalpel.  As  Virchow  remarks  in  his 
work  on  post-mortem  examinations,  fine  work  may  occasionally  lie  re- 
quired for  pathological  anatomy,  yet  it  is  not  the  rule.  It  may  1  »e  further 
stated  that  in  the  majority  of  medico-legal  inspections  it  is  still  more  ex- 
ceptional for  the  necessity  for  fine  dissections  to  occur.  The  ordinary 
dissecting-case  is  therefore  not  well  adapted  for  the  purposes  of  an 
autopsy.     The  incisions  in  the  soft  parts  are  of  two  kinds:  first,  that 


36  -I   SYSTEM   OF  LEGAL  MEDICINE. 

which  exposes  the  cavities  of  the  body,  for  which  purpose  a  rather  broad 
bu1  shorl  and  stunt  knife  is  used,  fitted  into  a  thick  and  broad  handle; 
second,  incisions  into  the  viscera  themselves.  For  the  purpose  of  avoid- 
ing a  number  of  short  cuts,  which  should  never  be  made,  a  knife  should 
be  used  as  long  as  an  ordinary  amputating-knife,  but  with  broader  blade,. 
for  making  sections  of  the  brain  and  the  larger  viscera  at  one  sweep. 
The  objecl  in  making  these  sections  of  the  viscera  in  this  maimer  is 
to  expose  a  broad  and  even  surface  for  examination  without  tearing  the 
tissues,  and  this  can  only  be  done  with  a  long- and  rather  broad  knife. 
For  liner  dissections  an  ordinary  scalpel  may  be  used.  The  blade  of  the 
first  knife  should  be  about  three  and  a  half  inches  long  by  one  inch  in 
breadth,  with  a  handle  four  inches  in  length.  The  long-section  knife 
should  have  a  length  of  eight  aud  a  half  inches,  a  breadth  of  one  and  a 
quarter  inches.  Other  instruments  which  are  of  use  in  the  autopsy  are 
a  saw,  a  hammer  with  hooked  handle  for  removing  the  calvarium,  a 
saw  slightly  curved  for  exposing  the  spinal  cord,  a  costotome  for  dividing 
the  ribs  when  ossified,  and  an  enterotome  for  slitting  the  intestines  or 
trachea.  A  few  probes  of  different  lengths,  the  chain  and  hooks  of  the 
dissecting-room,  and  a  blow-pipe  complete  the  necessary  appliances  of 
the  post-mortem  table.  A  brass  gauge  marked  in  millimeters  is  some- 
times used  for  the  purpose  of  making  such  measurements  as  the  thick- 
ness of  the  ventricular  walls,  etc.  A  pair  of  small  scissors  having  one 
blade  pointed,  the  other  probe-pointed,  is  often  of  use  in  laying  open  a 
small  duct  like  the  common  bile-duct,  but  the  necessity  for  such  an  ex- 
amination seldom  occurs  to  the  medical  jurist.  Where  the  weight  of 
the  viscera  is  likely  to  be  of  importance,  a  pair  of  scales  is  a  necessity. 
For  the  purpose  of  estimating  the  amount  of  fluid  found  in  a  large  cavity, 
such  as  the  chest,  a  large  sponge  is  useful  with  which  to  remove  the 
fluid,  which  is  afterward  expressed  into  a  vessel  of  suitable  size  and 
measured  in  a  graduate  provided  for  the  purpose. 

Usually  no  autopsy  ought  to  be  performed  earlier  than  twelve  hours 
after  death,  except  in  cases  where  death  has  resulted  from  violence,  and 
the  German  regulations  do  not  permit  an  autopsy  until  twenty-four 
hours  after.  Even  in  cases  of  death  by  violence  it  is  questionable 
whether  .in  earlier  examination  is  advisable,  for  it  is  possible  to  make  the 
external  examination  as  early  as  necessary,  deferring  the  autopsy  proper 
to  the  usual  time  after  death.  The  Bishop  case  will  no  doubt  occur  to 
the  reader  as  an  instance  where  neglect  of  this  precaution  was  the  cause 
of  great  annoyance  to  the  examiners,  who  were  even  indicted  for  their 
precipitation  in  hastening  the  autopsy.  Yet  it  was  because  of  their  fear 
that  post-mortem  changes  would  obscure  the  peculiar  condition  which 
they  sought  in  the  nervous  system,  that  they  hurried  the  autopsy,  with 
most  unpleasant  results  to  themselves.  However  desirable  an  early  ex- 
amination may  be,  considerations  of  humanity  and  obvious  expediency 
will  induce  the  examiner  to  defer  the  dissection  until  the  lapse  of  at  least 
twelve  hours  and  possibly  a  full  day  a'ter  death.  It  is  essential  that  an 
autopsy  should  not  be  held  by  artificial  light.  Differences  in  color,  par- 
ticularly such  as  denote  the  existence  of  pathological  changes  in  the 
nervous  system,  are  not  easily  appreciated  except  bv  daylight.  Frozen 
'""lies  should  be  thawed  out  in  a  warm  room,  but  the  thawing  process 
ought  never  to  be  hastened  by  artificial  means. 

In  corpses  other  than  those  of  new-born  infants,  the  order  in  which 


MEDICO-LEGAL  INSPECTIONS— TOST-MOETEM  EXAMINA  TIONS.     37 

the  examination  should  be  made  is  as  follows :  first,  the  brain  and  cranial 
cavity ;  second,  the  vertebral  column  and  spinal  cord ;  third,  the  thorax  ; 
and  lastly,  the  abdomen.     The  skull  is  to  be  exposed  by  an  incision 
through  the  scalp  made  from  ear  to  ear,  over  the  vertex.     The  two  flaps 
are  then  reflected  anteriorly  and  posteriorly  sufficiently  to  give  room  to 
saw  through  the  ealvarium.     Any  ecchymoses  not  before  visible  are  now 
to  be  noted,  and  the  surface  of  the  cranial  vault  examined  for  fractures. 
If  found,  they  should  be  traced  throughout  their  whole  extent,  especially 
when,  as  is  often  the  ease,  they  extend  into  the  base.     In  this  situation 
they  can  be  more  conveniently  followed  after  the  ealvarium  has  been  re- 
moved.    For  this  purpose  usually  it  is  directed  that  the  saw-cut  be  made 
in  a  perfectly  circular  manner  around  the  skull.     There  is  one  disadvan- 
tage connected  with  this  method,  which  is,  that  when  the  ealvarium  is 
replaced,  as  the  cut  surfaces  are  horizontal,  it  is  easy  for  them  lO  glide 
apart.     Thus  an  unsightly  ridge  or  depression  may  be  left  over  the  fore- 
head, marking  the  edge  of  the  sawn  bone,  after  the  soft  parts  have  been 
drawn  together  and  the  body  prepared  for  burial.     As  it  is  desirable  to 
conceal  all  traces  of  the  autopsy  subsequently,  when  possible,  a  modifica- 
tion of  the  usual  method  of  applying  the  saw  is  here  suggested.     Instead 
of  the  circular  cut  around  the  cranium,  two  saw-cuts  are  made,  one  on 
each  side  of  the  skull,  commencing  anteriorly  in  the  median  line  just 
above  the  superciliary  ridge,  running  backward  and  terminating  one  inch 
above  the  external  auditory  meatus.     Commencing  a  little  below  the 
"  lambda,"  two  other  similarly  oblique  cuts  are  made,  which  join  the  first 
at  their  termination.     The  ealvarium  may  now  be  removed.     The  dura 
should  be  cut  through  if  adherent.     The  ealvarium   should  never  be 
violently  torn  off,  for  fear  of  injuring  the  brain.     It  will  be  seen  that 
when  replaced  the  obliquity  of  the  saw-cuts  prevents  the  ealvarium  from 
sliding  in  either  direction.     An  ingenious  method  of  still  further  secur- 
ing the  ealvarium  when  replaced  is  practiced  at  the  Methodist  Episcopal 
Hospital  of  Brooklyn.     In  each  of  the  anterior  cuts,  a  little  in  front  of 
their  termination,  a  second  saw-cut  two  inches  long  is  made,  parallel  to 
the  zygoma.     Into  these  short  cuts  a  two-inch  roller  is  passed  directly 
through  the  skull  from  side  to  side.     The  ealvarium  is  then  replaced  and 
the  ends  of  the  roller  bought  together  over  the  vertex  and  pinned.     This 
renders  it  impossible  for  the  ealvarium  to  be  subsequently  moved.    The  tem- 
poral fascia  should  also  be  sutured  before  the  scalp  is  replaced.    (Fig.  1.) 
After  the  removal  of  the  ealvarium  its  interior  is  to  be  examined  with 
regard  to  the  condition  of  the  internal  table,  extensive  shattering  of  which 
may  exist  without  corresponding  injuries  of  the  external  table.     The 
dura  mater  is  then  to  be  inspected  and  its  condition  noted.     Extra-dural 
clots  are  to  be  turned  out  into  a  graduate  and  measured^- which  is  more 
exact  than  to  make  the  usual  loose  statements,  "a  quantity  of  clotted 
blood,"  "  a  large  clot."     The  meningeal  arteries  are  to  be  carefully  exam- 
ined, especially  where  extra-dural  clot  exists,  as  they  are  frequently  the 
seat  of  the  hemorrhage.     The  longitudinal  sinus  may  then  be  slit  up  and 
examined,  after  which  the  dura  is  to  be  divided  and  the  arachnoid  and 
pia  inspected.     Particular  attention  is  to  be  given  to  the  membranes 
with  reference  to  the  existence  of  such  conditions  as  lepto-  or  pachy- 
meningitis.    The  explanation  of  many  an  act  of  violence  may  often  be 
found  in  just  such  pathological  changes.     The  vascularity  of  the  mem- 
branes is  also  to  be  noted.     After  this  the  brain  is  to  be  removed,  the 


38 


.1    SYSTEM   OF  LEGAL   MEDICINE. 


section  of  the  cord  being  made  by  a  long  knife,  as  low  down  as  possible, 
to  secure  the  whole  of  the  medulla  for  examination  with  the  brain. 
The  base  of  the  skull  is  now  accessible  for  examination  after  removal 
of  the  dura  which  lines  it.    The  sinuses  of  the  base  can  also  be  inspected. 


Fig.  1. 


The,  brain  should  then  be  weighed.  The  circle  of  Willis  is  then  to 
be  examined  for  miliary  aneurism,  emboli,  etc.,  and  also  the  middle 
cerebrals,  so  frequently  the  seat  of  disease.  In  cases  of  suspected  poison- 
ing by  narcotics,  particular  attention  is  to  be  given  to  the  state  of  the 
membranes,  the  sinuses,  and  the  intra-cerebral  circulation.  In  poisoning 
1  >v  opium  the  veins  are  said  by  some  to  show  a  slightly  deeper  color  than 
the  arteries.  This  seems  doubtful  in  view  of  the  imperfect  aeration  of 
the  blood  which  occurs  in  these  cases.  At  any  rate,  this  disappears  after 
exposure  to  the  air,  as  both  veins  and  arteries  soon  take  up  oxygen  and 
become  of  uniform  color.  In  estimating  the  amount  of  congestion 
present  in  the  vessels  of  the  central  nervous  system,  it  is  never  to  be 
forgotten  that  the  injection  of  an  embalming  fluid,  particularly  where  a 
vein  has  not  been  opened  and  the  vascular  system  washed  out  previous 
to  the  injection  of  the  preservative  fluid,  is  perfectly  competent  to  pro- 
duce  an  appearance  which  it  is  difficult  to  distinguish  from  the  extreme 
congestion  of  narcotic  poisoning  or  other  pathological  congestions. 
There  will  be  found  the  same  arborescence,  the  same  punctate  appearance 


MEDICO-LEGAL   INSPECTIONS— POST-MOB TEM  EXAMINATIONS.     ;j(J 

of  the  white  matter  on  section,  the  same  tiu-gescence  of  the  choroid  plex- 
uses. The  coloration  of  arteries  and  veins  will  be  uniform,  however.  In 
the  Harris  case  the  defense,  singularly  enough,  overlooked  this  obvious 
point,  for  the  body  of  Mrs.  Harris  had  been  embalmed  previous  to  burial. 
In  this  connection  it  is  also  of  some  importance  to  remember  that  under- 
takers use  for  this  purpose  a  small  force-pump,  and  that  as  the  fluid  is 
forced  through  the  vessels  it  takes  up  the  coloring  matter  of  the  blood 
and  produces  the  appearance  above  referred  to.  The  writer  has  verified 
this  statement  many  times  in  the  dissecting-room.  The  more  dependent 
portions  of  the  brain  are  also  apt  to  have  a  congested  appearance  even 
when  no  injection  has  been  made,  simply  from  the  gravitation  of  fluids. 
The  fact  that  the  congested  appearance  is  restricted  to  the  more  depend- 
ent parts  will  prevent  this  condition  from  being  mistaken  for  true  con- 
gestion. 

The  dissection  of  the  brain  is  next  in  order.  T<  >  make  proper  sections 
here,  it  is  imperative  that  the  knife  used  should  be  as  keen  as  possible. 
.  The  cut  through  the  hemisphere  should  be  made  with  a  quick  drawing 
motion  with  the  minimum  of  pressure,  otherwise  the  soft  nervous  tissue 
will  certainly  be  torn  as  the  knife  drags  and  tears  its  way  through.  It 
has  been  recommended  by  Virchow  that  the  incisions  should  commence 
from  within  and  terminate  at  the  pia  mater,  which  is  not,  however, 
divided,  but  serves  as  a  binding  to  keep  the  various  sections  together  in 
proper  serial  order.  In  this  manner  the  relations  of  the  divided  struct- 
ures are  preserved,  and  it  is  possible  to  reexamine  them  in  their  natural 
order,  if  desirable.  With  regard  to  the  thickness  and  number  of  the 
sections  necessary,  it  may  be  observed  that  in  cases  where  it  is  likely 
that  the  condition  of  the  brain  will  form  an  important  part  of  the  case, 
it  is  easy  to  make  too  few  sections,  impossible  to  make  too  many.  In 
sections  half  an  inch  thick  many  a  spot  of  softening  or  small  hemor- 
rhage may  lurk  concealed.  This  is  particularly  true  of  the  "  pons  "  and 
medulla,  where  very  small  lesions  may  be  the  cause  of  very  formidable 
symptoms.  It  is  in  this  particular  part  of  the  brain,  therefore,  that  the 
sections  should  be  most  numerous,  perhaps  even  microscopic.  It  is 
recommended  that  the  first  sections  be  made  from  within  the  great  lon- 
gitudinal fissure  outward  serially  until  the  level  of  the  corpus  eallosum 
is  reached.  At  this  point  the  lateral  ventricles  are  to  be  opened  by  two 
incisions  a  quarter  of  an  inch  on  either  side  of  the  raphe.  The  cavity  of 
the  ventricle  once  found,  the  rest  of  the  ventricle  may  be  exposed  by 
cutting  through  the  roof  with  the  probe-pointed  scissors,  following  the 
floor  with  the  probe  blade.  The  presence  or  absence  of  serum  in  the 
ventricular  cavity  is  to  be  noted,  and  its  quantity,  if  present.  For  the 
purpose  of  measuring  the  contained  fluid,  it  may  be  withdrawn  from  the 
cavity  of  the  ventricle  by  the  aid  of  a  small  syringe,  and  measured  in  a 
graduate.  Some  writers  recommend  that  the  ventricles  be  opened  first 
before  any  other  incisions  are  made  in  the  brain,  lest  the  manipulations 
necessary' for  the  other  incisions  should  so  lacerate  the  substance  of  the 
brain  as  to  permit  the  escape  of  fluid.  It  is  difficult  to  see  how  a  satis- 
factory dissection  of  the  ventricles  is  possible  without  removing  so  much 
of  the  cerebral  lobes  as  to  bring  the  cut  surface  on  a  level  with  the  corpus 
eallosum  which  forms  the  ventricular  roof.  It  is  evident,  however,  tli.it 
the  utmost  care  is  needed  to  prevent  the  occurrence  of  lacerations  in 
handling  so  soft  a  tissue  as  that  of  the  brain.     The  most  important  parts 


40  -1    SYSTEM   OF  LEGAL   MEDICINE. 

to  be  examined  in  the  ventricles  arc  the  choroid  plexuses.  After  ascer- 
taining their  condition,  the  pillars  of  the  fornix  are  to  be  divided  and 
reflected,  when  the  velum  interpositum  will  come  into  view,  with  the 
veins  of  Galen.  The  state  of  the  vessels  in  this  tissue  is  to  be  noted,  after 
which  the  velum  is  to  be  reflected,  and  the  cavity  of  the  third  ventricle 
may  be  then  inspected,  together  with  the  corpora  quadrigemina,  the 
geniculate  bodies,  and  the  iter. 

With  regard  to  the  further  dissection  of  the  brain,  which  involves 
the  making  both  of  macroscopic  and  microscopic  sections,  it  has  already 
been  stated  that  the  examiner,  in  a  certain  class  of  cases,  is  more  likely 
to  make  too  few  than  too  many.  Indeed,  the  only  limit  which  can 
be  placed  on  the  number  of  the  sections  to  be  made  in  cases  like. that 
of  Harris  or  Buchanan  is  that  which  time  imposes.  In  ordinary  in- 
stances, sections  of  the  convolutions  made  at  intervals  of  half  a  centi- 
meter will  usually  be  sufficiently  close,  although  it  is  quite  possible, 
as  before  stated,  for  small  foci  of  softening-  to  lie  concealed  in  sections 
of  this  thickness.  Much  must  be  left  to  the  judgment  of  the  examiner 
in  each  individual  case  with  regard  to  the  thickness  and  number  of 
the  sections.  Virchow's  remark  in  this  connection  is  significant:  "The 
less  you  find,  the  greater  ought  to  be  the  number  of  the  sections." 
Microscopic  sections  will  rarely,  if  ever,  be  required  in  any  number  save 
in  the  regions  of  the  medulla  and  pons.  Where  these  are  required,  the 
examiner  may  remove  the  parts  mentioned  and  preserve  them  in  alcohol 
for  the  subsequent  microscopical  examination.  In  the  examination  of 
the  internal  capsule,  particular  attention  should  be  given  to  that  portion 
supplied  by  Charcot's  artery  of  hemorrhage,  the  lenticulo-striate  artery. 
This  is  a  branch  of  the  middle  cerebral,  which,  passing  through  a  separate 
hole  in  the  anterior  perforated  space,  runs  upward  between  the  lenticular 
nucleus  and  the  external  capsule,  then  perforates  the  internal  capsule, 
terminating  in  the  caudate  nucleus.  In  the  dissection  of  the  basal 
ganglia  the  incisions  should  be  made  radially  in  an  antero-posterior 
direction,  converging  toward  the  peduncle. 

The  floor  of  the  fourth  ventricle  should  be  inspected  for  the  petechial 
hemorrhages,  which  are  of  quite  frequent  occurrence  in  this  vicinity.  In 
cases  where  fracture  of  the  skull  has  occurred  they  are  not  uncommon, 
and  are  probably  the  result  of  concussion.  The  writer  has  also  seen 
them  in  cases  of  death  from  opium  poisoning,  and  from  gunshot  wound 
of  frontal  lobe.  In  one  case  they  were  in  the  pneumogastric  nucleus,  on 
each  side.  It  has  been  shown  that  they  also  are  found  in  this  vicinity  in 
criminals  who  have  been  put  to  death  by  electricity. 

The  examination  of  the  spinal  cord  is  next  in  order.  There  is  no 
part  of  the  autopsy  which  should  be  conducted  with  more  care.  It  has 
been  conclusively  shown  by  Van  Giesen  that  injuries  maybe  inflicted 
on  the  cord  by  rough  handling  during  its  removal,  which  may  simulate 
softening,  displacement  of  both  gray  and  white  matter,  etc.  For  a  com- 
plete account  of  the^ various  injuries  which  may  be  inflicted  on  the  cord 

rhich 
the 


..  nter 

araws  winch  are  to  be  noted  in  describing  the  technique  of  the  removal 

ot  the  cord  from  its  bony  canal,  are  as  follows:  The  use  of  mallet  and 

tuseJ  is  inadmissible  for  the  purpose  of  cutting  through  the  lamina?  of 


MEDICO-LEGAL  INSPECTIONS— POST-MORTEM  EXAMINATIONS.     41 

the  vertebrae,  because  it  is  easy  by  this  method  to  force  in  upon  the  dura 
and  cord  fragments  of  bone,  which  will  surely  produce  a  bruise.  The 
blows  of  the  mallet  are  of  themselves  quite  sufficient  to  produce  effects 
which  may  be  mistaken  for  pathological  changes.  The  use  of  heavy  bone 
shears  is  equally  to  be  deprecated,  as  the  introduction  of  the  inferior 
blade  into  the  vertebral  canal  is  almost  certain  to  result  in  a  contusion 
of  the  cord.  The  double-bladed  saw  is  objectionable  because  it  is  liable 
to  jam  in  the  saw-cut,  and  the  violence  which  is  necessary  to  release  the 
blades  may  thrust  them  into  the  vertebral  canal  and  injure  the  cord.  The 
chisels  of  Brunetti,  used  in  removing  the  cord  through  the  abdominal 
incision  by  chopping  through  the  pedicles,  while  expeditious,  are,  accord- 
ing to  Van  Giesen,  as  objectionable  as  the  use  of  the  chisel  in  the  ordi- 
nary manner.  Of  all  the  different  methods  employed  for  the  purpose, 
Van  Giesen  considers  that  the  use  of  the  chisel  is  most  likely  to  result  in 
the  production  of  artefacts.  He  recommends  the  use  of  a  single  saw 
"  slightly  curved  or  gently  rounded  at  the  point."  With  this  saw  the 
vertebral  archway  is  to  be  completely  severed  on  both  sides  of  the  spinous 
processes,  due  care  being  exercised  not  to  drive  the  saw  into  the  vertebral 
canal  so  as  to  injure  the  cord.  Prior  to  the  use  of  the  sa  \v.  the  soft  parts 
will  have  been  retracted,  aud  the  vertebrae,  especially  those  in  the  cervical 
region,  carefully  inspected  for  fracture.  After  finishing  with  the  saw, 
the  spines  are  to  be  gently  tested  with  the  hand,  and  if  any  are  found 
immovable  the  saw  is  to  be  reapplied  until  the  arches  have  been  com- 
pletely severed.  On  no  account  is  the  hook  or  chisel  to  be  used  to  release 
a  partly  divided  arch,  as  this  is  sure  to  result  in  bruising  the  cord.  The 
bone  shears  are  also  to  be  avoided.  With  regard  to  Dr.  Van  Giesen's 
criticisms  on  the  use  of  the  two-bladed  saw,  it  may  be  observed  that  this 
instrument  is  at  present  used  by  the  best  pathologists  in  Europe,  and 
that  the  single  saw  may  be  made  to  lock  in  the  saw  cut,  just  as  the 
double  blade.  The  older  instrument  furnishes  the  readiest  means  of 
exposing  the  spinal  canal,  and  if  used  carefully  ought  not  to  result 
in  the  production  of  artefacts.  After  the  removal  of  the  posterior 
vertebral  archway,  the  cord  is  to  be  taken  out  of  the  vertebral  canal  in 
its  dural  sheath,  any  epidural  hemorrhage  being  noted.  While  dividing 
the  attachments  of  the  dura,  the  spinal  nerves,  etc.,  care  is  to  be  taken 
not  to  handle  the  cord  itself.  It  is  safest  to  remove  the  cord  from  its 
•canal  by  taking  hold  of  the  dura  with  forceps  and  lifting  it  out  in  this 
way,  taking  care  neither  to  stretch  nor  twist  it.  As  the  examination  of 
the  cord  will  usually  be  made  by  the  aid  of  microscopic  sections,  it  must 
be  taken  to  a  distance  for  this  purpose,  and  in  order  to  avoid  injury 
should  be  carefully  placed  on  a  bed  of  soft  cotton  and  covered  with  alco- 
hol. It  may  be  divided  into  a  convenient  number  of  sections  for  this 
purpose.  Van  Giesen  relates  a  case  where  a  cord  was  taken  across  the 
city  resting  on  a  bed  of  pounded  ice.  The  cord  settled  down  in  the  ice 
in  transit,  and  bruises  occurred.  In  this  case  the  cord  was  already  very 
vulnerable  because  of  an  acute  myelitis.  Where  the  cord  has  been  trans- 
ported in  its  dural  sheath,  the  examination  of  the  subdural  space  for 
hemorrhages,  clots,  etc.,  must  be  left  for  the  microscopist,  or  the  examiner 
may  himself  be  present  when  the  dura  is  opened,  in  order  to  inspect  its 
interior.  The  practical  point  for  the  medical  examiner  to  bear  in  mind 
with  regard  to  the  spinal  cord  is  the  ease  with  which  artificial  injuries, 
inflicted  either  in  process  of  removal  or  transportation,  may  be  mistaken 


4j  a   SYSTEM   OF  LEGAL   MEDICINE. 

for  injuries  incurred  before  death.     The  importance  of  this  fact  to  the 
medical  jurist  cannot  be  overrated. 

The  incision  for  exposing  the  cavities  of  the  thorax  and  abdomen,  as 
usually  made,  commences  at  the  episternal  notch  and  terminates  at  the 
symphysis.  It  should  be  firm,  deep,  and  pass  to  the  left  of  the  umbilicus- 
bo  avoid  the  round  ligament  of  the  liver.  In  extending  the  incision 
through  the  peritoneum,  the  recti  muscles  may  be  severed  at  their  pubic 
attachments.  This  will  be  found  convenient,  especially  if  rigor  mortis  is 
well  developed  and  the  muscles  large.  As  in  medico-legal  autopsies  it 
frequently  becomes  necessary  to  examine  the  trachea,  pharynx,  and  cesoph- 
agus,  it  is  better  to  commence  the  incision  at  the  chin  and  complete  it 
as  usual.  This  is  the  present  German  method.  It  exposes  the  region 
.»f  the  neck,  and  renders  it  possible  to  remove  the  larynx,  trachea,  and 
oesophagus.  The  two  former  structures  will  always  require  examination 
in  cases  hearing  marks  of  violence  in  the  neck,  as  from  strangulation  or 
suspension.  Sometimes,  in  cases  where  the  body  has  been  found  face 
downward  in  a  shallow  pool  of  water,  an  examination  of  the  pharynx  and 
trachea  will  show,  by  the  presence  of  water,  sand,  or  weeds,  that  efforts- 
;it  respiration  had  taken  place  after  immersion  of  the  mouth;  and  such 
evidence  would  tend  to  the  conclusion  that  the  deceased  met  death  by 
drowning,  or  at  least  that  when  he  fell  into  the  pool  he  was  alive.  Where 
there  is  reason  to  expect  fracture  of  the  trachea  or  larynx,  it  has  been 
advised  that  the  structures  should  be  opened  from  behind,  and  examined 
after  removal.  In  those  instances  where  corrosive  poisons  have  been 
taken,  the  examination  of  the  oesophagus  will  show  the  action  of  the 
drug.  If  the  examination  of  the  trachea  and  larynx  reveal  reddening 
and  oedema,  it  should  not  be  forgotten  that  these  structures  are  almost 
the  first  to  undergo  putrefaction,  of  which  the  reddening  and  oedema 
may  be  but  signs.  In  the  somewhat  rare  cases  where  a  foreign  body 
has  lodged  in  the  oesophagus,  and,  as  in  a  case  seen  some  years  ago  by 
the  writer,  caused  ulceration  into  the  aorta  and  sudden  death  from  rapid 
hemorrhage,  an  examination  of  the  oesophagus  will  be  necessary  in  order 
to  show  the  cause  of  death ;  also  in  death  from  corrosive  poisons. 

In  order  to  expose  the  thorax,  it  is,  of  course,  necessary  to  reflect  the 
soft  parts  to  a  point  beyond  the  cartilages  of  the  ribs.  This  may  be  most 
conveniently  done  with  the  short,  broad  knife.  In  the  abdominal  region, 
the  primary  incision  may  extend  quite  down  to  the  peritoneum;  but  as- 
such  a  tour  de  force  can  only  be  accomplished  after  much  practice,  it  is 
better  to  make  several  incisions  through  the  abdominal  wall,  than  by  one 
ill-judged  slash  of  the  knife  to  wound"  the  intestines.  When  the  perito- 
neum is  reached,  it  may  be  opened  by  passing  two  fingers  into  a  narrow 
opening  made  for  the  purpose,  and  then  slitting  it  up  between  the  fingers 
as  a  guide.  The  abdomen  is  to  be  opened  and  inspected  first,  but  the 
contained  viscera  must  not  be  dissected  or  removed  until  after  the  exam- 
ination of  the  thorax,  because  the  division  of  the  large  vessels  of  the 
abdominal  viscera  would  certainly  drain  the  blood  from  the  cavities  of 
the  heart,  and  render  it  impossible  to  state  with  precision  their  condition 
with  regard  to  contained  blood.  So  too,  if,  on  the  other  hand,  the  thorax 
be  opened  first,  it  will  be  impossible  to  determine  the  position  of  the 
diaphragm — a  point  of  some  importance  in  autopsies  on  the  bodies  of  new- 
born infants.  The  inspection  of  the  abdomen  should  therefore  be  made 
with  a  view  to  determining  the  position  of  the  diaphragm  with  regard  to 


MEDICO-LEGAL  INSPECTIONS— POST-MORTEM  EXAMINATIONS.     43 

the  ribs,  the  color  of  the  contained  parts,  and,  where  this  can  be  ascertained 
without  dissection,  the  presence  and  position  of  any  foreign  body.  With 
regard  to  the  latter  consideration,  it  may  be  observed  that  the  search  for  a 
missile  in  the  abdominal  cavity  is  always  a  matter  of  difficulty,  as  witness 
the  autopsy  in  the  Garfield  case,  where  the  bullet  was  not  found  in  the 
abdomen  at  all,  although  most  careful  search  was  made  for  it,  but  was 
afterward  discovered  in  the  vessel  which  had  been  made  the  receptacle 
of  the  removed  viscera.  It  will  therefore  be  necessary  in  these  cases  to 
defer  the  search  for  the  foreign  body  until  the  dissection  of  the  abdomen. 
The  presence  of  fecal  matter  from  wounds  of  the  intestine,  of  clotted 
blood  or  of  serum,  may  be  ascertained  at  this  point.  Blood-clots  should 
be  transferred  to  a  graduated  vessel  and  thus  measured,  so  that  an  exact 
statement  of  the  amount  of  clot  may  be  made  in  the  report  in  place 
of  the  usual  inaccurate  wording,  "a  large  amount  of  clot,"  etc.  The 
quantity  of  blood-clots  or  other  fluids  in  the  cavities  of  the  body  may 
also  be  determined  by  weight.  Serum  may  best  be  measured  by  sopping 
it  up  with  a  large  moist  sponge  and  expressing  it  into  a  suitable  vessel, 
until  the  cavity  is  dry.  The  color  of  the  abdominal  contents  ought  to  be 
ascertained  soon  after  opening  the  cavity,  as,  owing  to  absorption  of 
oxygen,  they  quickly  change  from  a  dusky  red  to  a  deep  red,  which  may 
and  often  is  mistaken  for  the  signs  of  an  inflammation.  It  may  be  fur- 
ther remarked  that  bright  red  arterial  blood  is  never  found  in  the  dead 
body.  (Virchow.)  The  more  dependent  parts  of  the  abdominal  viscera 
always  assume  a  deeper  red  than  those  which  are  uppermost,  and  this 
fact  will  assist  the  examiner  in  determining  whether  the  color  is  due  to 
inflammation  or  not.  If  confined  to  the  dependent  parts,  it  is  certainly 
the  result  of  the  gravitation  of  the  blood  ;  whereas  if  uniform,  particularly 
if  the  peritoneum  have  lost  its  gloss,  it  is  probably  due  to  irritation  or 
inflammation.  Old  adhesions,  thickenings  of  peritoneum,  and  other  signs 
of  past  inflammation  are  to  be  noted. 

The  preliminary  inspection  of  the  abdominal  cavity  having  been  com- 
pleted, the  thorax  may  now  be  opened.  One  precaution  is  to  be  observed 
in  this  connection.  After  the  costal  cartilages  have  been  divided  close  to 
the  ribs,  in  disarticulating  the  sternum  from  the  clavicle  particular  care 
is  to  be  taken  not  to  wound  the  great  veins  beneath,  as  is  often  done. 
Where  this  happens,  it  is  impossible  to  determine  whether  the  blood 
which  is  certain  to  be  found  in  the  chest  is  the  result  of  the  wounding  of 
the  veins,  or,  if  there  is  a  wound  of  the  chest,  to  determine  what  propor- 
tion of  the  effused  blood  is  due  to  the  previous  injury  and  what  t<>  the 
divided  veins.  If  the  crescentic  shape  of  the  sterno-clavicular  articula- 
tion be  borne  in  mind,  the  separation  of  the  articular  surfaces  will  be 
facilitated  if  the  examiner  direct  the  knife  in  such  a  manner  as  to  follow 
the  curve.  The  cartilage  of  the  first  rib  is  frequently  ossified,  and  it  is 
here  that  the  greatest  care  must  be  exercised,  else  the  knife  or  costotome 
will  wound  the  vessels  beneath.  In  the  first  place,  it  is  to  be  remembered 
that  the  cartilage  of  the  first  rib  extends  about  half  an  inch  further  out- 
ward than  that  of  the  second,  consequently  the  incision  must  be  made 
with  this  in  mind,  else  the  knife  will  come  in  contact  with  the  manubrium. 
If  the  knife  is  placed  under  the  rib  and  the  cut  is  made  in  ;i  forward 
direction,  the  vessels  will  be  avoided.  After  dividing  the  sternal  attach- 
ments of  the  diaphragm,  the  entire  sternum  may  be  removed  or  reflected 
and  the  pleural  cavities  examined.     Any  fluid,  as  serum  or  blood,  is  care- 


I 


44  A   SYSTEM  OF  LEGAL  MEDICINE. 

fully  to  be  removed  with  the  sponge  and  expressed  into  a  vessel,  and 
measured  or  weighed.     The  presence  of  adhesions  is  to  be  noted,  and 
other  evidences  of  reeent  or  chronic  disease  which  appear  on  the  surface 
of  the  lungs.    The  mediastinum  is  also  to  be  inspected.    The  pericardium 
is  then  to  be  opened  carefully  so  as  to  prevent  the  escape  of  any  fluid 
therein  contained,  which  is  to  be  measured  as  before  directed.     Both  its 
visceral  and  parietal  surfaces  are  to  be  inspected  for  pathological  changes. 
Wil  h  regard  to  the  external  appearance  of  the  heart,  an  important  point 
is  the  condition  of  the  coronary  arteries.    After  the  removal  of  the  heart 
(heir  caliber  should  be  tested,  after  which  they  should  be  slit  and  their 
interior  examined  for  atheroma,  etc.     Many  a  case  of  sudden  death  may 
be  explained  by  an  inspection  of  the  coronary  arteries,  one  of  which  may 
be  found  to  be  almost  or  quite  occluded  by  a  thrombus,  which  has  rapidly 
formed  about  an  atheromatous  plate  stripped  up  by  the  blood  current. 
If  the  heart  be  now  removed  from  the  thorax,  much  of  the  blood  in  the 
auricles  may  escape,  and  an  exact  estimate  of  the  blood  in  the  heart 
rendered  impossible.     It  may  be  objected  that  such  exactitude  is  unnec- 
essary.    In  a  medico-legal  inquiry  it  is  impossible  to  be  too  exact,  as  the 
result  of  many  a  trial  has  shown,  to  the  mortification  of  the  too  confident 
medical  witness.     The  auricles  and  ventricles  are  therefore  to  be  opened 
in  the  manner  about  to  be  described,  and  their  contents  examined  both 
with  regard  to  color,  quantity,  and  general  appearance.     Ante-mortem 
clots  will  be  evidenced  by  their  extreme  pallor  and  toughness,  also  the 
fact  that  their  centers  are  disintegrated.    Pale  yellow  and  succulent  clots 
are  of  no  significance,  as  they  may  be  formed  in  the  last  moments  of  life, 
whatever  the  cause  of  death.    (Delafield.)    The  heart  should  be  opened  in 
such  a  manner  as  to  expose  the  cavities  and  valves  without  injuring  the 
latter.    The  dissection  of  the  heart  consists  of  two  stages.    The  first  stage 
includes  the  opening  of  the  auricles  and  ventricles,  the  heart  being  in 
■situ,  and  the  subsequent  estimation  of  the  clots  and  the  measurement  of 
the  a uriculo- ventricular  openings.     The  second  stage  consists  in  the  re- 
moval of  the  heart  and  the  examination  of  its  valves  and  interior.     The 
right  auricle  should  be  opened  first.     The  incision  should  commence  be- 
t  ween  the  two  vena*  cava?  and  end  in  front  of  the  base.    (Fig.  2.)    The  clot 
should  then  be  turned  out  into  the  pericardium,  from  whence  it  may  be 
removed  for  estimation  by  weight  or  measure.    If  measured,  an  ordinary 
glass  graduate  may  be  used.     The  approximated  index  or  middle  fingers 
«>t  the   ett  hand  may  then  be  introduced  through  the  tricuspid  valve  into 
tne  rjgnt  ventricle,  the  waUs  of  which  must  be  gently  separated.     If  the 
aunculo-ventricular  opening  permits  the  introduction  of  these  fingers, 
especially  if  the  fingers  be  thick,  the  lumen  of  the  valve  may  be  consid- 
ered normal.     In  the  case  of  slender  fingers,  it  is  possible  to  introduce 
between  the  index  and  middle  fingers  of  the  left  hand  the  index  finger  of 
tne  rmnt.   Alter  the  size  of  the  opening  has  been  ascertained  the  incision 
into  the  right  ventricle  should  be  made.    This  should  commence  close  to 
the  base,  pass  into  the  ventricle,  and  end  just  short  of  the  apex.     The 
septum  must  be  avoided.     In  the  case  of  each  cavity,  the  clot  is  to  be 
turned  out  as  before  directed  and  measured.     The  incision  for  the  left 
auricle  commences  at  the  left  pulmonary  vein  and  ends  in  front  of  the 

£Sf+?V°rOI17-Teins'     The  incision  int0  the  left  ventricle 

u      n       r      t  f^  K?  1S  Carried  d°Wn  tOWard   the  aPex<  Whidl  * 

must  not  quite  reach.     The  measurement  of  the  valves  and  dot  is  con- 


PLATE  II. 


Fig.  2. 
LINE  OF  EXTERNAL  INCISION  OF  HEART. 

(VIRCHOW.) 


Fig.  3. 
EXPOSURE  OF  INTERIOR  OF  HEART. 

(VIRCHOW.) 


MEDICO-LEGAL   INSPECTIONS— POST-MOBTEM  EXAMINATIONS.     47 

tinned  as  before.  The  heart  may  now  be  removed,  taking  care  to  cut  all 
the  vessels  rather  long-.  The  sufficiency  of  the  aortic  and  pulmonary 
valves  may  now  be  tested  by  pouring  water  into  these  vessels.  For  this 
purpose  the  heart  must  be  suspended  by  the  vessel  the  valves  of  which 
are  the  subject  of  the  test.  It  is  important  that  the  suspension  is  made 
in  such  a  manner  as  to  preserve  as  far  as  possible  the  circular  form  of 
the  artery.  This  may  be  done  either  by  passing  a  number  of  sutures 
through  its  walls  or  by  grasping  its  walls  with  the  fingers  of  both  hands 
in  such  a  manner  as  to  preserve  its  shape.  No  lateral  traction  should  be 
made.  The  real  efficiency  of  the  water  test  may  be  called  in  question,  for 
it  may  be  doubted  whether  the  integrity  of  the  valves  may  not  be  better 
determined  by  inspection  and  touch.  The  ventricles  may  now  be  fully 
opened  for  the  purpose  of  examining  the  flaps  of  the  auricnlo- ventricular 
valves,  the  endocardium,  and  other  structures  in  the  interior  of  the  heart. 
(Fig.  3.)  The  incision  for  the  right  ventricle  (Fig.  2)  is  made  by  entering 
a  pair  of  scissors  into  the  previous  incision  and  carrying  it  toward  the 
pulmonary  artery,  avoiding  the  anterior  papillary  muscle  by  passing  in 
front  of  it.  The  incision  for  the  left  ventricle  (Fig.  3)  is  made  in  a  straight 
line,  prolonged  from  the  aorta,  close  to  the  septum.  This  incision  must 
not  cross  the  pulmonary  orifice,  as  it  will  if  carried  too  close  to  the  sep- 
tum, nor  must  it  cut  that  portion  of  the  mitral  valve  which  is  attached  to 
the  left  border  of  the  aorta  by  going  too  far  to  the  left.  The  incision 
should  pass  midway  between  the  pulmonary  orifice  and  the  left  auricle. 

The  examination  of  the  heart  being  completed,  the  lungs  may  now  be 
removed.  This  is  done  by  seizing  each  lung  in  turn,  lifting  it  up,  and 
dividing  the  vessels  at  the  base.  The  bronchi  should  now  be  opened 
with  a  pair  of  scissors,  and  examined  for  foreign  bodies  and  morbid  ap- 
pearances, commencing  with  the  primary  bronchi  and  following  them 
up  to  their  subdivisions  as  far  as  necessary.  The  lung  tissue  itself  is  to 
be  examined,  by  means  of  long  incisions  made  with  sweeping  strokes  of 
the  knife,  from  apex  to  base,  on  the  posterior  aspect.  The  cut  surfaces 
may  then  be  inspected,  and  any  fluid  contained  in  the  lung  tissue  or 
smaller  bronchi  expressed  by  passing  the  edge  of  the  knife  at  right 
angles  over  the  surface  of  the  incision.  Blood,  pus,  mucus,  or  serum  may 
thus  be  squeezed  out  and  examined.  The  presence  of  sanguinolent  mucus 
in  the  air-tubes  is  significant. 

The  abdominal  viscera  are  now  to  be  dissected.  In  cases  of  gunshot 
wound  of  the  abdomen,  the  intestines  should  be  examined  first ;  but  in 
other  cases  it  is  best  to  leave  them  to  the  last,  for  the  sake  of  cleanliness. 
Where  it  is  necessary  to  search  the  intestinal  canal  for  perforations  re- 
sulting from  gunshot  wounds,  it  is  best  to  do  this  in  a  methodical  manner. 
The  search  may  commence  with  the  sigmoid  flexure  and  rectum,  thence 
extending  to  the  three  divisions  of  the  colon,  the  intestines  being  passed 
through  the  fingers  until  the  duodenum  is  reached.  The  location  of  all 
wounds,  their  number,  and  especially  their  position  with  regard  to  the 
wound  in  the  parietes,  are  to  be  noted.  In  order  to  search  for  the 
bullet,  it  will  be  usually  necessary  to  remove  the  intestines.  This  may 
be  best  accomplished  by  first  ligaturing  the  gut  both  at  the  rectal  and 
gastric  ends  with  a  double  ligature,  and  then  commencing  at  the  rectum, 
dividing  the  mesentery  until  the  whole  intestine  is  freed  from  its  attach- 
ments to  the  posterior  abdominal  wall.  Further  search  for  the  mis- 
sile may  now  be  made,  after  the  abdominal  cavity  has  been  thoroughly 


48  A   SYSTEM  OF  LEGAL  MEDICINE. 

cleansed.  Tn  eases  not  involving  perforating-  wounds  of  the  intestine,  it 
is  usual  to  examine  the  abdominal  viscera  in  the  following  order :  first, 
the  omentum,  which  maybe  inspected  for  miliary  tubercle  or  carcinoma; 
second,  the  spleen  ;  third,  the  kidneys,  suprarenal  capsules,  and  ureters; 
fourth,  the  sexual  apparatus;  fifth,  the  stomach  and  duodenum;  sixth, 
the  liver,  gall-bladder,  bile-ducts,  and  portal  veins;  lastly,  the  structures 
in  the  posterior  portion  of  the  abdomen,  such  as  the  abdominal  aorta,  the 
receptaculum  chyli,  lymphatics,  etc. 

As  a  rule,  the  spleen  possesses  no  special  interest  to  the  medico-legal 
examiner.  It  is  often  ruptured  as  a  result  of  violence.  Its  pulp  softens 
very  early  as  a  result  of  putrefaction.  The  kidneys  may  be  removed  by 
separating  the  peritoneum  from  them  and  dividing  the  vessels  and  ureter. 
The  capsule  is  then  to  be  stripped  off;  if  adherent,  this  is  to  be  noted. 
The  pelvis  may  be  inspected  for  calculi.  An  incision  is  then  to  be  made 
iu  the  convex  border  of  the  organ,  right  down  to  the  pelvis,  laying  the 
kidney  open  in  two  equal  parts.  The  cortical  and  medullary  portions 
may  then  be  inspected  for  evidences  of  disease.  This  should  never  be 
omitted.  In  cases  where  narcotic  poisoning  is  suspected,  the  examina- 
tion < it'  the  renal  organs  ought  to  be  as  exact  and  complete  as  possible.  In 
late  autopsies  the  naked-eye  appearances  are  perhaps  of  more  value  than 
the  deductions  of  a  microscopic  examination,  for  the  conclusions  which  can 
reasonably  he  drawn  from  microscopic  findings  after  the  changes  of  com- 
mencing putrefaction  have  set  in  are  untrustworthy.  It  may,  however, 
he  quite  possible  still  to  appreciate  a  change  in  the  proportion  of  the 
cortical  and  medullary  portions  of  the  kidney,  which  would  indicate  the 
existence  of  a  previous  chronic  disease.  It  is  not  usually  necessary 
to  remove  the  bladder  for  examination.  It  is  sufficient,  after  drawing 
the  urine  with  a  catheter,  to  make  an  incision  into  the  upper  surface 
of  the  viscus  and  examine  it  in  situ.  The  urine  should  be  preserved  for 
future  examination,  particularly  in  cases  of  poisoning.  It  is  important 
to  examine  the  bladder  walls  for  injury,  especially  in  cases  where  fracture 
of  the  pelvis  exists.  To  determine  whether  there  is  any  perforating  wound, 
the  viscus  maybe  filled  with  water  or  air  through  the  urethra,  before  open- 
ing. It  may  be  necessary  to  remove  the  entire  bladder  for  purposes  of 
examination,  in  which  case  care  should  be  taken  not  to  wound  the  blad- 
der wall— something  which  it  is  not  difficult  to  do  in  careless  manipula- 
tion. It  is  not  often  that  a  further  examination  of  the  male  genito- 
urinary organs  will  be  required  ;  but  if  this  should  become  necessary,  the 
penis  may  be  stripped  out  of  the  skin,  cut  off  at  the  glans,  and  drawn 
out  like  a  finger  from  a  glove.  It  may  then  be  removed  with  the  bladder 
attached.  A  pair  of  scissors  curved  on  the  flat  facilitate  the  necessary 
dissection. 

The  inspection  of  the  female  organs  of  generation  within  the  pelvis  is 
often  of  great  importance,  especially  in  cases  of  criminal  abortion.  The 
ovaries  are  to  be  inspected  for  the  corpora  lutea  of  pregnancy,  which  are 
to  be  distinguished  from  the  false  corpora  lutea  of  menstruation.  The 
pelvic  tissues  are  to  be  examined  for  evidences  of  old  or  recent  inflam- 
mation. The  uterus  will,  of  course,  receive  particular  attention  in  a  cer- 
tain class  of  cases.  Its  size  should  be  noted,  also  the  depth  of  its  cavity, 
the  condition  of  the  os  and  cervix,  the  thickness  of  its  walls.  If  any  dis- 
charge is  present,  either  in  the  cavity  of  the  uterus  or  vagina,  this  will  be 
ol   importance.     The  condition  of  the  uterine  sinuses  and  endometrium 


MEDICO-LEGAL   INSPECTIONS— -POST-MORTEM  EXAMINATIONS.     49 

•should  receive  attention,  also  the  Fallopian  tubes.  The  orifice  of  the  tubes 
will  not  admit  anything  larger  than  a  bristle,  as  a  rale,  and  this  can  be 
passed  most  easily,  after  the  uterus  has  been  laid  open  so  as  to  expose  the 
cornua.  The  entrance  to  the  Fallopian  tube  will  be  found  in  the  apex  of 
each  cornu.  In  cases  of  abortion  where  death  has  occurred  within  a  few 
days,  the  uterus  must  also  be  examined  for  signs  of  injury,  as  perforations, 
which  would  indicate  the  use  of  a  pointed  instrument— not  necessarily, 
however,  in  the  hands  of  another  than  the  woman  herself.  The  writer 
knew  of  two  women,  one  of  whom  was  accustomed  to  produce  an  abor- 
tion on  herself  by  the  aid  of  a  lead-pencil,  and  the  other  used  an  um- 
brella wire  for  the  same  purpose,  at  last  inflicting  a  fatal  injury.  The 
size  of  the  uterus  is  of  some  importance  in  determining  the  period  of 
pregnancy,  where  this  has  existed.  The  normal  unimpregnated  uterus 
measures  two  and  a  half  inches  in  length,  one  and  three  quarters  inches 
in  breadth,  and  one  inch  thick.  For  further  measurements  as  indicative 
•of  the  period  of  pregnancy,  the  reader  is  referred  to  the  appropriate 
chapter.  In  examining  the  uterus  where  death  has  taken  place  shortly 
after  confinement,  the  observer  ought  not  to  forget  that  the  site  of  the 
placenta  presents  appearances  which  may  be  mistaken  for  inflammation 
or  even  gangrene.  The  presence  of  pus,  the  condition  of  the  uterine 
sinuses,  the  coexistence  of  peritonitis,  and  the  presence  of  septic  micro- 
organisms, possibly  the  streptococcus  pyogenes,  will  make  the  distinction 
clear.  One  or  all  of  these  conditions  will  be  found  in  acute  inflamma- 
tions of  the  uterus.  The  ovaries  are  usually  involved  in  the  morbid  pro- 
cess, and  will  be  found  to  be  congested,  swollen,  and,  where  the  disease 
has  been  of  sufficient  duration  and  acuteness,  infiltrations  and  local  ab- 
scesses may  exist. 

The  examination  of  the  stomach  and  duodenum  is  of  special  importance 
in  cases  of  suspected  poisoning.  As  the  preservation  of  the  contents  is 
of  prime  importance,  in  order  that  this  may  be  done  without  even  the 
possibility  of  contamination,  it  is  recommended  that  the  stomach  and 
duodenum  be  ligatured  separately  with  double  ligatures,  and  placed  in 
new  glass  jars  with  glass  tops,  previously  well  washed  in  distilled  water. 
The  jars  should  then  be  sealed  and  at  once  sent  to  the  analytical  chemist. 
The  examiner  is  to  inspect  the  interior  of  both  stomach  and  duodenum 
after  the  chemist  has  transferred  their  contents  to  suitable  and  well- 
washed  vessels.  It  is  better  not  to  make  this  transfer  in  a  room  where 
chemicals  are  kept.  The  stomach  may  then  be  opened  along  its  greater 
curvature,  and  its  interior  examined.  This  is  a  method  which  involves 
some  extra  trouble;  but  as  the  contents  of  these  organs  are  not  removed 
until  they  reach  the  laboratory  which  is  their  final  destination,  there  is 
one  less  manipulation  to  call  in  question,  and  the  risk  of  possible  con- 
tamination is  consequently  lessened.  Nor  is  such  a  precaution  needless. 
Any  one  who  is  conversant  with  the  refinements  of  modern  chemistry 
and  the  history  of  past  trials  for  poisoning  will  admit  that  any  proceed- 
ing  is  proper  which  will  limit  the  suspicions  which  a  clever  defense,  aided 
by  a  friendly  chemist,  is  able  to  cast  on  any  chemical  analysis,  no  matter 
how  skillfully  conducted.  If  the  viscera  have  to  be  sent  to  a  distance, 
another  consideration  must  be  taken  account  of,  however,  which  is  the 
cloud  which  putrefactive  changes  occurring  in  transit  may  cast  on  the 
analysis,  by  the  production  of  ptomaines.  This  will  occur  particularly 
where  the  chemical  analysis  results  in  the  discovery  of  some  form  of 


50  -1    SYSTEM   OF  LEGAL  MEDICINE. 

alkaloidal  poison,  especially  morphine.  The  Buchanan  trial  may  be 
cited  as  an  instance  of  the  confusion  in  the  expert  chemical  testimony 
which  ihc  presence  of  ptomaines  occasioned.  Indeed,  in  this  case  it  may 
well  be  questioned  whether  the  accused  was  not  fairly  entitled  to  the 
doubt  which  was  raised  when  Professor  Vaughan  showed  the  similarity 
which  existed  between  the  reactions  of  morphine  and  indol.  Certainly 
•  in  the  testimony  alone  of  the  chemists  for  the  prosecution,  the  State  was 
not  entitled  to  a  conviction.  Where  putrefactive  changes  are  liable  to 
occur  in  transit,  it  is  better  to  transfer  the  contents  of  the  stomach  and 
duodenum  to  separate  vessels.  The  viscera  can  then  be  immediately  ex- 
am ined.  With  regard  to  the  inspection  of  the  mucous  membrane  of  the 
stomach,  it  is  to  be  remembered  that  post-mortem  digestion  commences 
at  from  twenty-four  to  thirty-six  hours  after  death,  causing  softening 
and  disintegration  of  the  mucous  membrane.  This  process  is  most  active 
in  the  pouch  of  the  greater  curvature  of  the  stomach,  which  may  serve 
to  distinguish  this  form  of  softening  from  that  caused  by  disease.  Occa- 
sionally when  death  takes  place  immediately  after  a  full  meal,  during 
active  digestion,  the  action  of  the  gastric  juice  has  produced  a  perfora- 
tion  of  the  stomach.  Ulcers  of  the  stomach  occur,  as  a  rule,  at  the 
pyloric  end  near  the  lesser  curvature,  although  they  may  be  found  any- 
where.    They  frequently  have  an  indurated  margin. 

The  examination  of  the  liver  is  frequently  of  the  utmost  importance 
in  medico-legal  cases,  as,  for  instance,  to  determine  the  existence  of  the 
changes  which  this  organ  undergoes  as  a  result  of  certain  poisons.  So, 
too,  in  cases  of  death  by  extreme  violence  the  autopsy  may  reveal  exten- 
sive lacerations  of  the  substance,  even  where  the  external  signs  of  violence 
were  absent.  The  liver  may  be  removed  for  examination  by  first  divid- 
ing the  diaphragm  on  either  side  as  far  as  the  spinal  column,  then  sever- 
ing the  lateral  ligaments,  the  broad  ligaments,  after  which  it  may  be 
turned  into  the  thorax,  the  vessels  and  coronary  ligament  divided,  and 
the  organ  removed.  If  it  seem  necessary,  the  bile-duct  must  be  exam- 
ined previous  to  removal.  For  the  purpose  of  inspecting  the  parenchyma, 
sweeping  incisions  niay  be  made  in  the  substance  of  the  organ  with  the 
long  knife.  After  the  removal  of  the  liver,  it  is  possible  to  examine  the 
posterior  sm-face  of  the  abdominal  wall.  The  receptaculum  chyli  and 
lymphatic  may  be  inspected  with  a  view  of  determining,  in  certain  cases, 
the  relation  of  the  time  of  death  to  the  ingestion  of  food. 

In  the  foregoing  description  of  the  method  of  conducting  an  autopsy, 
nothing  has  been  said  of  the  propriety  of  weighing  the  solid  viscera.  The 
utility  of  ascertaining  their  weight  is  doubtful,  as  this  may  vary  within 
quite  wide  limits.  Any  conclusions  based  on  the  evidence  of  the  scales 
ought  for  this  reason  to  be  accepted  with  caution.  For  the  purpose  of 
comparison,  however,  the  following  table  is  appended : 

Male.  Female. 

Weight  of  brain   46-53  oz.  -41-47  oz. 

hmgs 1-37  of  body-weight         1-43  of  body-weight. 

heart 10  oz.  8  oz. 

liver 60  oz.  50  oz. 

spleen 7  oz.  (average) 

kidneys 4|-6  oz.  4-5+  oz. 

uterus  8-10  drs. 


n 


MEDICO-LEGAL  INSPECTIONS— POST-MORTEM  EXAMINATIONS.     51 

Examination  of  the  Body  of  a  Child. — The  maturity  of  the  child 
should  first  be  determined.  For  this  purpose  its  length  and  weight 
should  be  taken,  also  the  length  and  condition  of  the  hair  on  the  scalp, 
the  condition  and  length  of  the  nails,  the  condition  of  the  eyes  with 
regard  to  the  presence  or  absence  of  the  membrana  pupillaris ;  finally, 
the  lower  epiphysis  of  the  femur  is  to  be  inspected  with  reference  to  the 
center  of  ossification.  For  this  purpose  a  curved  incision  is  to  be  made 
over  the  lower  end  of  the  femur,  the  patella  removed,  and  the  end  of  the 
bone  protruded  through  the  incision,  when  thin  cross-sections  may  be 
made  until  the  greatest  diameter  of  the  center  is  ascertained,  which 
should  be  measured  in  millimeters.  For  the  necessary  measurements 
the  reader  is  referred  to  the  article  on  infanticide.  The  head  must  be 
examined  for  injuries,  but  the  caput  succedaneum  formed  during  labor 
should  not  be  mistaken  for  an  ante-natal  ecchymosis.  The  fontanelles 
should  be  inspected  with  care.  There  is  a  case  on  record  where  a  mid- 
wife was  convicted  for  the  destruction  of  several  children,  which  she 
accomplished  by  piercing  the  fontanelle  before  birth  with  a  long  pin.  It 
is  important  to  examine  the  neck  for  the  marks  of  strangulation,  but 
the  ecchymosis  left  by  an  encircling  umbilical  cord  which  has  strangled 
the  child  must  not  be  mistaken  for  that  which  is  the  result  of  criminal 
strangulation.  When  this  has  been  accomplished  by  the  use  of  a  soft 
ligature,  it  will  be  exceedingly  difficult  to  make  the  distinction ;  but  if  a 
cord  has  been  used,  abrasions  and  excoriations  of  the  skin  will  be  found, 
and  the  mark  will  be  narrower  than  that  produced  by  the  umbilical  cord. 

The  mouth,  nose,  and  pharynx  should  be  inspected  for  foreign  bodies. 
As  it  may  be  sometimes  necessary  to  establish  the  identity  of  the  corpse, 
the  existence  of  any  peculiarities  or  malformations  should  be  noticed, 
also  the  condition  of  the  skin,  more  especially  as  to  the  presence  or  ab- 
sence of  the  vernix  caseosa,  for  if  this  be  absent,  we  may  infer  that  the 
child  has  been  washed,  although  not  necessarily  born  alive.  The  condi- 
tion of  the  cord  should  be  noted,  whether  succulent  or  mummified,  also 
the  state  of  the  umbilicus  with  reference  to  the  healing  process.  Evi- 
dences of  an  inflammatory  process  in  this  locality  show  that  the  child 
has  lived  some  time  after  birth.  Fractures  of  the  long  bones  cannot  of 
themselves  be  considered  evidence  of  criminal  violence,  as  they  not  in- 
frequently occur  as  the  result  of  accident  in  ordinary  labors.  If  the 
body  of  the  child  be  found  wrapped  in  a  covering  of  any  kind,  this 
should  be  carefully  preserved,  as  its  subsequent  inspection  may  furnish 
a  valuable  clue  to  the  identity  of  the  child.  Perhaps  the  most  important 
point  connected  with  the  technique  of  the  internal  examination  of  the 
body  is  the  rule  which  requires  that  the  abdomen  should  be  opened  be- 
fore the  thorax.  This  is  for  the  purpose  of  ascertaining  the  position  of 
the  diaphragm  with  reference  to  the  occurrence  of  respiration,  in  which 
case  the  convexity  of  the  diaphragm  is  said  to  be  found  at  from  (he 
fourth  to  the  seventh  rib,  but  if  respiration  has  not  taken  place  it  reaches 
only  to  the  fourth  or  fifth.  Evidently  if  the  position  of  the  diaphragm 
were  the  only  evidence  available  in  deciding  so  important  a  point,  in 
those  cases  where  the  diaphragm  is  found  at  the  fourth  or  fifth  rib,  as 
far  as  this  point  is  concerned,  the  child  may  or  may  not  have  breathed, 
and  can  onlv  be  of  value  where  the  diaphragm  is  found  occupying  the 
lowest  of  the  positions  possible.  In  any  event,  this  can  be  only  of  value 
as  corroborative  evidence. 


52  A   SYSTEM   OF  LEGAL   MEDICINE. 

The  technical  part  of  the  autopsy  is  conducted  precisely  as  in  the 
adult.  The  scalp  is  reflected  in  the  same  manner,  when  the  calvarium 
may  be  removed  with  a  pair  of  stout  scissors.  It  is  not  uncommon  in 
cases  of  difficult  or  instrumental  labor  to  find  extravasations  of  blood, 
not  only  on  the  surface  of  the  dura,  but  also  in  the  subdural  space,  and 
even  in  the  substance  of  the  brain  itself,  although  some  writers  consider 
that  effusions  in  the  substance  of  the  brain  are  sure  signs  of  extreme 
violence.  These  may  exist  cither  as  simple  ecchymoses  or  as  genuine 
clots.  On  this  account  the  medical  examiner  should  be  extremely  cau- 
tious in  making  the  deduction  that  such  appearances  are  the  result  of 
criminal  violence.  It  may  be  remarked,  however,  that  the  more  difficult 
a  labor  the  more  difficult  will  concealment  have  been;  and  if  instru- 
mental interference  has  been  necessary  and  concealment  practiced,  the 
probable  collusion  of  a  practitioner  must  be  inferred. 

The  brain  presents  no  peculiarity  worthy  of  mention.  It  is  some- 
what softer  than  in  the  adult,  and  a  little  pinker.  The  thorax  is  opened 
as  before  directed,  in  the  adult.  The  principal  point  of  difference  to  be 
noted  here  between  the  infant  and  adult  is  the  presence  of  the  thymus 
gland,  which  in  the  infant  covers  the  lower  part  of  the  trachea  and  the 
great  vessels.  It  is  about  two  inches  in  length,  about  one  inch  in  breadth, 
;ind  a  quarter  of  an  inch  in  thickness.  It  is  a  light  fawn  color,  and  ex- 
tends upward  as  far  as  the  thyroid  body  and  downward  as  far  as  the 
cartilages  of  the  fourth  rib.  The  thyroid  and  thymus  glands  are  con- 
nected by  two  flattened  bands  of  fibrous  tissue,  which  are  prolongations 
of  the  capsule  of  the  thymus.  The  weight  of  this  structure  at  birth  is 
about  half  an  ounce.  Immediately  on  opening  the  chest,  the  position  of 
the  lungs  in  the  pleural  cavities  is  to  be  noted,  and  also  their  relation  to 
tlie  pericardium.  When  the  child  has  not  breathed  they  lie  shrunken  in 
the  posterior  part  of  the  chest,  whereas  when  the  child  has  fully  respired 
they  fill  up  the  chest  and  cover  the  pericardium.  They  are  then,  more- 
oxer,  of  a  light  pink  color.  It  must  not  be  forgotten  that  if  the  observa- 
tion regarding  color  be  deferred  until  the  lungs  have  been  exposed  some 
time,  they  may  acquire  a  light  color  from  imbibition  of  oxygen.  Pre- 
vious to  the  removal  of  the  thoracic  viscera,  a  ligature  is  to  be  placed  on 
the  trachea  and  great  vessels.  After  removal  the  lungs  must  be  weighed 
separate  from  the  heart  in  order  to  obtain  the  data  for  the  static  test, 
which  depends  on  the  fact  that  the  lungs  are  heavier  after  respiration  has 
been  established  than  before.  As  the  weight  of  the  lungs  must  vary 
with  the  weight  of  the  child,  the  data  which  are  often  given  for  purposes 
of  comparison  cannot  be  considered  very  reliable.  Petechial  spots  are 
often  seen  ou  the  surface  of  the  pleura  in  cases  of  death  from  suffoca- 
tion, but  as  they  may  occur  in  death  from  other  causes,  they  must  be 
noted  with  due  allowance.  As  usually  directed,  the  ductus  arteriosus, 
the  ductus  venosus,  and  the  foramen  ovale  are  to  be  inspected  with 
reference  to  patency  or  closure.  They  may  not  be  completely  closed 
un1  il  a  week  after  birth.  The  amount  of  blood  contained  in  the  cavities 
of  the  heart  is  to  be  measured  or  weighed.  The  same  appearances  are 
to  he  expected  in  the  internal  viscera  in  death  from  apnoea  occurring  in 
infants  as  in  adults. 

The  abdomen,  previously  opened  for  the  determination  of  the  posi- 
tion of  the  diaphragm,  may  now  be  dissected.  The  stomach  and  intes- 
tines are  to  be  examined  with  reference  to  the  presence  of  air,  food,  and 


MEDICO-LEGAL  INSPECTIONS— POST-MORTEM  EXAMINATIONS.     53 

blood.  It  has  been  shown  by  Breslau  that  there  is  no  air  in  the  stomach 
or  intestines  of  new-born  children.  The  stomach  and  small  intestines, 
if  there  is  suspicion  of  poisoning-,  should  be  removed  in  the  same  manner 
.as  in  the  adult.  In  any  case,  the  contents,  if  any,  should  be  tested  for 
the  presence  of  starch,  and  examined  microscopically  for  the  oil-globules 
of  milk.  Blood  may  sometimes  be  found  in  the  stomach.  Its  presence 
has  not  the  same  significance  as  that  of  milk  or  starch.  The  liver  in  the 
infant  is  of  large  size  in  proportion  to  the  body.  It  is  said  to  diminish 
in  size  after  the  establishment  of  respiration,  but  this  fact  is  of  little  sig- 
nificance. Large  extravasations  of  blood  are  sometimes  found  under 
the  capsule  of  the  liver,  without  known  cause.  (Delafield.)  The  spleen 
may  be  abnormal  in  size.  The  kidne}rs  are  lobulated.  The  bladder  may 
be  full  or  empty.  It  is  rare  that  the  spinal  cord  needs  examination.  If, 
however,  the  examiner  deems  this  necessary,  the  same  precautions  are 
to  be  observed  against  the  production  of  artefacts  as  in  the  case  of  an 
adult.  The  natural  and  great  mobility  of  the  head  on  the  spinal  column 
in  the  infant  should  not  be  forgotten. 

In  conducting  the  examination  of  bodies  advanced  in  putrefaction, 
we  are  compelled  to  modify,  not  so  much  our  methods,  as  the  conclu- 
sions which  we  are  enabled  to  draw  from  the  autopsy.  The  identifica- 
tion of  the  body  in  these  cases  is  always  important  and  often  difficult. 
After  the  features  have  become  undistinguishable  the  question  of  sex 
•can  always  be  determined,  even  when  a  further  identification  is  impos- 
sible. Long  after  the  external  parts  of  generation  have  become  undis- 
tinguishable the  sex  may  be  determined  from  the  presence  of  hah'  on 
the  face  or  the  length  of  the  hair  of  the  scalp.  The  circle  of  hair  which 
surrounds  the  pubes  is  characteristic  of  the  female,  while  its  prolonga- 
tion upward  in  the  median  line  is  equally  distinctive  of  the  male.  In 
the  bodies  of  children  too  young  for  these  peculiarities  to  be  available, 
•even  although  the  soft  parts  have  become  an  undistinguishable  mass, 
the  uterus  may  still  be  recognized.  In  the  adult  it  is  possible  thus  to 
determine  the  existence  or  non-existence  of  pregnancy  months  after 
burial.  The  uterus  is  not  only  last  in  the  order  of  putrefaction,  but  is 
still  distinguishable  long  after  all  the  other  soft  parts  have  become  an 
undistinguishable  mass.  Casper  gives  numerous  instances  of  this  fact. 
In  one  case,  that  of  a  J^oung  servant-girl  drowned  in  a  privy  and  discov- 
ered nine  months  subsequent,  although  all  the  other  soft  parts  had  either 
been  changed  into  adipocere  or  were  but  black  and  greasy  masses,  from 
out  this  mass  of  putridity  Casper  was  able  to  separate  the  uterus,  which 
was  of  a  bright  red  color,  firm,  hard  to  feel  and  cut,  its  form  perfectly  rec- 
ognizable, its  size  that  of  a  virgin  uterus,  its  cavity  empty.  As  it  had  been 
charged  that  the  girl  was  pregnant  by  her  master  at  the  time  of  her  death, 
Casper  was  thus  enabled  to  prove  that  this  accusation  was  unfounded,  in 
spite  of  the  fact  that  the  body  had  lain  in  a  privy  for  nine  months. 

Such  a  case  as  this  ought  to  teach  us  that  there  is  no  stage  of  decom- 
position in  which  we  may  not  expect  to  gain  useful  information  from 
an  autopsy.  Frequently  the  question  of  sex  is  the  only  fact  relating  to 
identity  that  the  examination  will  settle.  Here,  however,  it  is  sometimes 
possible  to  gain  additional  information  from  such  peculiarities  as  old  or 
recent  fractures,  and  peculiarities  of  the  teeth.  In  ease  a  recent  fracture 
is  discovered  there  is  a  question  which  may  arise,  not  necessarily  con- 
nected with  that  of  identity,  as  to  whether  the  fracture  was  the  result 


-j  A    SYSTEM   OF  LEGAL  MEDICINE. 

of  violence  inflicted  before  or  after  death,  also  its  relation,  if  any,  to  the 
drntli  of  the  person  injured.  If  the  fracture  be  of  the  skull,  an  exami- 
nation of  its  interior  may  reveal  the  presence  of  extravasated  blood  or  of 
an  inflammatory  process,  as  evidenced  by  the  presence  of  pus,  in  which 
ease  the  answer'  will  not  be  difficult;  but  if  the  progress  of  decay  is  too 
far  advanced  to  admit  of  this,  it  will  be  extremely  hazardous  to  attempt 
to  give  a  definite  reply.  If  callus  be  found,  it  is  quite  certain  that  the 
fracture  preceded  death  at  least  a  week,  or,  according-  to  the  amount  and 
condition  of  the  callus,  even  longer.  Fractures  of  the  base  of  the  skull 
are  not  likely  to  be  produced  after  death,  and  if  extensive  fractures  of 
the  \ault  are  present,  it  is  most  unlikely  that  they  have  been  produced 
other  than  by  violence  before  death.  Circumstances  may  cause  us  to 
modify  such  a  declaration  as  this — as,  for  instance,  where  a  body  is 
found  in  the  ruins  of  a  fire  with  the  skull  crushed  and  other  bones  fract- 
ured. Here  the  character  of  the  fracture  in  the  skull  will  determine 
whether  it  was  the  result  of  injuries  inflicted  beforehand,  as  the  sharp 
incised  fracture  produced  by  a  cutting  instrument,  as  an  ax,  can  readily 
be  distinguished  from  the  crushed  condition  resulting  from  the  impact 
of  a  mass  of  debris.  The  findings  which  it  is  possible  to  make  from  the 
soft  parts  of  a  body  much  decomposed,  particularly  as  to  the  existence 
of  disease,  will  largely  depend  on  the  degree  of  disorganization  of  the 
organs  which  the  inquiry  concerns. 

Eveiy  anatomist  is  familiar  with  the  rapidity  with  which  the  tissue 
of  the  brain  undergoes  putrefactive  changes.  Therefore,  while  it  may 
still  be  possible  to  harden  and  make  sections  of  the  brain  quite  late,  yet 
it  would  be  dangerous  to  draw  any  conclusions,  with  regard  to  patho- 
logical processes,  based  on  a  microscopic  examination  of  such  sections. 
If  it  is  possible  to  produce  artefacts  in  the  comparatively  firm  texture  of 
the  cord  simply  by  rough  handling,  how  much  easier  may  this  happen 
as  the  result  of  the  softening  produced  in  a  texture  so  little  refractory  as 
that  of  the  brain.  After  putrefaction  has  advanced  to  any  extent  in  the 
external  tissues,  we  are  only  justified  in  making  such  findings  as  are 
based  on  the  grosser  lesions — as,  for  instance,  the  presence  of  decom- 
posed blood-clot  or  the  existence  of  pus.  The  same  remarks  apply  to  the 
microscopic  examination  of  other  structures,  as  the  kidneys  and  iiver,  in 
proportion  to  their  power  of  resisting-  putrefactive  processes.  He  is 
certainly  a  bold,  if  not  a  reckless,  pathologist  who  is  willing  to  make 
statements  based  on  a  microscopical  examination  of  these  organs  many 
days  after  death,  unmindful  of  the  cloudy  swelling  and  other  progressive 
changes  which  so  quickly  occur  in  their  epithelium.  It  is  quite  possible, 
however,  to  determine  such  microscopic  changes  as  an  altered  relation 
in  the  cortical  and  medullary  portions  of  the  kidney,  the  contracted  liver 
of  cirrhosis,  or  an  undue  predominance  of  connective  tissue.  These 
facts  are,  of  course,  evidence  of  chronic  disease  rather  than  the  acute 
processes  so  often  sought  for.  Acute  changes  in  the  digestive  tract, 
owing  to  the  fact  that  the  stomach  and  intestines  decay  relatively  early, 
cannot  be  discovered  with  certainty  long  after  death,  as  the  stomach 
commences  to  putrefy  in  about  six  days  thereafter ;  and  the  changes  in 
coloration  are  thenceforward  so  various,  its  condition  in  other  respects 
so  changeable,  that  it  is  difficult  to  give  a  precise  opinion  with  regard  to 
its  possible  condition  in  life. 

With  regard  to  the  detection  of  metallic  poisons,  it  may  be  stated 


ME  1H CO-LEGAL   INSPECTIONS— POST-MOBTEM  EXAMINATIONS.     55 

that  no  degree  of  decomposition  is  incompatible  with  their  discovery  by 
appropriate  analysis ;  therefore  the  stomach  and  intestines  should  be  re- 
moved as  carefully  as  possible,  taking  the  same  precautions  as  directed 
heretofore.  It  is  usual  in  such  cases,  whether  the  body  has  been  buried 
or  lain  exposed,  to  remove  a  portion  of  the  adjacent  soil  in  order  to  ex- 
clude by  analysis  the  presence  of  a  metallic  poison  therein.  This  precau- 
tion should  not  be  neglected.  The  foregoing  remarks  apply  equally  to 
autopsies  performed  on  bodies  advanced  in  putrefaction,  whether  before 
burial  or  after  exhumation.  Such  autopsies  are  not  attended  with  un- 
usual risk  to  the  examiner.  Post-mortems  in  fresh  subjects  are  attended 
with  far  more  risk.  Indeed,  the  only  serious  consequences  which  the 
writer  ever  saw  occurred  in  recent  cases.  In  an  experience  of  over  five 
years  in  the  dissecting-room  of  the  Long  Island  College,  no  cases  of 
poisoned  wounds  ever  came  under  the  author's  observation,  although  he 
saw  many  cut  fingers  and  one  or  two  bad  lacerated  wounds  made  with 
the  saw  in  process  of  removing  the  calvarium.  Late  autopsies  should 
always  be  made  in  a  room  through  which  a  draught  of  air  is  blowing, 
and  such  precautious  taken  as  will  readily  occur  to  the  reader.  Exhu- 
mations should  be  made  with  care,  rather,  however,  with  reference  to 
the  dead  than  to  the  living.  When  bodies  are  buried,  in  the  cheap  pine 
coffins  of  the  poorhouse,  the  thin  shell  soon  decays,  and  cannot  be  used 
to  raise  the  body  from  the  grave.  In  this  instance,  a  sheet  of  stout  can- 
vas with  rope  handles  on  either  side  may  be  slipped  under  the  frail  coffin, 
which  may  then  be  removed  from  the  grave  without  accident. 

It  occasionally  happens  that  the  medical  examiner  is  required  to 
make  medico-legal  inspection  so  long  after  death  that  the  bones  alone 
are  left.  When  it  becomes  necessary  to  disinter  the  remnants  of  the 
body  in  such  a  case,  it  is  best  to  take  the  following  precautions,  in  order 
that  all  the  bones  maybe  recovered:  a  space  much  exceeding  that  of  the 
grave  is  to  be  dug  over,  and  the  earth  in  the  vicinity  of  the  remains 
carefully  sifted  through  a  moderately  fine  sieve.  In  this  way  the  small 
bones  of  the  carpus  and  tarsus  may  all  be  recovered,  and  such  frag- 
ments as  the  separated  bones  of  the  infantile  skull.  There  is  one  case 
on  record  where  the  identification  of  the  body  depended,  on  the- fact  that 
the  fifth  metacarpal  bone  of  the  right  hand  possessed  two  articular 
facets,  the  deceased  having  had  a  supernumerary  finger  to  which  the 
second  facet  corresponded.  (Reese.)  It  would  have  been  impossible  in 
this  case  to  have  identified  the  exhumed  bones  had  it  not  been  for  the 
discovery  of  so  small  a  bone  as  the  fifth  metacarpal. 

The  main  facts  to  be  determined  by  the  inspection  of  bones  are  :  first, 
the  identity  of  the  remains ;  second,  whether  they  throw  any  light  on  the 
cause  of  death.  It  is  evident  that  the  question  of  identity  must  depend 
on  the  determination  of  sex,  age,  and  stature.  It  is  easier  to  speak  pre- 
cisely with  regard  to  the  first  two  points  than  the  last.  In  mature  bones, 
it  will  never  be  difficult  to  distinguish  the  peculiarities  of  the  two  sexes, 
where  the  pelvic  bones  are  entire.  In  the  male,  the  obturator  foramen  is 
oval  rather  than  triangular,  as  in  the  female.  With  regard  to  the  pelvis  as 
a  whole,  it  is  to  be  noted  that  the  bones  are  more  massive  and  the  mus- 
cular impressions  more  prominent  in  the  male  than  in  the  female.  The 
subpubic  arch  is  narrow  and  angular  in  the  male,  much  wider  and  more 
arched  in  the  female,  the  respective  angles  being  seventy-five  and  a  hun- 
dred degrees.     The  actual  size  of  the  pelvis  varies  in  different  mdivid- 


-,;  A    SYSTEM    UF  LEGAL  MEDICINE. 

uals;  in  the  male,  however,  the  anteroposterior  diameter  is  the  greatest, 
whereas  in  the  female  the  bilateral  is  the  largest.  The  bones  in  general 
of  the  female  are  more  slender  proportionately  than  those  of  the  male, 
and  if  the  age  of  the  remains  can  be  fixed,  even  thongh  the  pelvic  bones, 
are  missing,  by  comparing  the  proportion  of  the  bones  with  their  estimated 
iU.-e  i!  may  lie  possible  to  form  a  fairly  positive  opinion  as  to  the  sex  of 
the  remains.  No  positive  opinion,  however,  ever  ought  to  be  given 
which  is  not  based  on  an  inspection  of  the  pelvic  bones.  When  the  teeth 
are  present,  up  to  the  age  of  twenty-one  the  age  of  the  skeleton  may  be 
determined  by  them  alone.  If  no  teeth  be  found,  the  age  of  the  bones 
must  be  determined  by  the  degree  of  ossification  of  the  various  bones, 
and  by  the  union  of  the  epiphyses  to  the  shaft  of  the  long  bones.  This 
is  of  no  avail  after  the  age  of  twenty-four,  at  which  time  the  upper 
epiphysis  of  the  tibia  unites  to  the  shaft  of  the  bone,  being  the  latest  of 
all  the  epiphyses  to  unite  with  its  shaft.  From  the  twenty-fourth  year 
until  middle  life  it  is  not  possible  to  form  any  exact  idea  of  the  age,  as- 
ossification  is  complete.  If  the  metasternum  is  found  joined  to  the  mes- 
osternum  by  bone,  it  may  be  concluded  that  the  individual  had  reached 
middle  life.  It  is  quite  exceptional  for  the  presternum  and  mesosternum 
to  be  united  by  bone,  but  when  this  is  found  it  is  probable  that  the  indi- 
vidual had  attained  the  age  of  sixty.  The  same  applies  to  the  bony  union 
of  coccyx  and  sacrum.  The  process  of  absorption  which  takes  place  in 
the  alveolus  of  the  lower  jaw,  and  the  approach  of  the  mental  foramen 
to  the  lower  border  of  the  bone,  are  also  signs  of  old  age.  After  the  age 
of  twenty-four  it  is  only  possible,  therefore,  to  say  that  the  individual 
was  middle-aged,  or  that  he  had  reached  the  age  of  sixty,  or  that  he  was 
an  aged  man. 

Not  infrequently  the  teeth  are  found  detached  from  the  jaw-bone. 
The  following  brief  description  of  their  points  of  difference  may  serve  to 
then  distinguish  them.  The  central  upper  incisors  are  very  much  larger 
than  the  laterals;  the  lower  central  incisors  much  narrower  than  the 
upper  set,  The  root  of  the  first  bicuspid  is  either  single  or  marked  by 
a  single  longitudinal  depression,  while  the  root  of  the  second  is  double. 
The  lower  bicuspids  are  smaller  than  the  upper,  and  have  single  roots. 
The  upper  molars  have  four  cusps  and  three  roots ;  the  first  of  the  lower 
molars  has  five  cusps  and  two  roots,  which  are  sometimes  completely 
divided  by  a  groove  so  as  to  make  four;  sometimes  only  one  root  is  so 
divided  in  this  way.  The  second  lower  molar  has  but  four  cusps  or  a 
faintly  developed  fifth  cusp.  Its  roots  have  a  tendency  to  coalesce.  The 
roots  of  the  upper  wisdom  tooth  coalesce  and  form  a  cone.  The  lower 
wisdom  tooth  has  two  roots,  which  may  become  confluent.  (Morris.) 
When  no  teeth  are  found,  but  only  a  few  of  the  larger  bones,  we  must 
rely  on  the  degree  of  ossification  of  the  bones  and  the  condition  of  the 
epiphyses. 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS. 


BY 

FEANCIS  A.    HAEEIS,  M.D. 


In  the  preparation  of  an  article  which  shall  treat  of  the  subject  of 
death  in  its  relation  to  forensic  inquiry,  with  the  consideration  of  the 
phenomena  attending;  and  following  upon  certain  forms  of  violent  death, 
it  must  be  obvious  that  little  that  is  absolutely  novel  can  be  offered  to 
the  student  of  legal  medicine  who  has  availed  himself  of  the  careful  and 
scientific  exploitation  of  the  subject  by  such  eminent  writers  as  Devergie, 
Tardieu,  Casper,  Taylor,  and  Ogston,  who  from  their  great  opportunities 
for  observation,  and  from  the  fact  that  most  of  them  occupied  positions 
under  governments  which  at  a  very  early  period  recognized  the  impor- 
tance of  this  branch  of  medical  investigation,  and  which  provided  a  cer- 
tain fixed  and  logical  method  of  inquiry,  have  been  enabled  to  present 
most  accurate  data  in  the  matter  of  medico-legal  examinations ;  and  the 
writer  acknowledges  at  the  outset  that  he  has  availed  himself,  in  the 
preparation  of  this  article,  of  the  results  of  their  labors  as  found  in  their 
published  works.  He  will  only  endeavor  to  present  such  facts  as  have 
already  been  found  to  obtain,  and,  if  possible,  to  emphasize  them  by  such 
illustrative  cases  as  have  come  under  his  personal  observation  in  the 
course  of  the  past  sixteen  years,  while  acting  under  the  provisions  of  the 
so-called  medical-examiner  law  of  Massachusetts. 

Governmental  Regulation. — Other  countries,  notably  France  and 
Germany,  have  for  a  long-  time  had  statutes  which  provided  for  the  action 
of  medical  experts  in  criminal  cases,  or  in  those  which  were  supposed  to 
be  such,  and  have  even  laid  down  with  the  greatest  care  and  minuteness 
not  only  the  legal  steps  to  be  pursued,  but  definite  instructions  as  to  the 
method  of  performing  an  autopsy  and  recording  the  results  of  the  same. 

The  United  States  has  not  thus  far  advanced.  In  most  States  the 
old-fashioned,  illogical,  and  practically  worthless  system  of  investigation, 
derived  from  the  English  custom,  the  coroner's  inquest,  still  is  the  pri- 
mary court  of  inquiry,  and  the  solutions  of  questions  of  great  moment  to 
the  State  and  the  individual  are  still  left  to  men  who  have  neither  the  legal 
nor  the  medical  training  requisite  to  determine  either  the  cause  of  the 
death  in  a  given  case  or  decide  the  responsibility,  if  there  should  be  any. 

The  Massachusetts  law  still  leaves  much  to  be  desired  both  in  the 
matter  of  accurate  phrasing  and  the  complete  instruction  as  to  details  of 
a  medico-leg-al  examination.  It  is,  however,  a  great  step  in  advance  of 
anything  which  has  obtained  before,  and  has  worked  very  well  in  prac- 
tice.    The  essential  points  of  the  law  are  that  in  the  first  place  it  follows 

.".7 


58  A  SYSTEM   OF  LEGAL   MEDICINE. 

a  logical  order,  and  when  there  is  to  be  an  investigation  into  the  manner 
of  any  suspicious  death  it  puts  the  primary  part  of  the  inquiry— namely, 
Was  this  death  one  that  resulted  from  violence,  or  did  it  result  from 
natural  causes  .'—into  the  hands  of  trained  medical  men,  who  under  cer- 
tain conditions  and  under  certain  proper  restrictions  make  the  autopsy; 
and  it  puts  the  second  part  of  the  inquiry — if  there  should  be  demon- 
strated the  fact  that  the  death  was  due  to  violence  rather  than  to  natural 
causes— into  the  hands  of  a  judge  of  a  court  of  first  instance,  who  reports 
his  finding  to  the  superior  court,  and  so  everything  is  in  train  for  prose- 
cution. At  the  outset  there  was  naturally  doubt  in  the  minds  of  the 
medical  men  acting  under  its  provisions  as  to  what  really  was  meant  by 
a  dead  body.  They  were  required  to  act  if  they  received  notice  that  a 
dead  body  was  lying  within  their  district;  but  the  courts  had  never  de- 
cided what  a  dead  body  was.  Was  it  a  foetus  in  the  very  early  stages 
of  development?  Was"  it  a  child  that  was  at  viable  term,  say  at  the 
period  from  one  hundred  and  eighty  to  two  hundred  and  ten  days,  or 
must  it  be  a  child  at  term  to  be  considered  a  body  within  the  meaning 
of  the  law  ? 

Accepted  Period  of  Life. — Medically,  a  foetus  at  the  fourth  or  fifth 
month,  although  incapable  of  independent  life,  is  a  human  being;  but 
up  to  1893  there  had  been  no  decision  as  to  its  status  in  law,  that  is,  by 
the  .Massachusetts  courts.  The  laws  of  foreign  countries  had  made  the 
distinction  that  a  child  must  be  wholly  born  alive  before  it  could  be  the 
subject  of  an  assault,  and  had  even  gone  further,  and  decided  that  a  child 
who  was  born  alive  and  had  lived  not  only  for  hours,  but  even  days,  but 
who  on  account  of  some  congenital  deformity,  such  as  atresia  of  the 
rectum  or  the  oesophagus,  was  incapable  of  sustaining  independent  life, 
is  not  a  human  being  within  the  meaning  of  the  law,  whether  civil  or 
criminal.  On  the  other  hand,  a  child  who  had  been  born  alive  at  a  time 
when  it  was  capable  of  sustaining  a  life  independent  of  the  mother,  even 
if  it  was  born  prematurely,  would  be  a  subject  of  criminal  assault  like 
any  other  human  being.  During  the  present  year,  in  the  course  of  a 
trial  for  infanticide  it  was  found  that  there  had  been  no  decision  on  this 
point  in  the  State  of  Massachusetts,  and  for  the  first  time  the  law  was 
made,  following  the  English  law,  that  it  must  be  proved  that  the  child 
had  been  wholly  born  alive  and  capable  of  maintaining  a  separate  exist- 
ence before  a  charge  of  infanticide  could  be  sustained. 

Whether  this  law  has  been  established  by  the  courts  of  other  States 
or  not,  the  writer  has  no  knowledge ;  but  it  is  probable  that  if  it  is  to 
be  established  it  will  be  on  the  same  lines.  Such  legal  requirement,  of 
course,  increases  the  difficulty  of  securing  the  conviction  of  persons 
charged  with  killing  a  new-born  child;  but  that  is  a  matter  which  more 
nearly  concerns  the  bar  and  the  judiciary  than  the  medical  jurist. 

The  medical  jurist  may  be  required  to  examine  the  body  of  a  foetus 
at  any  term  when  the  question  of  pregnancy  is  involved ;  but  in  general, 
he  lias  to  consider  that  only  as  a  dead  body  which  has  arrived  at  least  at 
a  period  of  development  where  it  is  capable  of  sustaining  independent 
life — that  is,  from  the  one  hundred  and  eightieth  to  the  two  hundred 
and  tenth  day,  and  later. 

The  Determination  of  Death.— At  the  above-named  period  and  later, 
a  dead  body,  as  far  as  the  purposes  of  forensic  inquiry  are  concerned,  is 
a  dead  human  being,  and  an  investigation  into  the  cause  of  its  death 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  59 

may  be  necessary  to  assist  the  criminal  courts ;  and,  furthermore,  an 
examination  of  a  dead  body  may  be  necessary  to  establish  certain  civil 
rights,  such  as  succession,  by  determining  the  period  at  which  death  has 
occurred. 

This  brings  us  naturally  to  the  consideration  of  the  signs  of  death, 
and  the  changes  produced  in  the  economy  by  the  cessation  of  the  vital 
functions. 

Identity  of  the  Dead  Body. — Before  proceeding  directly  to  that  sub- 
ject, however,  it  occurs  to  me  that  a  few  words  on  the  question  of  estab- 
lishing the  identity  of  an  unknown  body  may  not  be  out  of  place,  as  such 
an  inquiry  would  naturally  precede  the  autopsy  itself.  I  am  indebted  to 
Dr.  C.  A.  Hebbert  for  very  great  assistance  in  the  preparation  of  the 
portion  of  this  article  relating  to  this  question  of  identity-  His  experi- 
ence with  Mr.  Bond,  of  London,  renders  his  work  of  great  value,  and 
several  cases  cited  by  him  in  the  Westminster  Hospital  reports  are 
exceedingly  interesting. 

The  determination  of  the  identity  of  human  remains  is  one  of  the 
most  important  and  often  most  difficult  problems  submitted  to  the  med- 
ical jurist.  It  is  especially  interesting  to  the  student  of  forensic  medi- 
cine in  the  United  States,  as  the  nation  is  composed  of  people  from  all 
parts  of  the  world.  Not  only  are  met  members  of  all  the  European  races, 
but  also  the  negroid,  Australoid,  and  Mongoloid  races,  each  presenting 
different  and  distinct  characteristics.  The  examination  will  also  include 
the  subordinate  or  mixed  people,  such  as  the  mulatto,  a  mixture  of  the 
European  with  the  negro,  the  mestizos,  a  mixture  of  the  European  and 
the  American  indigenes,  and  the  zambos,  a  mixture  of  the  American  in- 
digenes with  the  negroes,  and  in  these  sub-races  the  plrysical  characters 
and  proportions  are  necessarily  modified.  These  sub-races  are  particu- 
larized, inasmuch  as  they  are  all  prolific  and  not  sterile,  as  is  the  marriage 
of  the  European  with  the  Australoid. 

Let  us  first  consider  the  cases  where  the  whole  body  or  the  whole 
skeleton  has  been  found,  and  secondly  where  the  body  has  been  muti- 
lated, dismembered,  or  partially  destroyed,  so  that  only  a  portion  or  por- 
tions have  been  discovered,  and  see  how  far,  from  such  data  as  we  have, 
we  can  identify  the  individual. 

Such  study  will  involve  observation  of  the  following  points : 

1.  Race. 

2.  Sex. 

3.  Age. 

4.  Stature  (including  measurement  of  body  and  limbs). 

5.  Features  (hair,  nails,  etc.). 

6.  Scars,  moles,  depressions  on  fingers  by  rings,  or  on  legs  by  garters. 

7.  Deformities. 

8.  Occupation,  as  shown  by  stains  on  body  or  fingers,  or  tanning  by 
exposure  to  the  sun,  callosities* (bursa^,  corns,  etc.),  the  effects  of  pressure 
of  dress  on  various  parts  of  the  body,  the  presence  of  foreign  substances 
on  the  body  (hair,  straw,  flour,  etc.). 

In  addition  to  the  above  there  is  to  be  remembered  the  great  value 
of  photography,  not  alone  in  the  case  of  the  features,  but  also  where 
several  portions  of  a  corpse  are  found  at  different  intervals,  and  the 
question  arises  whether  they  belong  to  the  same  individual.  In  such  a 
case,  in  addition  to  detailed  measurements,  photographs  of  the  two  arms 


qq  A   SYSTEM  OF  LEGAL   MEDICINE. 

or  of  the  two  feet  would  be  of  material  assistance  in  determining  the 
question  of  identity. 

i.  Race. — Where  the  corpse  is  entire  and  but  partially  decomposed, 
no  great  difficulty  will  be  met,  as  the  characters  of  the  four  great  families- 
are  distinct  ;  but  it  will  be  useful  to  bear  in  mind  a  brief  summary  of 
these  features. 

(a)  The  Austrahid  type,  such  as  the  coolies  in  southern  India  and  the 
native  Australians  :  skin  chocolate-colored,  hair  black  and  wavy,  the  skull 
aarrow  or  dolichocephalic,  the  brow  ridges  prominent,  with  a  projecting 
or  prognathous  jaw,  and  thick  lips;  the  nasal  index  platyrhine. 

(b)  The  negroid  type:  the  skin  dark  brown  to  black,  the  hair  black, 
crisp,  or  woolly,  the  skull  dolichocephalic,  the  brow  ridges  not  prominent, 
the  jaw  prognathous,  with  fleshy,  protuberant  lips,  the  nose  and  nasal 
bones  flat,  the  index  being  platyrhine. 

{<■)  The  Mongolian  ti/pc,  which  includes  the  Chinese,  the  Japanese,  and 
the  American  indigenes  :  skin  from  yellowish  brown  to  a  mahogany  tint, 
the  skull  broad  or  brachycephalic,  the  hair  black  and  straight,  the  brow 
ridges  not  prominent,  the  jaw  not  projecting  except  in  the  Esquimaux, 
the  nose  mesorhine,  small  and  flat  in  the  Japanese  and  Chinese,  with 
oblique  eyes,  and  the  cheek-bones  high.  In  some  of  the  American  Indians 
the  nose  is  prominent ;  but  as  we  are  dealing  with  such  peoples  as  are 
commonly  met  with,  it  is  not  necessary  to  do  more  than  specify  the 
typical  features  of  the  main  group. 

(d)  The  whites,  divided  by  Huxley  into  the  Xanthochroi,  or  fair  whites, 
with  pale  skin,  fair,  wavy,  or  curly  hair,  light-colored  eyes,  mesocephalic 
skull,  jaw  orthognathous,  and  nose  leptorhine ;  and  the  Melanochroi,  or 
dark  whites,  the  complexion  darkening  to  a  sallow  or  swarthy  hue, 
the  hair  dark,  and  the  eyes  brown  or  black,  the  skull  mesocephalic,  with 
orthognathous  jaw  and  leptorhine  nose. 

The  comparison  of  the  foregoing  characteristics  will  at  once  decide 
the  question  of  the  membership  of  a  definite  race ;  but  as  in  the  sub- 
races  the  skull  and  facial  points  are  modified  by  the  mingling  of  types 
so  that  other  and  probably  external  circumstances  will  be  required  for 
a  proper  decision,  these  will  be  considered  hereafter,  chiefly  under  the 
discussion  of  features.     (Vide  Identity  of  the  Living.) 

No  mention  is  made  of  the  stature  or  size  of  races,  as  it  is  well  known 
that  the  height  of  individual  members  of  each  race  varies,  the  Melanochroi, 
for  instance,  though  being  smaller  than  the  Xanthochroi  as  a  rule,  having 
among  them  large  and  powerful  individuals,  and  in  the  negroid  group 
the  Bosjesman  is  much  smaller  than  the  average  negro.  The  value  of 
the  various  indices,  cephalic,  facial,  and  nasal,  is  as  follows.  The  cephalic 
index  is  the  comparison  of  the  length  of  the  skull  to  its  breadth,  the 
length  being  taken  as  100.  The  length  of  the  skull  is  taken  from  the 
ophryon  to  the  occipital  point,  the  breadth  the  greatest  interparietal 
measurement.  If  the  index  is  above  80  the  skull  is  brachycephalic,  as  in 
the  Mongoloid  races ;  if  from  75  to  80,  mesocephalic,  as  "in  the  whites ; 
if  below  75,  dolichocephalic,  as  in  the  negroid  and  the  Australoid  races. 
For  example,  if  the  length  is  seven  inches  and  the  breadth  five  inches, 
the  index  is  / 1.4.  or  dolichocephalic.  If  the  length  is  seven  inches  and  the 
breadth  six  inches,  the  index  is  85.7,  or  brachycephalic. 

The  gnathic  index  is  reckoned  by  comparing  the  basi-alveolar  length 
with  the  basi-nasal  length,  the  basi-alveolar  length  being  taken  from  the 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  61 

basion  to  the  alveolar  point,  the  basi-nasal  from  the  basion  to  the  nasion, 
the  basi-nasal  being  taken  at  100.  Below  98  the  jaw  is  orthognathous ; 
from  98  to  103,  mesognathous ;  above  103,  prognathous,  as  in  the  negroid 
or  Australoid  groups. 

The  nasal  index  is  the  comparison  of  the  height  of  the  aperture  with 
the  width,  the  height  being  from  the  nasion  to  the  sub-nasal  point,  the 
width  being  the  greatest  transverse  diameter  of  the  anterior  aperture, 
the  height  being  taken  as  100.  If  below  48,  leptorhine ;  from  48  to  53, 
mesorhine ;  above  53,  platyrhine,  as  in  the  negroid. 

These  indices  are  here  exploited  to  furnish  aid  to  such  as  may  be 
obliged  to  examine  a  case  wdiere  the  head  or  skull  alone  is  presented  for 
investigation,  and  where  the  first  step  toward  determining  identity  is  the 
fixing  the  race,  though  such  minute  descriptions  and  measurements  are 
rarely  necessary.  Still,  the  medical  jurist  should  observe  everything 
when  he  is  examining  a  dead  body,  and  this  applies  to  the  part  as  well 
as  the  whole,  and  in  any  medico-legal  inquiry  it  is  not  always  possible 
at  the  outset  to  say  what  may  be  of  the  most  vital  importance  in  the  case 
before  its  conclusion. 

The  method  of  arriving  at  the  above-mentioned  indices  may  be  made 
more  plain,  possibly,  by  the  example  of  an  equation  such  as  the  follow- 
ing: 

Dolichocephalic,  7:5::  100   :  x; 

x  =  71.4. 

Brachycephalic,  7:6::  100  :  x; 

x  =  85.7. 

Figs.  4  and  5  are  intended  to  illustrate  the  above-mentioned  measure- 
ments. 

2.  Sex — The  distinction  of  sex  where  a  whole  unmutilated  corpse  is- 
presented  for  inspection  is  too  obvious  to  require  comment.  On  the 
other  hand,  if  the  body  is  mutilated  and  decomposed,  great  care  is  re- 
quired on  the  part  of  the  expert,  and  still  further  difficulties  are  presented 
when  it  is  the  skeleton  alone  with  which  he  has  to  deal.  Indeed,  there 
may  be  cases  where  the  whole  body  has  been  so  mutilated  that  it  is  by 
the  preparation  of  the  skeleton  alone  that  an  idea  of  the  sex  may  be 
formed.  Just  such  a  case  might  have  occurred  in  one  of  the  so-called 
Whitechapel  murders  in  London,  in  the  years  1887-89.  Here  nine 
women  were  murdered  and  mutilated  by  an  unknown  assassin. 

In  the  particular  illustrative  instance,  the  woman  was  murdered  in  a 
bedroom.  The  bodv  was  naked  when  found.  The  eyebrows,  eyelids, 
ears,  nose,  lips,  and  chin  had  been  cut  off,  and  the  face  gashed  by  numer- 
ous knife-cuts.  The  breasts  had  been  cut  off,  and  the  whole  abdominal 
parietes,  together  with  the  external  organs  of  generation,  had  been  re- 
moved. The  skin  and  much  of  the  muscular  tissue,  not,  however,  ex- 
posing the  bone,  had  been  slashed  away  from  the  anterior  aspect  of  the 
thighs  as  far  as  the  knees.  The  abdominal  viscera  and  pelvic  viscera, 
including  bladder,  vagina,  and  uterus  with  appendages,  had  been  torn 
from  their  cavities,  and  in  fact  there  was  no  sign  of  sex  except  the 
long  hair  upon  the  head,  and,  as  is  well  known,  that  alone  is  not  a  posi- 


C2 


A  SYSTEM  OF  LEGAL  MEDICINE. 


Fig.  4.    Skull  of  European. 


Fig.  5.    Skull  of  Australian. 
Op,  ophryon:  0,  occipital  point:  06,  obelion;  Bg,  bregma;  B,  basion;  N,  nasion:  A,  alve- 
olar point  :  S,  subnasal  spine;  Pt,  pterion;  As,  asterion;  I,  inion,  or  external  occipital  protu- 
berance: L.  lambda. 


DEATH  IX  ITS   MEDICO-LEGAL   ASPECTS. 


63 


tive  sign,  inasmuch  as  in  some  nations  the  hair  is  worn  long  by  men. 
The  fact  that  the  whole  bladder  had  been  removed  did  away  with  the 
help  that  might  have  been  afforded  by  the  presence  of  the  prostate  gland. 
In  this  case,  to  be  sure,  all  the  organs  except  the  heart  were  found 
scattered  about  the  room,  and  showed  the  sex  without  doubt.  But  if  all 
the  organs  and  parts  had  been  taken  away  or  the  body  exposed  to.  the 
effects  of  decomposition,  a  careful  preparation  of  the  skeleton  would  have 
been  imperative  to  decide  that  the  body  was  that  of  a  woman. 

It  might  further  be  stated  that  in  this  case,  in  consequence  of  the 
hacking  of  the  features,  the  presence  or  absence  of  a  beard  could  not  be 
stated,  and  if  the  hair  had  been  designedly  cut  off  there  would  have  been 
absolutely  no  sign  by  which  sex  could  have  been  determined.  The  hair 
on  the  pubes  had  been  removed  in  this  case,  and  the  difference  iu  the 
growth  of  the  pubic  hah*  tapering  up  toward  the  umbilicus  in  the  male, 
and  simply  surrounding  the  organs  of  generation  in  the  female,  could 
not  be  availed  of  as  an  indication  of  sex. 

Of  course,  if  there  be  only  decomposition  or  destruction  of  the  exter- 
nal organs  of  generation,  the  internal  examination  would  decide  the  point 
of  sex  by  demonstrating  the  presence  of  either  a  uterus  or  a  prostate 
gland,  both  of  which  organs  resist  decomposition  longer  than  most  if  not 
any  other  parts.  In  general,  it  may  be  said  that  the  female  is  smaller, 
lighter,  and  has  a  less  developed  muscular  system  than  the  male ;  but 
here  we  are  again  met  with  the  objection  that  a  healthy,  hard- working 
woman  would  have  stronger  limbs  and  more  powerful  frame  than  a  sickly 
student  or  clerk. 

Therefore,  in  the  case  of  the  examination  being  limited  to  a  single 
limb,  as  an  arm  or  a  leg,  it  is  in  a  measure  guesswork,  though  with  care 
the  guess  may  be  pretty  accurate.  A  case  in  point  will  be  cited  in  extenso 
hereafter,  where  an  arm,  large  and  muscular  and  lengthy,  was  decided 
to  be  that  of  a  woman,  and  the  opinion  was  at  a  later  date  found  to  have 
been  correct. 

The  skeleton  of  the  male  is  generally  larger,  stronger,  and  has  more 
prominent  processes  and  im- 
pressions for  muscular  at- 
tachment on  the  bones  of  the 
limbs  than  the  female  skele- 
ton. The  sternum  is  less 
convex,  and  the  xiphisternal 
articulation  is  opposite  the 
curve  of  the  fifth  rib,  while 
in  the  female  the  sternum  is 
more  convex  and  shorter,  and 
the  xiphisternal  articulation 
is  opposite  the  curve  of  the 
fourth  rib.  It  is  in  the  pelvis, 
however,  that  we  find  the 
main  distinguishing  points. 
The  male  pelvis  is  composed 
of  more  massive  bones,  with 
rough,  well-marked  pro- 
cesses •  the  cavity  of  the  true  pelvis  is  deeper,  narrower,  and  has  smaller 
apertures.     The  curve  of  the  sacrum  is  more  evenly  distributed,  and  not 


Fig.  6.     Pelvis  of  Man. 


6-4 


A  SYSTEM  OF  LEGAL  MEDICINE. 


so  abruptly  marked  in  the  lower  part  as  in  the  female.     The  subpubic 
arch  is  more  pointed,  the  obturator  foramen  oval,  the  tuberosities  of  the 

ischia  nearer  together,  and 
the  diameters  of  the  true 
pelvis  narrower  than  in  the 
female,  as  will  be  shown  in  a 
subsequent  table. 

The  female  skeleton  has 
a  shallower  false  pelvis,  with 
more  widely  spreading  alad 
ilii.  The  bones  of  the  true 
pelvis  are  lighter,  with  much 
less  marked  impressions.  The 
cavity  is  shallower,  and  the 
sacrum  is  flatter  in  the  upper 
two  thirds,  and  then  curves 
somewhat  abruptly  below. 
The  apertures  are  wider,  the 
subpubic  angle  has  a  lower 
and  rounder  arch,  and  the  obturator  foramina  are  triangular,  the  rami 
of  the  pubes  and  ischium  are  more  everted,  and  the  diameters  are  much 
longer. 

The  following  table  gives  the  respective  measurements  as  found  in 
the  male  and  female : 


Fig. 


Pelvis  of  Woman. 


Male. 


111. 


Distance  between  widest  part  of  iliac  crests  .  . .  o ° . .  10-11 

Distance  between  antero-superior  spines  of  ilia 9-i— 10 

Distance  between  front  of  symphysis  pubis  and  sacral  spines 

(external  conjugate)  6^-7 


Female. 
In. 

104-11 

10-10i 

64-7i 


True  Pelvis  Diameters. 


Brim. 
In. 


Transverse 44 

Oblique 4| 

Antero-posterior,  or  conjugate..      4 


Male. 
Cavity. 
In. 

44 

4i 


Outlet. 
In. 

4 
3± 


Female. 

Brim.    Cavity.     Outlet. 
In.  In.  In. 


5 

4* 


5 
5i 


4f 
4f 
5 


In  addition  to  the  measurements  of  the  pelvis  it  is  also  well  to  notice 
that  the  angle  of  the  neck  of  the  femur  with  its  shaft  more  nearly  ap- 
proaches a  right  angle  in  the  female  than  in  the  male ;  but  this  difference 
is  only  of  importance  where  the  limbs  of  the  same  or  of  different  bodies 
can  be  compared,  and  is  not  a  valuable  sign  where  only  one  leg  is  dis- 
covered. The  above  indications  should  ordinarily  be  sufficient  to  guide 
the  examiner  to  a  proper  decision  in  the  matter  of  sex  where  this  is  in 
dispute,  or  the  object  of  inquiry. 

3.  Age. — Though  the  features  of  the  living  are  fairly  well  marked  on 
external  examination  in  each  of  the  ages  of  man,  from  the  infant  to  the 
"lean  and  slippered  pantaloon,"  yet  after  death  the  effacing  work  of 
decay  so  rapidly  alters  the  special  characters  that  we  require  more  deci- 
sive and  scientific  points  to  ascertain  the  probable  age  of  the  deceased. 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS. 


65 


Take  the  face  as  an  illustration.  The  general  suggestions  of  age  from 
the  wrinkles  about  the  corners  of  the  eyes,  the  so-called  crow's-feet,  and 
the  deepening  of  the  lines  at  the  wings  of  the  nose  and  corners  of  the 
mouth,  the  drooping  of  the  angles  of  the  jaw  with  the  gradual  approxi- 
mation of  the  lips  caused  by  the  absorption  of  the  alveolar  borders  of  the 
maxilla,  are  all  absent  or  modified  in  the  first  appearances  after  death ; 
nor  would  the  smooth,  rounded  look  of  the  young  give  more  than  an 
indication  of  age,  though  an  estimate  with  some  degree  of  accuracy  could 
be  made  by  a  trained  observer.  Therefore  it  is  clear  that  more  than  a 
mere  inspection  of  the  external  appearances  is  necessary.  Take  the  case 
of  a  newly  bom  infant,  for  instance,  though  this  belongs  more  properly  to 
a  chapter  on  infanticide.  We  know  that  the  length  should  be,  for  a  child 
at  term,  eighteen  to  twenty  inches,  and  the  weight  from  six  to  eight 
pounds  avoirdupois.  The  finger-nails  project  beyond  the  ends  of  the 
fingers,  and  the  toe-nails  reach  nearly  to  the  ends  of  the  toes.  The  um- 
bilicus is  at  most  three  quarters  of  an  inch  below  the  center  of  the  length 
of  the  body.  In  the  male  the  testicles  are  in  the  scrotum,  and  if  the 
child  has  lived  a  short  time  the  anus  will  probably  be  smeared  with  me- 
conium. The  most  reliable  sign  of  age  at  this  period  is  the  presence  of 
a  small  ossific  center  in  the  lower  epiphysis  of  the  femur.  It  is  the  first 
and  as  a  rule  the  only  epiphysial  center  to  appear  before  birth,  though 
the  upper  epiphysis  of  the  tibia  can  be  occasionally  noticed  at  full  term. 
The  femoral  epiphysis  usually  appears 
shortly  before  birth.  The  size  of  this 
center  is  about  one  eighth  of  an  inch 
in  diameter.  As  the  appearances  of 
the  epiphyses  and  their  union  with  the 
bodies  of  the  bones  are  the  most  impor- 
tant proofs  of  age  from  birth  to  the  age 
of  twenty-five,  the  different  dates  of  their 
appearance  must  be  borne  in  mind.  To 
generalize  these  points  is  a  matter  of 
some  difficulty ;  but  it  may  be  stated 
that  there  are  times  in  the  development 
of  the  body  when  growth  appears  to  be 
more  energetic.  For  instance,  in  the 
first  three  years  there  is  ossific  deposit 
in  the  epiphyses  of  the  humerus,  femur, 
ulna,  tibia,  and  fibula — that  is,  the  extremities  are  practicabV  mapped 
out  in  bone  :  and  it  is  also  in  this  period  that  the  fontanelles  of  the  skull 
close  and  the  cranial  bones  unite. 

Again,  about  puberty  we  have  another  period  of  activity,  the  vertebras 
attaining  their  full  size  and  shape,  and  in  the  pelvis  additional  centers 
appear  in  the  sacrum  and  ossa  innominata,  so  that  during  this  time  the 
trunk  is  solidifying.  The  third  period  of  importance  is  that  from  twenty 
to  twenty- fire,  the  latter  being  the  full  attainment  of  adult  age,  and  at  this 
time  in  the  majority  of  cases  all  the  epiphyses  have  become  joined  to  the 
bodies  of  the  bones,  though  the  complete  ossification  of  the  vertebnv  may 
be  delayed  for  a  year  or  more. 

After  the  age  of  twenty-fire  until  the  changes  of  advanced  life,  which 
will  be  hereafter  alluded  to,  occur,  it  is  difficult  to  satisfactorily  determine 
the  age  from  the  points  of  ossification  alone  :  but  it  should  be  remembered 


Fig.  8. 
showing 
cesses. 


Inferior  Maxilla  of  New-born. 
Union    of   Rudimentary    Pro- 


,;,;  ./    SYSTEM    OF  LEGAL   MEDICINE. 

thai  the  sexual  powers  are  in  full  activity,  and  in  the  female  the  breasts, 
tlie  uterus,  and  ovaries  will  aid  in  determining  the  age.  If  there  are 
signs  of  present  or  recent  menstruation,  the  presence  of  corpora  lutea 
either  of  menstruation  or  pregnancy,  or  the  secretion  of  milk  in  the 
breasts,  we  should  have  an  indication  that  the  woman  was  probably  under 
forty  or  forty-five.  On  the  other  hand,  the  presence  of  spermatozoa  in 
the  vesicuke  seminales  or  the  testicles  woidd  not  afford  much  assistance, 
as  men  have  been  known  to  have  been  capable  of  procreation  at  an  ad- 
vanced period  of  life.  The  eruption  of  the  milk  and  permanent  teeth 
affords  a  very  trustworthy  sign  of  the  age  of  the  young,  and  a  case  oc- 
curring in  London  is  worth  citing  on  that  point.  Diu-ing  the  repair  of 
a  house,  a  few  remains  were  found  buried  under  the  hearthstone,  and 
these  on  examination  proved  to  be  those  of  a  human  lower  jaw,  with  the 
small  though  well-marked  mental  process  (no  other  animal  has  a  chin), 
part  of  the  upper  jaw  and  shaft  of  a  small  femur,  with  some  few  light 
brown  long  human  hairs.  As  the  second  molar  teeth  had  erupted,  and 
there  was  an  indication  of  a  cavity  in  the  upper  jaw  where  the  first  molar 
of  permanent  teeth  had  begun  to  develop,  the  age  was  determined  as  be- 
tween three  and  four  years.  The  hair  indicated  the  complexion,  and  the 
length  thereof  the  sex.  On  inquiry  it  was  learned  that  a  long  time  ago 
a  little  girl  of  three  and  a  half  years  had  disappeared.  The  mother  of 
this  child  was  confronted,  and  confessed  that  the  girl  had  died  of  natural 
causes,  and  had  been  buried  in  this  spot  by  the  parents  to  escape  the  ex- 
pense of  an  ordinary  sepulture. 

As  age  advances,  structural  changes  occur  in  the  cartilages  of  the 
larynx  and  ribs,  so  that  they  become  ossified ;  but  these  changes  may 
occur  at  any  period  after  thirty,  and  indeed,  are  so  modified  by  disease, 
such  as  that  of  the  heart  or  kidney,  that  they  are  only  a  general  indica- 
tion. In  old  age,  or  in  those  who  have  lost  their  teeth,  the  alveolar 
borders  of  the  jaws  are  gradually  absorbed,  giving  the  angle  of  the  jaw 
an  appearance  of  obtuseness  which  is  more  apparent  than  real.  The 
angle  of  the  neck  of  the  femur  with  its  shaft  is  obtuse  in  man,  rectangu- 
lar in  woman,  and  with  increasing  age  the  angle  becomes  more  rectan- 
gular— may  even  sink  below  the  level  of  the  trochanter. 

From  the  foregoing  it  will  be  seen  that  our  best  guide  to  the  ascer- 
tainment of  age  is  the  examination  of  the  skeleton ;  but  that  even  that 
is  not  wholly  accurate,  but  only  approximate,  and  that  all  other  appear- 
ances possible  must  be  considered  in  arriving  at  a  correct  solution  of  the 
problem. 

The  following  resume,  chiefly  from  Quain,  will  be  of  service  in  deter- 
mining identity  as  far  as  light  is  thrown  on  the  matter  by  the  study  of 
the  matter  of  ossification.  The  value  of  this  test  of  age  will  be  found 
principally  in  the  examination  of  the  long  bones  and  the  pelvis;  and 
wlide  in  works  on  forensic  medicine  it  is  customary  to  give  very  elaborate 
tables  of  all  the  times  of  appearance  of  centers  and  junction  of  epiphyses 
with  the  bodies,  in  practice  it  is  better  to  consider  these  special  parts  in 
the  three  periods  before  mentioned. 

In  the  first  year  the  nucleus  for  the  head  of  the  femur  appears. 

In  the  second  year  nuclei  for  the  head  of  the  humerus,  lower  extrem- 
ities of  the  tibia  and  fibula,  carpal  end  of  radius. 

In  the  third  year  the  nuclei  for  the  great  tuberosity  of  the  humerus, 
upper  end  of  the  fibula,  capitellum  of  the  humerus. 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  67 

111  the  fourth  year  the  nuclei  for  the  great  trochanter  of  femur,  and 
carpal  end  of  ulna. 

In  the  fifth  year  the  nucleus  for  the  lesser  tuberosity  of  humerus, 
which,  uniting  with  the  greater  tuberosity  and  head,  forms  a  distinct 
epiphysis.  In  the  same  year  appear  the  nuclei  for  the  internal  condyle 
of  humerus  and  the  head  of  the  radius. 

Thus  in  the  first  five  years  we  have  the  most  of  the  important  epiph- 
yses of  the  long  bones ;  the  lower  end  of  the  femur  and  the  upper  end  of 
the  tibia,  as  before  mentioned,  being  in  evidence  at  or  soon  after  birth. 

In  the  age  period  eleven  to  fourteen  are  to  be  found  the  nuclei  of  the 
trochlea  and  external  condyle  of  the  humerus,  a  small  epiphysis  of  the 
olecranon  and  the  lesser  trochanter,  and  at  the  period  of  puberty  the 
three  portions  of  the  innominate  bone  are  united  iu  one  by  the  ossifica- 
tion of  the  Y-shaped  epiphysis  in  the  acetabulum. 

It  must  be  remembered  that  the  blending  of  the  epiphyses  of  the  long 
bones  takes  place  in  an  order  the  reverse  of  their  appearance,  with  the 
single  exception  of  the  upper  end  of  the  fibula. 

From  sixteen  to  eighteen,  union  between  the  bones  and  the  lower 
epiphysis  of  the  humerus  and  the  upper  epiphyses  of  the  radius  and  ulna 
occurs. 

From  the  eighteenth  to  nineteenth  year  occurs  the  union  of  the  head 
of  the  femur  and  the  lower  end  of  the  tibia. 

In  the  twentieth  year  union  occurs  in  the  head  of  humerus,  lower  end 
of  radius  and  ulna,  and  lower  end  of  femur. 

In  the  twenty-first  year  this  process  occurs  in  the  upper  end  of  tibia, 
and  of  the  epiphyses  of  the  metacarpal  and  metatarsal  bones. 

In  the  twenty-fourth  year  the  process  occurs  in  the  upper  end  of  the 
fibula,  and  in  the  twenty-fifth  in  the  sternal  end  of  the  clavicle,  the 
acromial  process  of  the  scapula  and  crest  of  the  ilium  unite  with  their 
respective  bones,  the  ossification  of  the  vertebra?  is  completed,  and  at  this, 
the  period  of  adult  life,  the  whole  skeleton  becomes  ossified. 

The  eruption  of  the  teeth  is  in  the  following  order : 

Milk  Teeth. 

Central  incisors Sixth  month. 

Lateral  incisors Sixth  to  ninth  month. 

.     First  molars Eighth  to  twelfth  month. 

Canine  Eighteenth  month. 

Second  molars Twenty-fourth  month. 

Permanent  Teeth. 

First  molars Sixth  year. 

Central  incisors Seventh  year. 

Lateral  incisors Eighth  year. 

First  premolars Ninth  year. 

Second  premolars Tenth  year. 

Canines Eleventh  to  twelfth  year. 

Second  molars Twelfth  to  thirteenth  year. 

Third  molars Eighteenth  to  twenty-fifth  year. 

Of  course,  it  must  be  borne  in  mind  that  the  time  of  the  eruption  of 
the  teeth  varies,  and  especially  in  weakly,  scrofulous,  and  rachitic  chil- 
dren, where  dentition  is  both  'irregular  and  delayed ;  but  here  only  the 


(J8  A   SYSTEM  OF  LEGAL  MEDLCINE. 

normal  growth  and  development  is  taken  as  the  standard  both  in  regard 
to  the  teeth  and  the  ossification  of  the  skeleton. 

At  the  end  of  the  article  on  identity  some  illustrative  cases  will  be 
cited,  in  which  the  determination  of  age  was  an  interesting  feature,  and 
in  one  the  exact  age  was  decided  by  the  fact  that  the  acromial  end  of  the 
scapula  was  not  united,  while  the  upper  epiphysis  of  the  fibula  had  evi- 
dently only  recently  joined  the  shaft. 

4.  Stature. — The  estimation  of  stature  is  our  next  consideration. 
There  are  many  inaccuracies  and  differences  in  each  of  the  various  modes 
of  estimation  usually  adopted.  If  the  whole  skeleton  be  found,  by  plac- 
ing the  bones  in  position  and  adding  one  and  a  half  inches  for  the  soft 
parts,  we  shall  get  a  fairly  accurate  notion  of  the  stature,  allowance  being 
made  for  any  shrinking  of  the  bones  or  partial  destruction  of  their  ends. 
Next  we  will  take  the  method  of  calculating  the  height  by  measuring 
the  long  bones,  and  according  to  Orfila's  tables,  as  quoted  below,  the  re- 
sult differs  to  the  extent  of  several  inches.  Roughly  speaking,  however, 
it  may  be  said  that  the  length  of  the  femur  equals  one  quarter  of  the 
whole  length  of  the  body. 

In  analyzing  Orfila's  tables  we  have  separated  the  observations  on  the 
upper  and  lower  extremities. 

Orfila's    Tables. 
Upper  Extremity.  Stature. 

Ft.    In.     L.  Ft.    In.    L. 

First  Table.  Maximum.  Minimum.     Difference. 

Humerus,  6  observations  .,110  613  599  36 

Ulna,  7  observations  10      8  6        1        3  550  83 

Second  Table. 

Humerus,  19  observations.       126  581  546  37 

Ulna,  14  observations 10*8  5      10      10  5      5      8  5      2 

Lower  Extremity. 

First  Table.  Ft.    In.    L.  Maximum.  Minimum.      Difference. 

Femur,    7  observations  ...161  6        00  570  50 

Tibia,       7  "  ...130  5      10       6  550  56 

Second  Table. 

Femur,  12  observations  ...159  5        98  546  52 

Tibia,     11  "  ...125  598  546  52 

The  great  discrepancy  in  the  calculation  will  be  seen  from  these 
tables  ;  but  to  make  such  tables  valuable,  the  age  of  the  bodies  examined, 
the  entire  absence  of  disease,  such  as  bowing  of  the  bones  or  curvature  of 
the  spine,  ought  to  have  been  noticed,  and  the  same  difficulty  constantly 
occurs  in  deciding  the  stature  of  the  whole  body. 

Observations  made  by  Dr.  Hebbert,  of  London,  in  very  many  cases- 
upward  of  one  hundred— iu  the  post-mortem  room  on  the  full  length  of 
the  femur,  show  that  this  bone  equals  in  length  one  quarter  of  the  full 
length  of  the  body,  the  variation  in  general  being  about  one  inch. 

The  next  method  of  estimation  is  by  measuring  the  length,  by  taking 
the  upper  border  of  the  symphysis  pubis  as  the  center  of  the  body  after 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  69 

the  twenty-fifth  year.  M.  Sue  first  suggested  this  mode,  but  Orfila  at- 
tempted to  show  that  there  was  an  average  difference  of  two  and  one 
third  inches,  and  that  usually  the  lower  half  was  the  shorter,  especially 
in  women.  As  the  top  of  the  head  of  the  femur  is  on  the  same  line  as 
the  top  of  the  symphysis  pubis,  it  follows  that  the  total  length  of  the 
lower  extremity  is  equal  to  one  half  the  total  length  of  the  body. 
M.  Sue's  tables  take  an  average  from  numerous  observations : 

Body.  Trunk.  Lower  Extr.  Upper  Extr. 

5  ft,  8  in.  2  1.  2  ft.  10  iu.  1  1.  2  ft,  10  in.  11.  2  ft.  8  in.  0  1. 

According  to  Orfila,  in  women  six  out  of  seven  have  the  greatest  length 
from  vertex  to  pubes. 

In  men  (fifteen  observations),  vertex  to  pubes,  2  ft.  9  in. ;  lower  ex- 
tremities, 2  ft,  7  in. 

The  commonest  mode,  however,  and  the  one  which  has  hitherto  been 
most  relied  on,  when  only  the  arms  or  upper  parts  are  found,  is  the  figure 
carre  ties  ancients;  that  is,  when  the  body  is  lying  flat  with  legs  extended, 
and  the  arms  lying  at  right  angles  to  the  trunk,  a  square  can  be  described 
around  the  body.  Now  this,  although  fairly  correct  in  the  living  subject, 
is  faulty  in  three  ways  when  applied  to  a  single  limb.  We  are  told  to 
double  the  length  of  the  arm,  and  add  twelve  inches,  five  for  each  clavicle 
and  two  for  the  sternum.  Now,  the  first  error  is  that  when  the  arm  is  at 
right  angles  to  the  trunk  the  head  of  the  humerus  is  from  a  half  to  three 
quarters  of  an  inch  to  the  inner  side  of  the  acromial  end  of  the  clavicle. 
Secondly,  the  sternal  ends  of  the  clavicles  projecting  more  forward  than 
the  outer  ends,  an  obtuse-angled  triangle  is  formed  with  the  apex  forward, 
and  we  ought  to  take  the  measure  along  a  transverse  vertical  plane  of  the 
truuk,  that  is,  the  hase  of  the  triangle  instead  of  the  sides ;  this  difference 
is  from  half  an  inch  to  one  inch,  as  verified  by  several  measurements  of 
skeletons.  Thirdly,  in  females  the  outer  end  of  the  clavicle  is  directed 
a  little,  though  very  slightly,  downward,  as  shown  by  their  more  sloping 
shoulders,  so  that  to  calculate  from  the  exact  length  of  the  clavicle  would 
again  give  two  sides  of  a  triangle  instead  of  the  base.  This  mode  of 
estimating  height  is  furthermore  misleading  in  females,  on  account  of 
their  relatively  shorter  legs,  so  that  it  cannot  be  safely  trusted.  Other 
methods  are  derived  from  the  ancient  Egyptian  canon,  viz.,  that  the 
length  of  the  middle  finger,  as  measured  down  from  the  root  of  the 
thumb-nail  at  right  angles  to  the  axis  of  the  middle  finger  when  the  hand 
is  laid  flat  on  a  table,  equals  one  nineteenth  of  the  height,  and  that  the 
forearm,  from  the  tip  of  the  olecranon  to  the  end  of  the  mid-finger, 
equals  five  nineteenths  of  the  height. 

In  order  to  be  accurate  in  these  measurements,  several  observations 
should  be  made,  forasmuch  as,  if  only  a  finger  be  measured,  an  inaccu- 
racy of  one  sixteenth  of  an  inch  will  give  a  false  result, 

In  a  case  to  be  afterward  given  in  detail,  it  will  be  seen  that  the  two 
measurements  agreed  to  one  fortieth  of  an  inch. 

A  number  of  observations  were  made  in  London  by  each  of  these  last 
methods,  both  in  the  living  and  the  dead,  and  the  conclusion  derived  is 
that  they  are  both  fairly  reliable,  and  especially  the  calculation  of  the 
measurement  of  the  forearm,  which  has  been  for  centuries  ;i  standard  of 
measure  under  the  name  of  cubit.     According  to  the  old  Egyptian  canon, 


yjj  |    SYSTEM    OF  LEGAL   MEDICINE. 

the  human  body  can  be  divided  by  transverse  lines  into  nineteen  parts, 
of  which  live  parts  represent  the  length  of  the  forearm  and  hand,  and 
our  pail  the  exacl  length  of  the  middle  finger.  This  measurement  must 
be  made  not  from  the  prominence  of  the  knuckle,  which  is  the  head  of 
the  metacarpal  bone,  but  from  the  upper  end  of  the  proximal  phalanx, 
which  is  exactly  on  a  line  with  the  base  of  the  thumb-nail  in  a  well-pro- 
portioned man. 

In  the  latter  part  of  this  section  are  indicated  the  methods  of  meas- 
uring the  body.  The  points  of  measurement  of  the  height  and  breadth, 
and  the  various  indices  of  the  skull,  have  been  described  under  the  head- 
ing of  race.  The  circumference  of  the  skull  is  taken  in  a  plane  from  the 
ophryou  in  front  to  the  occipital  point  behind. 

If  the  limbs  be  still  attached  to  the  trunk,  in  measuring  the  two  arms 
it  is  usual  to  measure  from  the  tip  of  the  acromion  to  the  external  condyle 
of  the  humerus,  and  thence  to  the  styloid  process  of  the  radius,  all  these 
being  in  one  straight  Hue ;  and  from  the  last  point  the  length  of  the  hand 
is  to  be  measured.  The  legs  are  measured  from  the  top  of  the  great 
trochanter  externally  to  the  heel,  and  internally  from  the  symphysis  pubis 
to  the  heel.  If  separated  from  the  trunk,  of  course  the  greatest  length 
is  selected.  In  measuring  the  circumference  of  the  limbs,  it  is  best  to 
take  the  greatest  measurement,  and  then  take  measurements  at  different 
points  expressed  in  inches  from  a  flexure  of  the  limb  or  other  fixed  points. 
The  umbilicus  is  always  below  the  center  of  the  line  from  the  xiphisternal 
articulation  to  the  pubes,  and  about  a  half-inch  to  one  inch  above  the 
highest  point  of  the  iliac  crest.  The  circumference  of  the  trunk  should 
be  taken  transversely  at  the  nipple  line — that  is,  opposite  the  fourth  rib 
and  just  below  the  costal  arch. 

5.  Features. — The  general  character  of  the  capital  features  in  the 
great  races  have  already  been  indicated ;  but  in  addition  the  exact  linea- 
ments of  the  individual  should  be  described,  such  as  the  size  and  color  of 
the  eyes,  the  shape  of  the  nose,  the  curve  of  the  lips,  and  the  shape  of 
the  ear,  mentioning  whether  it  projects  or  not  from  the  head,  the  pres- 
ence or  absence  of  the  lobule,  the  character  of  the  helix,  and  the  presence 
of  the  Darwinian  tubercle,  a  small  projection  just  at  the  curve  of  the 
helix.  The  teeth  should  be  carefully  examined  to  note  those  absent,  or 
to  remark  the  presence  of  artificial  teeth.  Apropos  of  this  examination 
of  the  teeth,  it  may  be  remembered  that  in  a  case  in  London  known  as 
the  Great  Coram  Street  murder,  an  apple  with  a  single  bite  taken  was 
found  by  the  woman's  bedside.  A  cast  of  this  was  taken,  but  it  proved 
to  correspond  to  the  woman's  own  mouth. 

This  is  an  instance  of  the  importance  of  never  missing  any  detail, 
though  in  this  case  it  did  not  lead  to  the  discovery  of  the  murderer. 
Apart  from  the  general  description  of  the  indices  of  the  head  and  face, 
any  peculiarity  of  the  skull,  such  as  undue  prominence  of  the  frontal  or 
parietal  eminences,  or  of  the  supraorbital  ridges,  or  the  deep  depression 
often  found  in  front  of  the  lambdoid  suture,  and  which  an  ignorant  per- 
son might  take  for  an  old  depressed  fracture,  should  be  noticed.  The 
chin  and  lower  jaw,  which  are  very  significant  features,  should  be  ex- 
amined. 

The  color  and  character  of  the  hair,  both  in  head  and  face,  are  the 
next  points  to  be  noticed.  The  difference  between  human  and  animal 
hairs  mil  be  discussed  later.     Care  must  be  taken  to  discriminate  between 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  71 

general  or  partial  baldness,  whether  due  to  personal  peculiarity  or  to  ad- 
vancing life,  and  the  alopecia  of  constitutional  disease,  such  as  syphilis 
or  that  due  to  fungi,  e.g.,  alopecia  decalvans.  After  the  description  of 
the  features  of  the  face  and  head,  the  body  shoidd  be  noticed  in  detad. 
In  the  female,  the  breast,  the  pelvis,  whether  large  or  small,  the  external 
organs  of  generation,  including  the  orifice  of  the  vagina,  must  be  exam- 
ined, and  any  peculiarity  or  malformation  noted. 

On  the  lower  part  and  sides  of  the  abdomen  may  possibly  be  seen  the 
linea?  alba?,  which  have  been  caused  by  overstretching  of  the  abdominal 
walls,  and  usually,  though  not  necessarily,  associated  with  pregnancy. 
In  the  male,  after  examining  for  any  defect  of  the  genitalia,  the  result 
of  circumcision  shoidd  be  looked  for,  though,  as  said  elsewhere,  this  is  a 
practice  not  now  confined  to  Jews  and  Mohammedans.  In  both  sexes 
the  inguinal  glands  should  be  examined. 

In  describing  the  arms  first  note  the  general  appearance,  the  greater 
muscularity  of  the  male,  the  deltoid,  triceps,  and  biceps  being  specially 
prominent,  the  flatter  forearm,  and  wider,  thicker  wrist  of  the  man,  while 
the  woman's  arm  is  rounder  and  softer,  the  wrist  more  slender,  and  her 
fingers  more  tapering. 

Note  also  the  nails,  their  shape  and  appearance,  as  to  their  having 
been  pared  or  bitten  or  neglected.  In  the  living  the  question  may  arise, 
as  in  the  great  Tichborne  case,  as  to  how  far  the  features  may  be  modified 
by  age  and  by  change  of  life  and  habits,  the  claimant  being  a  very  coarse, 
corpulent  man  with  bloated  features,  and  the  heir  who  originally  disap- 
peared being  a  slim  youth  with  delicate  face  and  timid  manner.  Another 
feature  in  this  remarkable  trial  was  the  peculiarity  of  the  genital  organs, 
an  unusual  condition  being  present  in  the  claimant,  and  known  to  be  a 
peculiarity  of  the  missing  heir.  In  this  trial  it  was  stated  that  the  direc- 
tion of  the  curve  of  the  two  eyes  was  markedly  different,  and  also  the 
shape  of  the  nose  and  the  condition  of  the  ear,  the  claimant  having  ears 
with  large  pendulous  lobes,  and  the  real  heir  small  ears  without  lobes. 

6.  Scars,  etc. — A  scar  or  cicatrix  is  the  term  applied  to  the  result- 
ing appearance  in  the  skin  after  the  loss  of  its  substance,  together  with 
the  deeper  tissues.  It  is  due  to  the  formation  of  firm,  fibrous  tissue  and 
its  subsequent  contraction,  as  in  the  repair  of  a  wound.  The  wound  may 
be  superficial  and  only  affect  the  epidermis,  and  may  entirely  disappear ; 
or  it  may  be  deep,  and  destroy  the  true  skin  and  deeper  tissues.  The  scar 
which  follows  in  the  latter  case  will  be  well  marked,  and  generally  resem- 
bles in  shape  the  wound  which  was  inflicted,  or  it  may  become  smaller  and 
narrower. 

All  scars  run  through  two  distinct  stages,  that  of  inflammatory  red- 
ness and  that  of  brown  discoloration;  and  when  the  destruction  is  con- 
siderable or  the  inflammation  high  a  third  condition  may  be  seen,  namely, 
bleaching.  The  first  stage  lasts  during  the  period  of  healing,  two,  three, 
or  four  weeks ;  the  brown  or  coppery  stage  from  a  few  months  to  a  year ; 
the  white  is  permanent. 

In  examining  a  scar  carefully  measure  it,  note  its  color  and  the  con- 
dition of  the  surrounding  tissues,  observe  whether  it  is  on  a  level  with  or 
sunk  below  the  surface,  and  its  mobility  in  relation  to  surrounding  tis- 
sues. It  may  be  mentioned  that  a  considerable  bleached  area  of  the  skin. 
such  as  occurs  sometimes  in  negro  races,  resembles  a  superficial  scar ;  but 
if  the  surface  is  carefully  examined  for  lanugo  or  the  fine  downy  hairs 


72 


A   SYSTEM   OF  LEGAL  MEDICINE. 


found  on  most  parts  of  the  body,  their  presence  will  decide  the  question, 
as  there  are  no  hairs  in  scar  tissue.  With  regard  to  scars  produced  by 
such  means  as  setons,  cupping,  venesection,  vaccination,  pitting  from 
smallpox,  an  operation  on  a  boil  or  carbuncle,  etc.,  the  position,  shape,. 
size,  and  appearance  would  readily  indicate  the  causation,  and  these  are 
generally  known  even  to  the  laity. 

The  brown  discoloration  following  herpes  is  a  fair  illustration,  as  no 
other  sens  would  so  closely  follow  the  distribution  of  a  nerve. 

With  regard  to  scars  caused  by  wounds  of  any  kind,  each  case  must 
be  taken  on  its  merits ;  but  as  much  depends  on  exact  description  in  prov- 
ing the  identity  of  a  person,  such  description  should  be  most  accurate. 
Many  cases  are  on  record,  and  can  be  easily  studied.  The  identity  of  a 
mutilated  woman  in  a  well-known  English  case  was  decided  by  an  oblique 
scar  on  the  wrist  caused  by  a  cut  from  a  bottle.  In  the  Wainwright 
case,  where  the  mistress,  Harriet  Lane,  was  shot  by  her  paramour  and 
the  body  buried  in  quicklime,  the  identity  was  established  a  year  later  by 
the  presence  of  a  scar  on  the  anterior  aspect  of  the  shin.  The  scar  was 
caused  by  a  burn.  A  preparation  of  this  scar  is  still  in  the  Black  Museum 
at  Scotland  Yard. 

Tattoo  marks  would  form  a  very  decided  indication  of  the  identity  of 
a  person,  if  the  design  was  previously  known  to  friends.  Their  presence 
or  absence  may  be  of  the  greatest  importance,  as  in  the  Tichborne  case. 
( Vide  Identity  of  the  Living. )  It  is  a  very  usual  habit  for  a  man .  especially 
a  sailor,  to  have  his  own  initials  tattooed.  An  American  sailor  would  be 
more  likely  to  have  a  flag  with  the  stars  and  stripes  than  the  tricolor  of 
France.  Moles,  birth-marks,  nrevi  of  all  kinds  should  be  described  as  to 
locality,  shape,  color,  etc.,  as  such  marks  are  usually  known  to  intimate 
friends  and  relatives,  and  may  prove  of  great  value  in  identification.  It 
is  not  necessary  to  do  more  than  mention  these  en  passant. 

In  addition  to  true  cicatrices  there  are  two  appearances  which  resem- 
ble slightly  superficial  scars,  for  instance  : 

If  a  finger-ring  be  worn  for  any  length  of  time,  there  is  a  well-marked 
depressed  line  made  by  the  ring.  This  is  paler  than  the  surrounding 
skin,  as  it  is  unexposed  to  the  air,  and  unless  made  by  a  wedding-ring 
has  generally  some  irregularity  in  outline  according  to  the  design  of  the 
ring,  e.g.,  a  signet-ring.  The  mark  made  by  a  wedding-ring  in  European 
countries  is  a  slender,  even-defined  circular  mark  around  the  left  fore- 
finger. A  signet- ring  is  usually  worn  on  the  fifth  finger.  Another  mark 
is  that  made  by  the  garter  on  the  legs  of  a  woman.  This  may  be  above 
or  below  the  knee,  and  is  best  seen  below.  It  is  more  customary  to  find 
this  mark  among  the  lower  classes,  and  is  usually  below  the  knee,  I  believe 
because  the  richer  classes  wear  suspenders  or  garters  above  the  knee. 
This  may  be  a  means  toward  establishing  identity. 

7.  Deformities. — It  would  seem  a  simple  matter  to  identify  a  corpse 
by  a  deformity,  such  as  a  curved  spine  or  the  various  forms  of  talipes, 
and  this  is  no  doubt  the  case ;  but  in  smaller  deformities,  such  as  the 
loss  of  a  finger  or  contraction  of  a  joint,  confusion  often  arises.  A  case 
in  point  happened  in  London  in  1889,  where  the  body  of  a  man  was  found 
drowned,  and  was  identified  by  the  relatives  on  account  of  a  curiously 
contracted  ring-finger,  and  while  the  inquest  was  being  held  the  real  man 
appeared,  showing  precisely  the  same  physical  condition.  One  point  is, 
however,  clear,  and  it  is  that  any  deformity  found  in  the  dead  body, 


DEATH  IX  ITS  MEDICO-LEGAL  ASPECTS.  73 

whether  of  head,  spine,  or  limbs,  is  real,  but  it  is  by  no  means  uncommon 
for  deformities  to  be  feigned  by  "old  soldiers";  but  this  is  beyond  our 
inquiry.  Among  malformations  to  be  described  may  be  mentioned 
shortening  of  limbs,  spinal  curvature,  talipes,  imperfect  conformation  of 
the  genitals,  anchylosis  and  contraction  of  joints,  polydactylism,  whether 
of  hands  or  feet,  or  the  absence  of  one  or  more  members. 

8.  Occupation,  etc. — In  the  examination  of  a  corpse  some  aid  toward 
identity  may  be  obtained  by  carefully  observing  if  there  are  any  marks 
on  the  body  or  limbs  which  are  the  results  of  the  occupation  followed 
during  life.  These  would  be  found,  in  most  instances  on  the  bodies  of 
manual  laborers,  or  those  exposed  to  wind  and  weather,  such  as  sailors, 
soldiers,  engineers,  etc.,  rather  than  on  the  studious  or  wealthy  classes, 
who  are  protected  from  such  influences.  The  delicacy  of  the  skin,  espe- 
cially the  softness  of  the  palms  of  the  hands,  the  care  taken  of  the  nails, 
the  trimming  of  the  hair  in  either  sex,  would  sufficiently  indicate  that  the 
body  is  that  of  a  person  in  a  good  position  in  life. 

With  regard  to  outdoor  workers,  the  face  of  a  sailor  or  a  soldier  is  gen- 
erally well  tanned  by  the  sun,  in  the  case  of  sailors  the  tan  reaching  down 
the  neck  to  the  chest,  where  it  is  seen  as  a  triangular  patch  with  the  apex 
downward.  In  the  case  of  the  soldier  the  tan  is  over  the  face  and  neck 
only,  while  the  forehead  is  often  obliquely  marked  by  the  wearing  of  the 
cap  on  one  side,  and  the  chin-strap  may  protect  a  part  of  the  cheeks  and 
chin  from  the  sun,  and  so  its  position  is  kno  wn  by  a  paler  color.  It  may  here 
be  noticed  that  among  the  colored  races  in  India,  in  some  instances,  one  arm 
and  shoulder  and  part  of  the  breast  is  exposed,  while  the  other  is  covered, 
the  two  being  separated  by  a  Avell-marked  oblicpie  line  of  a  lighter  shade. 

The  palms  of  the  hands  of  laborers  and  outdoor  workers  are  hard- 
ened, and  generally  there  are  hardenings  at  the  base  of  the  fingers  over 
the  heads  of  the  metacarpal  bones  from  grasping  weapons  or  tools  of 
various  kinds.  (See  Identity  of  the  Living.)  Other  callosities  may  be 
produced  by  certain  occupations  where  constant  pressure  is  made  upon  a 
part.  In  India  these  callosities  are  found  on  the  feet — sometimes  on  the 
outside  of  the  foot,  sometimes  on  the  dorsum,  according  to  the  sect; 
while  sometimes  there  is  a  distinct  mark  on  the  forehead  of  a  Moham- 
medan, from  striking  the  head  on  the  ground  as  he  bows  toward  Mecca. 
Stains  on  the  fingers  again  may  be  of  help.  These  are  found  in  those 
working  in  chemical  factories  or  laboratories,  or  in  dye-works,  and  are 
produced  by  acids  or  dyes  of  various  kinds ;  nitric  acid,  for  instance, 
leaving  a  yellow,  while  sulphuric  acid  leaves  a  blackish,  stain,  and  nitrate 
of  silver  leaves  also  a  black  stain.  Other  occupations  may  be  discovered 
by  the  presence  of  skin  affections,  such  as  the  washerwoman's  eczema  on 
the  back  of  the  hand,  and  the  so-called  baker's  itch,  also  on  the  hand. 

In  regard  to  muscles,  it  may  just  be  mentioned  that  blacksmiths,  engi- 
neers, and  prize-fighters  have  the  upper  part  of  the  body  developed  more 
strongly  than  the  lower.  The  well-formed  calf  of  the  ballet-dancers  is 
another  well-known  instance  of  muscle  hypertrophy  from  occupation. 

With  regard  to  the  effect  of  pressure  by  dress,  the  marks  of  tight 
lacing  are  well  seen,  the  waist  being  much  narrowed  and  the  organs  dis- 
placed, the  liver  and  stomach  sometimes  being  close  to  the  pelvis. 

Corns  on  the  toes  and  bunions  are  often  the  result  of  a  short  tight 
shoe  with  pointed  ends,  and  more  often  remarked  in  women's  feet.  The 
hands  of  the  well-to-do  are  generally  soft  and  white  from  wearing  gloves. 


74  A    SYSTEM    01    LEGAL   MEDICINE. 

All  these  points  should  aid  in  giving  an  idea  of  the  occupation  of  an  un- 
known person,  no  single  point  being-  sufficient  in  itself. 

The  presence  of  foreign  substance,  such  as  hay,  straw,  grains  of 
wheat,  flour,  animal  hairs,  or  human  hairs  differing  from  those  of  the 
deceased,  may  be  an  important  help  toward  finding  out  both  the  occupa- 
t  ion  and  identity  of  the  deceased.  For  instance,  a  coachman  would  more 
likely  have  horse's  hairs  on  his  person  or  dress,  and  a  baker  would  more 
likely  have  flour.  In  one  case  a  murder  of  a  girl  preceded  by  rape  was 
traced  t<>  a  miller,  in  consequence  of  some  grains  of  wheat  being  found 
on  the  girl's  person  and  underclothing. 

Hairs  are  appendages  of  the  skin,  and  are  modified  epithelium.  Each 
hair  consists  of  a-  bulb — which  is  the  dilatation  of  the  hair  fixed  in  a  de- 
pression in  the  skin  called  the  hair-follicle — a  shaft  or  stem,  and  a  point. 
The  stem  is  generally  cylindrical,  or  more  or  less  flattened,  the  section  of 
a  hair  in  the  straight-haired  races  being  circular,  in  the  woolly-haired 
smaller  and  oval.  The  stem  is  covered  by  finely  imbricated  scales,  the 
edges  of  which  give  rise  to  a  series  of  fine,  waved,  transverse  lines,  and 
these  are  the  lines  which  are  so  characteristic  in  different  animals. 

Internal  to  this  is  a  fibrous  substance  consisting  of  fusiform  fibers  with 
more  or  fewer  pigment-granules  and  diffused  coloring  matter.  Internal 
again  is  the  medulla  or  pith,  though  it  is  not  present  in  all  hairs.  This 
is  formed  of  cubical  cells  with  air-bubbles  among  them;  the  presence  of 
the  air-bubbles  gives  a  dark  appearance  on  transmitted  light,  but  a  white 
appearance  to  reflected  light,  The  bulbous  extremity  wdiich  fits  in  the 
depression  of  the  true  skin  called  the  hair-follicle  is  lighter  and  softer 
than  the  stem.     The  point  of  the  stem  tapers,  and  is  free  from  a  medulla. 

Human  hairs  have  a  diameter  of  1-170  inch  to  about  1-3000,  the 
female  hairs  being  larger  and  from  1-2500  to  1-3000  inch  less  in  diam- 
eter, except  on  the  pubes,  where  the  male  hairs  have  a  smaller  diameter. 

Human  hairs  may  be  distinguished  from  animal  hairs  by  the  fine, 
wavy,  transverse  lines  of  the  cortex,  which  are  more  marked  in  man  than 
in  any  other  mammal.  The  size  of  the  hair  of  the  deer  and  horse  is 
greater  than  that  of  man,  and  there  is  in  these  animals  a  greater  develop- 
ment of  the  medulla  at  the  expense  of  the  cortex. 

In  man  and  monkey  the  pigment  is  confined  to  the  cortex,  while  in 
the  rodent  it  is  found  in  the  medulla. 

Diameters. 

Hair  from  young  girl's  arm 1-1666 

Hair  from  head  (female) '. 1-34 

Hair  from  pubes  (female)  1-166 

Hair  from  beard 1-166 

Hair  from  head  (male) 1-333 

Hair  from  pubes  (male) 1-233 

Deer l_25o 

Horse 1_340 

Fox  1-600 

Do<? 1-1100 

Rabbit 1-1125 

The  value  of  photography  has  already  been  commented  on,  and  its  use 
is  becoming  of  daily  increasing  importance.  Careful  photographs  are 
taken  of  every  unknown  body  examined  by  the  medical  examiners  in 
Boston,  and  they  prove  of  the  greatest  value. 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  75 

We  have  now  discussed  in  somewhat  the  form  of  an  essay  the  vari- 
ous points  of  importance  in  the  identification  of  the  dead,  and  have  given 
several  rules  for  guidance  of  the  students  in  this  inquiry.  We  add  a 
tabular  statement  of  the  points  to  be  observed,  and  conclude  by  giving 
in  detail  four  cases,  illustrative  of  many  of  these  points. 

TABULAR   STATEMENT   OF   DETAILS   TO  BE   NOTED   IN   THE   EXAMINATION   OF   BODIES,  OR 
OF   PARTS   OF   BODIES,   OR   OF   BONES   IN   THE   QUESTION   OF   IDENTITY. 

1.  The  surroundings  and  conditions  of  parts  found. 

2.  Height. 

3.  Weight. 

4.  Probable  age,  considering  teeth,  maxilla?,  skull,  fontanelles,  centers  of  ossifica- 
tion, and  condition  of  ephiphyses. 

5.  Sex  ;  genital  system  and  breasts  ;  general  shape,  hair,  pelvis  bones. 

6.  Deformities. 

7.  Marks  on  skin,  including  scars,  tattoo  marks,  signs  of  previous  disease,  such 
as  scrofula,  .syphilis,  smallpox,  skin  diseases,  na?vi,  moles,  warts. 

8.  Injxiries,  wounds,  fractures,  dislocations. 

After  this  examine  in  detail  the  various  parts  and  organs  of  the  body. 

1.  Head  and  features. 

2.  Neck. 

3.  Chest. 

4.  Pelvis. 

5.  Extremities. 

Mutilated  Remains. 

1.  Accuracy  of  the  fitting  of  the  various  parts. 

2.  Nature  of  mutilations,  whether  the  soft  parts  were  cut  with  blunt  or  sharp 
knife,  or  done  with  or  without  skill ;  whether  the  bones  have  been  chopped  or  sawn 
by  coarse  or  fine  saw. 

3.  Whether  they  have  been  burned,  boiled,  acted  on  by  chemicals,  or  buried  in 
earth  or  macerated  in  water. 

The  following  cases,  which  came  under  the  observation  of  Dr.  Heb- 
bert  in  London,  are  cited  in  extenso  for  the  purpose  of  illustrating  many 
of  the  points  alluded  to  in  the  preceding  part  of  this  article. 

Case  I. 

In  July,  1887,  Mr.  Bond  was  requested  by  the  treasury  to  examine 
some  remains  found  in  various  parts  of  London,  and  I  had  the  oppor- 
tunity of  helping  at  the  autopsy.  All  the  portions  were  found  either  in 
the  Thames  or  in  the  Regent's  Canal,  and  consisted  of  eight  separate 
parts.  In  the  inquiry  we  had  to  determine  the  following  points :  whether 
they  were  human  and  belonged  to  the  same  body,  the  race,  age,  sex, 
height,  complexion,  and  condition  of  life,  and,  if  possible,  the  cause  of 
death,  and  the  skill  or  ignorance  of  the  operator. 

The  parts  were :  (a)  the  lower  part  of  the  thorax  and  the  upper  part 
of  the  abdomen,  from  the  fifth  dorsal  vertebra  to  the  third  lumbar  ver- 
tebra; (b)  the  pelvis  below  the  third  lumbar  vertebra ;  (c)  the  right  thigh, 
including  patella ;  (d)  the  left  thigh ;  (e)  both  legs  and  feet,  the  left  hav- 
ing patella  attached ;  (/)  the  arms  from  the  shoulders  to  the  fingers.  They 
were  obviously  human,  and  on  applying  the  various  joint  and  bone  sur- 
faces together  we  found  that  they  fitted.  The  skin-cuts  apparently  cor- 
responded, but  had  been  too  much  altered  by  decomposition  to  warrant 


76  A   SYSTEM   OF  LEGAL   MEDICINE. 

a  certain  opinion.     The  limbs  were  muscular,  and  the  remains  generahy- 
had  a  fair  amount  of  subcutaneous  fat. 

The  various  parts  were  then  described  in  the  report.  First,  the 
thorax  had  been  cut  above,  through  the  body  of  the  fifth  dorsal  vertebra, 
and  below,  through  the  body  of  the  third  lumbar  vertebra,  the  bones 
having  fiat  but  somewhat  rough  surfaces,  and  through  the  skin  and  other 
tissues  by  a  series  of  more  or  less  clean-cut  incisions,  so  that  the  fourth 
left  rib  and  the  fifth  right  rib  had  been  left,  and  the  sternum  below  the 
articulations  of  these  ribs.  The  diaphragm  was  intact,  but  the  lungs, 
heart,  and  other  thoracic  viscera  were  absent.  Below  the  diaphragm 
were  the  liver,  stomach,  both  kidneys,  and  spleen ;  the  remaining  viscera 
of  the  abdomen  were  included  in  the  pelvis  below  the  third  lumbar  ver- 
tebra. 

The  lower  piece  of  the  trunk  was  the  abdomen  from  the  third  lumbar 
vertebra  and  the  pelvis.  No  part  of  the  small  intestine  from  the  duode- 
num was  found,  nor  the  large  intestine,  except  the  sigmoid  flexure  and 
rectum  in  the  lower  fragment.  In  the  pelvis  were  the  uterus,  vagina, 
ovaries  and  appendages,  and  the  bladder.  The  acetabula  were"  empty, 
the  thighs  being  separated  from  the  pelvis  by  incisions  passing  around 
the  flexure  of  the  joint.  The  external  organs  of  generation  were  those 
of  a  female.  The  uterus  measured  three  and  one  eighth  inches,  the  body 
one  and  one  half  inches,  and  the  cervix  one  and  five  eighth  inches.  The 
os  internum  was  well  marked,  and  the  arbor  vitas  very  distinct.  The  os- 
externum  was  small,  and  would  barely  admit  the  point  of  a  sound.  The 
ovaries  were  small,  and  one  showed  a  corpus  luteum  of  menstruation. 
The  rugae  of  the  vagina  were  prominent.  On  the  pubes  were  some  black 
hairs.  An  incision  had  evidently  been  made  from  the  ensiform  cartilage 
to  the  pubes.  There  was  no  trace  of  ecchymosis  in  the  skin  of  the  in- 
cisions separating  the  limbs  or  those  dividing  the  trunk. 

The  skin  of  the  two  pieces  of  the  trunk  was  partly  decomposed  and 
sodden,  but  was  evidently  fail-  in  color. 

The  arms  had  been  taken  off  at  the  shoulder  by  incisions  passing 
obliquely  downward  and  outward  from  the  tip  of  the  shoulder  around 
the  axilla,  so  as  to  leave  most  skin  on  the  upper  and  outer  aspect  of  the 
arm.  The  heads  of  the  humeri  had  been  cleanly  disarticulated.  The 
skin  of  the  arms  was  peeling  off,  and  that  of  the  palms  thick,  white,  and 
sodden ;  the  two  terminal  phalanges  of  the  fingers,  with  the  exception  of 
the  thumb  and  the  left  ring-finger,  had  rotted  off.  The  length  of  the  left 
arm  and  hand  was  twenty-five  and  three-eighth  inches.  There  was  no 
circular  depressed  mark  on  the  left  ring-finger. 

The  thighs  had  been  cut  off  at  the  hip-joint  by  cuts  around  the  flex- 
ure of  the  joint,  and  the  heads  of  the  femora  disarticulated.  The  right 
thigh  had  the  patella  attached,  but  was  separated  from  the  leg  at  the 
knee-joint,  The  left  thigh,  which  was  found  at  a  later  date,  showed  not 
only  more  signs  of  decomposition,  but  the  head  of  the  femur  was  riddled 
with  the  small  circular  holes  of  a  water  worm.  The  femur  measured 
sixteen  and  one  eighth  inches  from  the  head  to  the  lower  level  of  internal 
condyle. 

The  legs,  including  the  feet,  had  been  cut  off  bv  circular  cuts  from 
the  center  of  the  knee-joints,  the  left  leg  having  the  patella  attached. 
The  legs  were  well  shaped  and  muscular,  and  the  foot  small  and  without 
deformity.     There  were  circular,  slightly  depressed  marks,  about  half  an 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  77 

inch  deep,  just  below  the  knees.  Each  leg  with  the  foot  measured  six- 
teen  inches ;  right  and  left  tibia?,  thirteen  inches ;  right  and  left  fibulae, 
thirteen  inches.  The  skin  of  the  thighs  and  legs  was  decomposing,  the 
cuticle  in  places  being  raised  in  bullas  and  peeling  off.  The  cuticle  of 
the  feet  had  disappeared  with  the  nails,  and  the  terminal  phalanges  had 
fallen  off. 

The  following  inferences  were  then  drawn  from  the  foregoing  facts : 

1.  The  sex  was  easily  told,  as  the  external  organs  of  generation,  as 
well  as  the  uterus  and  ovaries,  were  present. 

2.  The  age, — The  union  of  the  epiphyses  proved  the  age  was  over 
twenty-five. 

3.  The  complexion  was  dark,  as  shown  by  the  pubic  hair,  while  the  fair 
skin  proved  Caucasian  origin. 

4.  Height. — The  length  of  the  arm  being  25f  in.,  by  doubling  this  and 
adding  12  in.  for  clavicles  and  sternum  we  should  have  a  result  of  5  ft. 
2f  in.  The  length  of  the  lower  extremity  was  32£  in.  x  2  =  64J,  i.e., 
5  ft.  4|  in.  By  measuring  the  ring-finger  the  length  was  3J  in.  x  19 
=  5  ft.  1J  in.,  so  we  had  to  average  the  three  measurements,  and  calcu- 
late her  as  about  5  ft.  3  in.  in  stature. 

5.  Condition  of  Life, — The  skin  of  the  hands  and  feet  was  too  much 
decomposed  to  show  whether  she  had  led  a  life  of  hard  manual  work. 
There  was  no  mark  made  by  a  wedding-ring.  The  uterus  was  that  of  a 
virgin,  but  the  vulva  was  too  decomposed  to  give  indication  with  regard 
to  old  or  recent  injury.  The  mark  around  the  leg  showed  that  garters 
were  worn  below  the  knee — a  custom,  I  believe,  more  common  among  the 
lower  than  the  upper  classes,  who  either  wear  garters  above  the  knee  or 
suspenders.     She  had  recently  menstruated. 

The  cuts  on  the  surfaces  of  the  vertebrae  were  such  as  would  be  made 
by  a  saw,  and  the  long  clean  sweeping  incisions  through  the  skin  showed 
that  a  very  sharp  knife  had  been  used.  The  disarticulations  were  neatly 
and  cleanly  done,  in  each  case  the  joint  being  exactly  opened.  The  ab- 
sence of  ecchymosis  showed  that  all  the  cuts  were  made  after  death. 

It  was  obvious,  from  the  direction  and  manner  of  the  cuts,  that 
no  ordinary  surgical  or  dissecting-room  operation  had  been  carried  out. 
Although  no  special  knowledge  of  anatomy  was  shown,  the  cuts  indicated 
a  practical  skill  in  amputating  limbs  at  joints,  and  making  clean  sweep- 
ing skin  cuts.  It  may  be  argued  that  such  skill  would  be  gained  by  a 
hunter  or  a  butcher,  as  either  of  these  are  in  the  habit  of  rapidly  and 
skilfully  separating  limbs,  and  of  cutting  up  a  trunk  into  several  parts. 
I  do  not  think  that  any  surgeon  or  anatomist  could  have  done  the  work 
so  well,  as  they  are  not  constantly  operating,  while  a  butcher  is  almost 
daily  cutting  up  carcasses.  Moreover,  the  limbs  were  separated  in  almost 
precisely  the  way  a  butcher  or  hunter  would  adopt,  i.e.,  making  a  series 
of  cuts  around  the  flexure  of  the  joint,  and  then  by  a  strong  twist  wrench- 
ing out  the  head  from  the  joint,  and  cutting  the  capsule. 

The  condition  of  the  skin  showed  that  each  part  had  been  lying  and 
decomposing  in  water,  and  that  several  months  had  elapsed  since  the 
date  of  death. 

The  summary  was  that  the  remains  were  those  of  an  adult  female  of 
Caucasian  origin  and  dark  complexion,  from  twenty-five  to  thirty-five 
years  old,  and  about  5  ft.  3  in.  high,  that  she  had  not  borne  a  child,  and 
in  fact,  from  the  small  size  of  the  os  uteri,  was  unlikely  to  conceive  ;  that 


;>  A   SYSTEM   OF  LEGAL   MEDICINE. 

the  body  had  been  mutilated  after  death  by  some  person  who,  though 
not  necessarily  a  skilled  anatomist,  yet  had  some  knowledge  of  joints 
and  the  readiesl  mode  of  separating  limbs,  and  by  inference  a  butcher  or 
hunter;  that  decomposition  had  taken  place  in  water,  and  some  months 
had  elapsed  since  death. 

Case  II.     September  16,  1888. 

"  {a)  On  this  date  I  examined  a  right  human  arm,  separated  from  the 
trunk  at  the  shoulder  by  an  incision  passing  obliquely  around  the  upper 
third  of  the  humerus,  so  that  the  lowest  point  is  internal  and  five  inches 
vertically  from  the  head  of  the  humerus,  and  the  highest  point  external 
and  t  wo  and  three  quarter  inches  vertically  from  the  head  of  the  humerus. 

-(b)  The  head  and  neck  of  the  humerus  are  exposed,  the  capsule  of 
the  joint  having  been  cut  circularly  and  the  head  enucleated.  The  carti- 
lage shows  two  or  three  small  nicks.  The  amputation  has  been  made  by 
seven  separate  cuts,  cleanly  dividing  the  tissues. 

"  (c)  Description. — The  arm  is  large,  shapely,  and  muscular,  but  has 
rather  the  roundness  and  general  contour  of  a  female  than  the  muscu- 
larity, as  shown  by  the  development  of  the  triceps  and  biceps,  of  a  male 
limb.  The  wrist  is  small,  the  hands  long,  with  tapering  fingers ;  the  nails 
are  small,  flat,  and  well  formed,  and  have  been  carefully  trimmed.  The 
Angers  of  the  hand  are  firmly  flexed  and  stiff,  and  the  thumb  opposed 
and  flexed.  In  dissecting  the  limb  it  is  found  that  the  flexion  of  the 
fingers  is  due  to  the  rigor  mortis  of  the  flexores  digitorum. 

"  {(1)  Skin. — The  skin  of  the  arm  is  adherent  and  white,  though  there 
are  several  patches  of  brown  color  and  of  a  hard  leathery  consistence 
from  decomposition.  There  is  some  fine  downy  hair  on  the  back  of  the 
forearm,  not  thick  and  strong  as  in  a  man.  There  are  no  bruises  nor 
cuts  nor  old  scars.  The  skin  of  the  hand  is  thick,  white,  and  much  cor- 
rugated, in  some  places  the  epidermis  being  raised  from  the  cutis  vera. 
The  nails  are  firmly  adherent.  There  is  no  circular  depressed  mark  on 
the  fingers. 

"  (e)  Hair. — There  are  a  few  hairs  in  the  axilla,  of  a  dark  brown  color. 

"(/)  Weight— 7  1b.  6  oz.     x 

"  (<j)  Measurements. — Length  of  the  whole  arm  from  head  of  humerus 
to  tip  of  middle  finger,  31|  in. ;  the  measurements  along  both  flexor  and 
extensor  aspects  corresponding.  Length  of  forearm  from  tip  of  olecranon 
to  tip  of  middle  finger,  18  in.  Humerus  from  external  condjde  to  great 
tuberosity,  12^  in.  Humerus  from  head  to  internal  condyle,  12J  in. 
Ulna  from  tip  of  olecranon  to  styloid  process,  lOf  in.  Hand  from  third 
metacarpal  bone  to  tip  of  finger,  7£  in.  Third  finger  from  tip  to  point 
on  first  phalanx,  which  meets  a  line  drawn  transversely  from  root  of  the 
thumb-nail,  3|  in.  Circumference  of  arm  just  below  the  lower  end  of 
incision,  1  3  in.  Circumference  five  inches  above  internal  condyle,  12^  in. 
Circumference  of  forearm  one  inch  below  tip  of  olecranon,  10|  in. 
Wrist,  6§  in.     Hand,  8£  in. 

"  (h)  Ligature.— Surrounding  the  arm  six  inches  above  the  internal 
condyle  is  a  piece  of  string,  tightly  tied ;  this  string  is  partlv  wrapped  in 
paper  (newspaper).  The  mark  made  by  the  string  is  circular,  and  shows 
the  strands  of  the  ligature.  The  skin  below  the  string  is  parchment-like 
in  character,  but  there  is  no  ecchvmosis. 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  79 

"  The  tissues  divided  by  the  amputation  show  no  clotting  nor  ecchy- 
mosis.  The  veins  are  full  of  black  fluid  blood,  which  has  been  kept  in 
by  the  ligature. 

"  (i)  Disease. — There  is  no  disease  of  the  joint  or  limb. 

"  ( j)  Age. — The  epiphyses  of  the  humerus  are  firmly  uuited  to  the 
shaft,  and  also  that  of  the  fourth  metacarpal  bone.  These  unions  occur 
from  the  eighteenth  to  the  twentieth  year. 

u Height. — The  height  is  suggested  by  three  methods: 

"  (a)  Twice  the  length  of  the  arm  plus  ten  inches  for  the  clavicles 
(or  less  in  the  female)  and  one  inch  for  the  episternal  notch.  This 
would  give  31  x  2  =  62  +  10  =  72,  which  is  probably  several  inches  too 
much. 

"  (b)  The  length  of  the  third  finger  from  the  tip  to  a  point  meeting  a 
line,  drawn  transversely  from  the  root  of  the  thumb-nail,  is  tV  part  of 
the  height.     3f  x  19  =  68|  =  5  ft,  8|  in. 

"  (c)  The  length  of  the  forearm  from  the  tip  of  olecranon  to  tip  of 
third  finger  equals  ■£§  of  the  height ;  this  is :  18  x  ^  =  68*  —  5  ft.  8f  in. 

"Inferences.  Date  of  death. — The  appearance  of  the  hands  would 
suggest  maceration  in  water  from  three  to  four  weeks,  and  the  absence 
of  ecchymosis  proves  that  the  limb  was  separated  after  death. 

"  History. — The  limb  is  clearly  not  separated  by  the  ordinary  surgical 
operation  at  the  shoulder- joint,  for  the  following  reasons : 

"  1st.  The  incision  of  an  ordinary  operation  by  transfixion  has  the 
lowest  part  outside  and  the  highest  inside  for  the  formation  of  the  flap ; 
and  if  by  the  double  flap  methods,  the  longest  piece  of  skin  is  taken  from 
the  outside  of  the  arm. 

"  2d.  The  entire  absence  of  disease,  either  of  joint  or  limb,  such  as 
would  warrant  an  operation. 

"  3d.  The  separation  took  place  after  death. 

"  It  certainly  shows  no  trace  of  having  been  prepared  for  the  dissect- 
ing-room, as  there  is  no  injection  in  the  vessels,  nor  sign  of  preservation 
by  antiseptics." 

The  general  shape  and  appearance  of  the  hand  and  arm  suggested  at 
once  a  female  limb,  the  taper  fingers,  the  small  wrist,  and  the  absence  of 
any  special  peculiarity  all  favoring  this  view ;  the  neat  appearance  of  the 
nails,  and  the  absence  of  any  deformity  by  occupation,  were  against  a 
low-class  person. 

The  manner  in  which  the  limb  had  been  separated  was  exactly  the 
same  as  in  the  first  case,  and  similar  arguments  as  to  the  occupation  of 
the  operator  will  apply  in  this  case. 

"  Summary. — The  limb  is  apparently  that  of  a  female  adult  above 
twenty  years  of  age,  of  Caucasian  race,  of  dark  complexion,  and  about 
5  ft.  9  in.  in  height. 

"  It  has  not  been  separated  by  the  ordinary  surgical  operation  during 
life,  but  has  been  cut  off  after  death  by  a  person  with  some  knowledge 
of  anatomy. 

"  The  ligature  was  either  tied  around  to  prevent  the  bleeding  from  the 
veins,  or  to  fix  a  newspaper  wrapper  around  the  limb.  In  either  case  it 
had  the  result  of  preventing  the  draining  out  of  the  blood. 

"  Decomposition  had  begun  after  maceration  in  water." 

A  few  days  after  this  a  portion  of  the  trunk  was.  found  in  Whitehall, 
and  was  examined  by  Mr.  Bond  and  myself.     It  consisted  of  the  whole 


jjy  A   SYSTEM  OF  LEGAL  MEDICINE. 

thorax  and  the  upper  part  of  the  abdomen  as  far  as  the  fourth  lumbar 
vertebra. 

Description. — The  trunk  is  that  of  a  female,  the  breasts  being  present, 
It  comprises  the  thorax  and  upper  part  of  the  abdomen,  the  head  having 
been  separated  at  the  sixth  cervical  vertebra,  and  the  pelvis  and  lower 
part  of  the  abdomen  at  the  fourth  lumbar  vertebra.  The  bones  have 
been  cut  through  the  middle  of  the  bodies,  showing  flat,  somewhat  rough 
surfaces.  The  skin  incisions  have  clean,  well-defined  edges.  There  is  a 
fair  amount  of  subcutaneous  fat,  and  the  muscles  are  large  and  well  de- 
veloped. 

Measurements. — Length,  17  in.  Circumference  of  thorax  at  level  of 
nipple  line,  35£  in.     Circumference  of  waist,  28J  in. 

Surface. — The  skin  is  fair,  and  not  much  decomposed.  The  breasts 
are  large  and  prominent,  with  small,  well-shaped  nipples.  There  are  no 
scars  nor  wounds,  but  there  are  impressions  made  by  the  string  with 
which  the  trunk  was  tied.  These  are  four  in  number,  two  running  down 
obliquely  from  the  shoulder  and  two  crossing  the  chest,  one  at  the  level 
of  the  nipples  and  one  across  the  upper  part  of  the  sternum.  The  divided 
surfaces  are  much  decomposed,  and  the  parts  full  of  maggots.  There 
are  no  appearances  of  linea?  alba?  on  the  surface  of  the  abdomen. 

( 'tit  Surfaces.  Arms. — The  arms  have  been  amputated  at  the  shoulder- 
joints  by  several  incisions  passing  obliquely  downward  and  outward  from 
the  tip  of  the  shoulder  around  the  axilla.  The  glenoid  fossa?  are  bare, 
and  the  limbs  cleanly  disarticulated. 

Neck. — The  skin  of  the  neck  has  been  divided  opposite  the  cricoid 
cartilage  by  two  clean  lateral  cuts,  joined  in  front  and  behind  by  several 
small,  jagged  incisions ;  the  posterior  plate  of  the  cricoid  and  the  body 
of  the  sixth  cervical  vertebra  have  been  sawn  through.  The  tissues  of 
the  neck  on  either  side  are  in  an  advanced  state  of  decomposition. 

Organs.  Breast. — The  mammary  glands  are  large  and  healthy.  On 
opening  the  thorax  it  is  noticed  that  the  rib  cartilages  are  unossified. 

Heart. — The  substance  of  the  heart  is  healthy,  the  valves  normal,  and 
there  is  no  staining  of  the  endocardium  of  either  ventricle. 

Lungs. — The  left  lung  is  free  from  adhesions,  and  the  substance 
healthy.  The  right  lung  is  firmly  adherent  to  the  chest  wall  and  dia- 
phragm by  old  adhesions ;  the  substance  appears  healthy. 

The  liver,  spleen,  and  kidneys  are  normal. 

Stomach  contains  about  one  ounce  of  partially  digested  food. 

Intestines. — The  small  intestines,  with  the  mesentery,  are  in  situ,  and 
appear  healthy.  There  are  a  few  remains  of  the  transverse  ascending 
and  descending  parts  of  the  colon,  but  the  lower  parts  are  absent,  as  well 
as  the  pelvic  viscera. 

Hair. — There  are  a  few  dark-brown  hairs  in  the  axilla. 

The  clavicle  measures  six  inches,  and  the  sternum  six  inches.  The 
sternal  epiphysis  of  the  clavicle  is  united  to  the  shaft. 

Comparison  with  Arm. — The  arm  discovered  in  Pimlico  and  examined 
on  the  16th  of  September  was  brought  to  the  mortuary,  and  found  to 
exactly  correspond  to  the  trunk.  The  skin  incisions  fit,  and  the  bones, 
i.e.,  the  humerus  and  scapula,  evidently  belong  to  the  same  joint.  The 
hair  taken  off  the  arm  and  the  hair  from  the  axilla  of  the  trunk  are  iden- 
tical. 

Summary.— The  trunk  is  that  of  a  large,  well-nourished  woman,  of  an 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  81 

age  of  full  sexual  activity,  as  shown  by  the  breasts.  It  could  not  be  de- 
cided whether  she  had  been  a  mother,  but  the  appearance  of  the  breasts 
would  indicate  that  she  had  not  suckled  children.  The  trunk  had  been 
mutilated  after  death,  and  the  death  had  probably  occurred  about  two 
months  previously.  Decomposition  had  taken  place  in  the  air,  as  shown 
by  the  presence  of  maggots. 

A  fortnight  after  this  a  left  leg  and  foot  were  found.  The  skin  was 
incrusted  with  earth,  and  partly  covered  with  mold.  The  cuticle  of  the 
sole  of  the  foot  and  toes,  with  the  nails,  had  nearly  separated.  The  nails 
were  well  shaped  and  properly  trimmed.  The  skin  of  the  leg  was  fair, 
and  not  much  altered  by  decomposition. 

The  limb  had  been  separated  from  the  thigh  at  the  knee-joint,  the 
patella  being  absent.  The  incision  had  clean  and  well-defined  edges,  and 
the  joint  exactly  opened. 

The  length  of  the  leg  was  17£  in. ;  circumference  of  calf,  14  in. ;  ankle, 
8%  in. ;  length  of  foot,  9£  in.  On  the  outside  of  the  leg  was  a  dark  purple 
mark  the  size  of  a  shilling,  and  the  tissue  beneath  contained  clotted  blood. 
A  small  but  similar  mark  was  on  the  inside  of  the  leg. 

The  length  and  size  of  the  leg  and  foot  pointed  to  its  being  part  of  the 
same  body.  The  marks  were  ante-mortem  bruises.  The  date  of  death 
was  from  six  weeks  to  two  months  previously. 

The  remains  showed  various  kinds  of  putrefaction  :  the  arm  had  been 
in  the  water,  the  trunk  exposed  to  the  air,  and  the  leg  buried. 

As  will  be  gathered  from  the  description,  the  arm  in  the  second  case 
had  been  cut  from  the  trunk  in  a  precisely  similar  manner  to  that  in  the 
first  case ;  in  fact,  as  soon  as  I  saw  the  arm  I  was  struck  by  the  close  re- 
semblance of  the  modes  of  separation,  and  the  mutilatiou  of  the  trunk 
was  in  every  respect  identical. 

Case  III. 

The  parts  found  were :  (1)  two  large  flaps  of  skin,  the  uterus  and 
placenta ;  (2)  both  arms  and  hands ;  (3)  both  thighs ;  (4)  both  legs  and 
feet ;  (5)  the  trunk  divided  into  three  parts. 

The  Trunk. — The  first  portion  of  the  trunk  included  the  shoulders  and 
the  upper  part  of  the  back ;  the  head  and  neck  had  been  taken  off  oppo- 
site the  sixth  cervical  vertebra ;  the  skin,  muscles,  and  vessels  were 
divided  cleanly  by  a  series  of  cuts ;  the  cricoid  cartilage  was  cut  through, 
and  the  body  of  the  sixth  cervical  vertebra  divided  through  the  center, 
showing  a  flat  and  somewhat  rough  surface.  The  edges  of  the  skin  and 
the  section  of  the  vessels  were  sharply  defined.  This  part  was  separated 
from  the  trunk  below  at  the  junction  of  the  seventh  and  eighth  dorsal 
vertebras. 

The  chest  had  been  opened  in  front  by  the  mid-line,  the  upper  part 
•of  the  sternum  cut  through,  and  the  contents  of  the  chest  had  been 
removed. 

Both  arms  had  been  taken  off  opposite  the  shoulder-joints  by  three 
or  torn1  long,  sweeping  cuts,  the  joints  neatly  disarticulated.  Decompo- 
sition had  not  far  advanced ;  the  skin  was  white  and  sodden,  the  epidermis 
peeling  off  in  places.  The  second  portion  of  the  trunk  included  both 
breasts  and  the  upper  part  of  the  abdomen  as  far  as  the  intervertebral 
substance  between  the  third  and  fourth  lumbar  vertebrae.     The  upper 


82  A   SYSTEM    OF   I. ECU.    MEDICINE. 

surface  of  this  portion  exactly  fitted  the  lower  surface  of  the  former  part. 
It  had  also  been  opened  down  the  center  of  the  sternum. 

The  ribs  from  the  fourth  downward  were  present ;  the  lower  border 
showed  a  clearly  defined  skin  margin  from  the  back  at  the  junction  of 
tin1  third  and  fourth  lumbar  vertebras  to  a  point  an  inch  and  a  half  above 
the  umbilicus  on  the  left  side,  and  a  point  just  below  the  umbilicus  on 
the  right  side. 

The  intestines  had  been  removed,  but  the  duodenum  and  a  piece  of 
the  stomach  remained.  There  were  also  present  both  kidneys,  the  spleen, 
pancreas,  aud  liver.  The  breasts  were  firm  and  compact,  and  enlarged ; 
the  areolae  well  marked,  and  follicles  distinct.  All  the  organs  found  were 
healthy.     The  liver  was  much  decomposed. 

The  third  portion  of  the  trunk  consisted  of  the  pelvis  from  below  the 
third  lumbar  vertebra.  The  thighs  had  been  taken  off  opposite  the  hip- 
joints  by  long,  sweeping  incisions  through  the  skin,  muscles,  and  tissues 
down  to  the  joint,  the  heads  of  the  bones  neatly  disarticulated.  The 
incisions  separating  both  the  arms  from  the  upper  piece,  and  the  thighs 
from  the  lower  piece,  were  exactly  opposite  the  flexure  of  the  joints.  The 
pelvis  contained  the  lower  part  of  the  vagina  and  the  lower  part  of  the 
rectum,  the  front  part  of  the  bladder  including  the  urethra.  The  vagina 
was  flaccid,  the  mucous  membrane  healthy,  and  still  showing  rugae. 
There  was  no  rupture  of  the  vaginal  walls  or  fourchette,  nor  was  there 
any  swelling  nor  congestion  of  the  parts. 

The  flaps  of  skin  and  subcutaneous  tissues  consisted  of  two  long, 
irregular  slips  taken  from  the  abdominal  walls.  The  left  piece  included 
the  umbilicus,  the  greater  part  of  the  mons  veneris,  the  left  labium  majus, 
and  labium  minus.  The  right  piece  included  the  rest  of  the  mons  ve- 
neris, the  right  labium  majus  and  minus,  and  part  of  the  skin  of  the  right 
buttock.  These  flaps  accurately  fitted  together  in  the  mid-line,  and 
laterally  corresponded  to  the  incisions  in  the  two  lower  pieces  of  the  trunk. 
The  skin  was  fair,  and  the  mons  veneris  was  covered  with  light  sandy 
hair.  There  were  no  appearances  of  linear  alba?.  The  upper  part  of  the 
vagina  was  attached  to  the  uterus,  both  ovaries  and  broad  ligaments 
were  present,  and  the  posterior  wall  of  the  bladder.  The  uterus  had 
been  opened  on  the  left  side  by  a  vertical  cut,  six  inches  long,  through 
the  left  wall.  The  organ  was  much  dilated,  the  vessels  on  the  inner  sur- 
face large  and  open,  and  the  mucous  membrane  swollen  and  softened. 
The  uterus  measured  10  in.  long  by  7£  in.  wide.  The  circumference  of 
the  os  externum  was  4  in.  The  length  of  the  cervix  from  the  os  exter- 
num to  the  os  internum  was  §  in.  Inside  the  uterus  were  the  placenta, 
cord,  and  membranes.  The  cord  measured  8  in.,  and  the  distal  ends 
showed  a  clean  cut,  The  vessels  contained  fluid  blood.  The  placenta 
was  circular,  and  measured  6£  in.  in  diameter.  The  ovaries  were  irreg- 
xdar  and  shriveled,  the  right  containing  a  cyst. 

The  Arms. — The  arms  had  been  removed  from  the  trunk  at  the 
shoulder-joint ;  when  the  upper  ends  of  the  arms  were  placed  against  the 
shoulders  of  the  trunk  it  was  found  that  the  joint  surfaces  corresponded, 
and  that  the  margins  of  the  skin  accurately  fitted ;  the  two  limbs  were 
identical  in  appearance  and  measurements.  The  skin  of  the  hands  was 
white  and  much  corrugated,  and  the  epidermis  peeling  off;  the  nails 
were  still  adherent.  The  nails  were  short,  the  edge  much  below  the  tip 
of  the  finger,  with  an  irregular  outline.     There  was  no  thickening  of  the 


DEATH  IN  ITS  MEDICO-LEGAL   ASPECTS.  83 

skin  of  the  palm  or  fingers.  The  hair  in  the  armpit  was  similar  in  color 
to  that  on  the  pubes.  On  the  upper  and  outer  side  of  the  left  arm  were 
four  round  superficial  cicatrices.  On  the  back  of  the  left  ring-finger  was 
a  small  discoloration,  a  quarter  of  an  inch  broad ;  this,  when  cut  into, 
showed  extravasation  of  Mood  in  the  tissues.  On  the  inner  side  of  the 
left  forearm,  about  one  inch  above  the  wrist,  there  was  an  irregular, 
white,  hard  cicatrix  one  inch  long  and  a  quarter  of  an  inch  wide.  There 
was  a  small  bruise  over  the  internal  condyle  of  the  left  arm,  and  another 
one  just  below  the  right  internal  condyle. 

Measurements. — Whole  length  of  arm  and  hand,  26£  in. ;  from  the 
elbow  to  tip  of  middle  finger,  16£  in.  Length  of  middle  finger,  3^  in. 
Length  of  hand,  6f  in. ;  breadth  of  hand,  3£  in.  Circumference  of  wrist, 
5|  in.  Circumference  of  palm,  7  in.  Humerus,  great  trochanter,  and 
external  condyle,  lOf  in.  Head,  to  internal  condyle,  11^  in.  Ulna,  to 
styloid  process,  9^  in. 

Lower  Extremities. — Thighs:  On  placing  the  upper  ends  of  the  thighs 
to  the  hip-joints  of  the  pelvis,  the  heads  of  the  femora  exactly  fitted  the 
cotyloid  cavities,  and  the  margins  of  the  skin  corresponded.  The  legs 
had  been  removed  at  the  knee-joint,  the  left  thigh  having  the  patella 
attached,  and  also  the  semilunar  cartilages.  The  length  of  the  femur 
from  the  head  to  the  internal  condyle  was  17  in. ;  the  circumference  at  the 
knee-joint,  13  in. ;  and  the  maximum  circumference,  19£  in.  At  the  inner 
side  of  the  upper  part  of  the  thigh  were  some  light  sandy  hairs  similar  in 
color  to  those  on  the  pubes.  The  skin  was  fair,  not  decomposed,  and  the 
tissues  were  fresh.  The  right  thigh  exactly  resembled  both  in  measure- 
ments and  condition  the  left. 

Legs  :  On  placing  the  lower  ends  of  the  thighs  against  the  upper  ends 
of  the  legs,  the  joint  surfaces  and  the  cuts  in  the  skin  were  found  to  fit. 
The  leg  and  foot  measured  16i  in.  The  tibia  was  13£  in.  long;  fibula, 
13  in.  long;  foot,  9i  in.  long.  The  circumference  of  the  left  calf  equals 
13£  in.,  of  the  right,  13J  in.  There  was  no  deformity  of  the  toes,  and 
the  feet  were  well  shaped.  The  whole  length  of  the  lower  extremities 
equals  32J  in. 

Epiphyses. — The  sternal  ends  of  the  clavicle  had  recently  joined,  but 
the  line  of  the  union  was  still  evident,  the  tips  of  the  acromial  processes 
of  the  scapulae  had  not  joined  the  spine.  The  upper  ends  of  the  fibulae 
had  firmly  united. 

The  following  inferences  were  then  drawn  from  the  foregoing  facts. 

Sex. — The  sex  was  female.  The  uterus  was  that  of  a  pregnant  woman, 
and  the  size  of  the  uterus  as  well  as  that  of  the  placenta  would  indicate 
that  the  pregnancy  had  advanced  to  between  six  and  seven  months.  The 
measurement  and  appearance  of  the  os  and  the  length  of  the  cervix 
showed  that  delivery  had  not  taken  place,  but  the  foetus  had  evidently 
been  removed  through  the  incision  in  the  left  wall  of  the  womb.  The 
condition  of  the  vagina  and  the  non-rupture  of  the  fourchette  confirmed 
this  view. 

Age. — The  complete  union  of  the  epiphyses  of  the  fibulae  proved  her 
age  to  be  over  twenty-four  years,  while  the  not  complete  union  of  the 
acromial  processes  and  the  sternal  ends  of  the  clavicle  showed  she  was 
under  twenty-five.     The  complexion  was  fair,  as  shown  by  the  hair. 

Height.— Twice  the  length  of  the  whole  lower  extremities  equals  65| 
in.      The  length  of  the  forearm,  16f  x  V-  =  03-A-g-.      Length   of  middle 


84  J.   SYSTEM   OF  LEGAL   MEDLCINE. 

finger,  3£  x  19  =  63£  in.  Twice  the  length  of  the  arm  =  53f  +  11  in. 
for  the  clavicles  ami  sternum  =  64f  in. 

Incisions. — The  surfaces  of  the  vertebra?  are  such  as  would  be  made 
by  a  fine-toothed  saw.  The  clean  edge  of  the  skin  incisions  showed  that 
a  very  sharp  knife  had  been  used.  The  joints  in  each  case,  with  the  ex- 
ception of  the  left  knee,  were  exactly  opened,  and  the  limbs  neatly  dis- 
articulated. In  the  case  of  the  left  knee  the  semilunar  cartilages  were 
attached  to  the  ends  of  the  femur. 

Condition  of  Life. — There  was  no  thickening  of  any  portion  of  the  skin 
of  the  hands  which  would  suggest  any  special  occupation.  The  bruise 
on  the  back  of  the  left  ring-finger  might  have  been  made  by  the  forcible 
removal  of  a  ring.  There  was  no  mark  either  on  the  thighs  or  the  legs, 
as  is  made  by  the  pressure  of  a  garter.  It  was  clear  from  the  direction 
and  manner  of  the  cuts  that  no  ordinary  surgical  or  dissecting-room 
operation  had  been  carried  out,  but  the  system  of  division  of  the  parts 
gave  evidence  of  design  and  skill — the  design  probably  being  for  the 
purpose  of  concealment  of  the  crime  and  easy  carriage  of  the  parts ;  the 
skill  not  showing  the  anatomical  knowledge  of  a  surgeon,  but  rather  the 
aptitude  learned  by  a  butcher,  horse-knacker,  or  other  person  used  to 
deal  with  dead  animals  and  to  readily  separate  limbs  at  the  joints. 

All  the  parts  evidently  belonged  to  the  same  body.  The  state  of  de- 
cornp*  >sition  of  the  various  pieces  is  consistent  writh  the  theory  that  death 
took  place  about  twenty-four  hours  before  the  discovery  of  the  first  two 
portions. 

Summary. — The  summary  was  that  the  remains  were  those  of  an 
adult  female  of  fair  complexion,  with  light  sandy  hair,  well  formed  and 
well  nourished,  from  twenty-four  to  twenty-five  years  old,  and  about  5  ft. 
4  in.  in  height;  that  she  was  pregnant  of  about  six  to  seven  months' 
duration ;  that  she  was  undelivered  when  death  took  place,  and  that  the 
foetus  had  been  removed  by  an  incision  through  the  walls  of  the  uterus 
after  death ;  that  the  mutilations  were  carried  out  after  death  by  some 
person  with  a  considerable  technical  knowledge  of  the  speediest  mode  of 
cutting  up  animals ;  that  decomposition  had  taken  place,  partly  in  water 
and  partly  in  the  air ;  and  that  death  occurred  about  twenty-four  hours 
before  the  first  discovery.  That  an  injury  had  been  suffered  to  the  left 
forearm  which  left  a  permanent  cicatrix. 

The  great  interest  in  this  case  was  that  the  foregoing  inferences  were 
verified  by  the  identification  of  the  woman.  She  was  proved  to  be  an 
unfortunate,  named  Elizabeth  Jackson,  who  was  in  her  twenty-fifth  year, 
measured  5  ft.  4i  in.  in  height,  and  was  known  to  be  far  gone  in  pregnancy. 

The  verification  of  the  remains  was  confirmed  by  the  cicatrix  on  the 
left  wrist,  which  was  caused  by  a  fall  ou  a  broken  bottle  some  years  pre- 
viously.    She  was  last  seen  two  days  before  the  discovery  of  the  remains. 

With  regard  to  the  height,  the  various  calculations  do  not  exactly 
correspond,  but  the  average'of  the  four  would  give  a  little  over  04^  in., 
so  that  the  inference  was  very  near  the  exact  truth. 

This  case  is  remarkable  from  the  fact  that,  beginning  with  one  limb 
only,  the  other  parts  of  the  body  were  found.  "The  adoption  of  four 
different  methods  was  pursued  in  estimating  the  height.  Each  method 
gave  a  result  within  an  inch ;  and  then,  taking  the  mean  of  the  four 
measurements,  we  arrived  at  the  actual  height  as  described  by  the  per- 
sons who  identified  the  body. 


DEATH  IN  ITS  MEDICO-IEGAL  ASPECTS.  §5 

Case  IV. 

This  case  was  that  of  a  trunk  found  under  an  archway  in  White- 
chapel,  and  on  September  11,  1889,  I  was  present  at  the  post-mortem  ex- 
amination, and  made  the  following  report  to  the  police. 

The  remains  consisted  of  the  trunk  and  arms  of  a  female  bod}-.  The 
head  had  been  cut  off  at  the  lower  part  of  the  neck,  and  the  thighs  had 
been  separated  at  the  hip-joints. 

The  trunk  was  plump  and  well  formed,  with  Ml  breasts,  fail*  skin, 
and  dark-brown  hair  on  the  pubes  and  axilla? ;  the  arms  well  shaped^ 
hands  small,  and  nails  well  kept.  The  weight  of  the  trunk  could  not  be 
taken.  The  length  was  26  in.,  and  circumference  of  chest  at  nipple-line 
31  in.,  and  below  breasts,  31  f  in. 

Rigor  mortis  had  passed  off,  and  decomposition,  as  shown  by  green 
discoloration  of  the  abdomen,  just  beginning.  The  cut  surfaces  at  the 
hips  were  black  and  dry,  but  the  surface  at  the  neck  moist  and  red. 
The  skin  and  muscles  of  the  abdomen  had  been  cut  by  a  vertical  incision, 
running  from  two  inches  below  the  ensiform  cartilage  downward,  and 
ending  on  the  left  side  of  the  external  genitals,  just  opening  the  vagina, 
but  not  opening  the  peritoneal  cavity.  There  were  a  number  of  small 
round  bruises  on  the  forearms  and  arms,  most  ou  the  inner  surface  of 
the  forearms,  and  varying  in  size  from  a  shilling  to  a  sixpence.  On  the 
left  wrist  were  two  cuts,  one  just  grazing  the  skin,  three  quarters  of  an 
inch  long,  and  the  other  cutting  through  the  skin,  and  one  inch  long. 
There  was  no  ecchymosis  on  the  edges,  and  no  gaping  of  the  wounds. 
There  are  no  linea?  alba?  on  the  abdomen,  and  no  further  scars  or  injuries. 

The  incisions  separating  the  head  were  apparently  two  in  number: 
the  first  beginning  behind,  opposite  the  spinal  column,  and  ending  in 
front  on  the  right  side,  and  carried  from  left  to  right ;  the  second  begin- 
ning on  right  side  in  front  and  carried  to  back,  joining  the  first,  but 
leaving  a  tongue  of  skin  behind.  There  was  no  ecchymosis  in  the  skin. 
The  muscles  and  tissues  down  to  the  spinal  column  were  cut  on  the  same 
level,  the  cricoid  cartilage  being  cut  about  the  center.  The  spinal  col- 
umn was  divided  at  the  junction  of  the  fifth  and  sixth  cervical  vertebra1, 
through  the  intervertebral  substance,  just  a  thin  shaving  of  the  body  of 
the  fifth  cervical  vertebra  being  left.  The  ends  of  the  vessels  were  very 
clean  cut.     There  was  no  retraction  of  the  muscles  or  other  tissues. 

The  thighs  had  been  separated  at  the  hip-joints,  the  skin  cut  through 
by  two  or  three  sweeping,  circular  incisions,  beginning  apparently  just 
below  the  hip-bone,  and  carried  downward  and  inward  around  the  but- 
tock. The  capsules  of  the  hip-joints  were  opened,  and  the  heads  of  the 
bones  neatly  disarticulated. 

There  was  no  retraction  of  the  muscles  and  tissues,  and  the  incisions, 
both  at  the  hip  and  neck  and  in  the  abdomen,  had  very  clear-cut  edges. 

The  internal  viscera  were  then  examined. 

Heart. — The  walls  were  flaccid,  the  ventricles  empty  and  dilated  ;  the 
valves  healthy  and  competent,  the  muscle  pale  and  fatty.  On  the  peri- 
cardium was  a  patch  of  old  inflammation.     Weight,  9^  oz. 

Lungs. — Right  upper  lobe  adherent  to  pleura  by  <>1<1  firm  adhesions. 
Left  lung  free.  Both  lungs  were  apparently  healthy,  but  were  beginning 
to  decompose. 


g6  A    SYSTEM   OF  LEGAL  MEDICINE. 

Spleen  large,  soft,  decomposing;  7£  oz. 

lAver— Weight,  50  oz. ;  decomposing,  substance  fairly  healthy. 

Kidneys. — Weight,  7  oz.  each ;  slight  decomposition,  substance  fairly 

healthy. 

Stomach. — Walls  normal,  with  healthy  mucous  membrane.  About  a 
dram  or  so  of  partly  digested  food,  which  appeared  to  be  plums;  there 
was  no  odor  of  the  contents. 

/„/,  $tine. — The  large  intestine  contained  fa?ces.  There  was  no  abnor- 
mality in  either  large  or  small  gut. 

Vulva. — The  vulva  is  patent,  and  there  is  no  hymen.  The  fourchette 
is  unruptured.  The  vagina  is  wide,  but  still  rugose.  The  mucous  mem- 
brane is  healthy. 

The  uterus  weighs  rather  less  than  2  oz.,  and  is  3  in.  long,  of  which 
the  body  measures  1£  in.,  the  cervix,  1£  in.  The  cavity  of  the  body  is- 
triangular,  with  a  convexity  downward  at  the  base.  The  cervix  has  well- 
marked  arbor  vita?.  The  os  is  small,  and  the  lips  are  not  everted.  The 
os  just  admits  a  large  probe.  There  is  a  little  whitish  thick  mucus  ooz- 
ing from  the  os  uteri.  The  mucous  membrane  is  rather  thick,  and  covered 
with  a  reddish  mucus. 

The  ovaries  are  small,  cystic,  and  degenerating.  There  is  a  small  ex- 
travasation of  blood  in  the  left  ovary. 

The  measurement  of  the  arms  outstretched  across  the  chest  equals 
64  in.  The  forearm  measured  16£  in.,  the  hand,  6£  in.  long  and  6f  in.  in 
circumference  at  the  palm. 

On  the  first  joint  of  the  dorsal  surface  of  the  right  little  finger  is 
a  small  round  hardening,  not  amounting  to  a  corn,  and  a  similar  but 
smaller  hardening  on  the  inner  side  of  the  back  of  the  first  joint  of  the 
right  ring-finger. 

The  sternal  epiphysis  of  the  clavicle  had  united  by  bone. 

The  tissues  generally  were  pale  and  bloodless. 

Comment. — The  remains  are  those  of  a  large,  well-nourished  woman. 

Her  height,  as  calculated  by  the  transverse  measurements  and  forearm,, 
about  5  ft.  3£  in.  The  length  of  the  forearm  was  16£  in.,  and  this  mul- 
tiplied by  -V1  equals  62  nr  in. ;  the  transverse  measurement  of  outstretched 
arms  equals  64  in.,  so  that  the  mean  equals  63£. 

Her  age  is  above  twenty-five,  as  shown  by  the  union  of  the  epiphyses. 
The  presence  of  a  small  extravasation  of  blood  in  the  ovary  showed  that  she 
had  not  reached  the  menopause,  but  we  could  not  calculate  her  age  more 
accurately  than  to  say  she  was  over  twenty-five  and  under  forty  years  old. 

Hhe  had  not  borne  children,  as  shown  by  the  uterus  and  absence  of 
lineas  alba?,  and  the  breasts  did  not  give  the  impression  of  having  been 
used  for  suckling. 

She  was  apparently  not  a  virgin,  and  the  vagina  had  been  distendedT 
though  not  so  patent  as  after  child-bearing.  The  skin  is  fair  and  the 
hair  dark  brown.  The  hands  are  shapely,  and  the  skin  soft.  There  are 
no  marks  indicating  any  occupation,  except  that  on  the  right  little  finger 
is  a  small  circular  hardening,  but  no  corn.  This  mark  is  such  as  might 
be  made  by  writing.  There  is  no  mark  as  of  a  ring  worn  on  the  left 
ring-finger. 

The  immediate  cause  of  death  was  syncope,  as  shown  by  the  condition 
of  the  heart,  and  the  general  bloodlessness  of  the  tissues  would  indicate 
hemorrhage  as  the  cause  of  the  syncope. 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  37 

There  was  no  organic  disease  of  the  viscera  examined  which  would  have 
caused  death. 

The  edges  of  the  cuts  showed  that  a  very  sharp  knife  had  been  used; 
all  the  cuts  had  been  made  after  death. 

All  the  cuts  were  made  from  left  to  right  except  those  separating  the 
right  thigh  and  right  arm,  which  had  been  carried  from  right  to  lefl 
across  the  flexures  of  the  joints,  and  so  probably  done  by  a  right-handed 
man. 

The  incisions  were  evidently  made  with  design,  and  were  skilfully 
performed,  as  by  a  man  who  had  some  knowledge  of  the  position  of 
joints  and  the  readiest  means  of  separating  limbs — such  knowledge  as  a 
butcher  or  slaughterer  would  possess.  They  do  not  indicate  a  special 
anatomical  knowledge  of  the  human  body. 

Signs  of  Death.— The  question  of  the  reality  of  death  as  distinguished 
from  apparent  death  is  not  often  raised  in  these  days.  There  has  been, 
however,  among  the  people  of  all  countries  a  dread  of  being  buried  alive 
— a  fear  that  has  been  augmented  by  sensational  reports  of  exhumations 
where  the  position  of  the  body  differed  so  much  from  that  presented  when 
committed  to  the  earth  as  to  cause  the  belief  in  the  minds  of  the  unin- 
formed that  life  had  not  been  extinct  at  time  of  sepulture.  The  expla- 
nation of  this  change  of  posture,  as  will  be  seen  later,  is  undoubtedly  due 
in  most  instances  to  the  effects  of  the  gases  arising  from  decomposition, 
and  not  to  voluntary  muscular  movements. 

It  is  possible  that  in  times  of  severe  epidemics  of  diseases,  such  as. 
for  iustance,  cholera  or  smallpox,  there  may  have  been  in  the  desire  for 
speedy  intermeut  an  occasional  case  of  burial  before  life  was  demonstra- 
bly extinct,  especially  in  Eastern  countries,  but  such  cases  are  the  rare 
exception.  I  can  recall  several  cases  of  persons  so  imbued  with  the  fear 
of  premature  burial  that  they  have  insisted,  as  a  last  request,  upon  the 
opening  of  a  vein  or  artery  after  death.  One  case  in  particular  was 
that  of  a  very  intelligent  man,  a  clergyman  and  an  editorial  writer,  who 
was  in  the  greatest  state  of  anxiety  upon  this  subject,  and  extracted  a 
solemn  promise  from  me  that  I  would  not  permit  the  burial  to  take  place 
till  I  had  opened  both  veins  at  the  elbow.  In  consequence  of  such  appre- 
hension, the  medical  man  may  be,  and  doubtless  is  occasionally,  called 
upon  to  decide  the  question  of  the  reality  of  death.  The  apparent  ab- 
sence of  some  of  the  more  commonly  known  signs  of  death  have  a  dis- 
quieting effect  upon  the  minds  of  relatives  and  friends,  so  that  careful 
consideration  of  the  signs  of  death,  both  those  presenting  themselves 
immediately  at  the  cessation  of  life  and  those  which  are  observed  as  the 
consequence  of  chemical  and  putrefactive  changes  at  a  later  period,  is 
most  necessary. 

It  is  well  recognized  that  death,  whatever  may  have  been  the  remote 
cause,  begins  at  one  or  the  other  of  three  points,  the  brain,  the  lungs,  or 
the  heart,  all  three  being  soon  involved  in  the  cessation  of  vital  molecular 
process. 

It  is  only  necessary  to  consider,  however,  for  the  purpose  of  deter- 
mining the  reality  of  death,  the  question  of  the  arrest  of  respiration  and 
circulation.  To  the  onlooker  the  more  obvious  of  these  two  things  is  the 
cessation  of  the  breathing,  which  is  followed  in  a  short  time  by  the  cessa- 
tion of  the  circulation  in  consequence  of  the  stopping  of  the  action  of  the 
heart.     Usually  the  breathing  is  arrested  some  seconds,  or  even  minutes, 


83  A   SYSTEM  OF  LEGAL   MEDICINE. 

before  the  cessation  of  the  heart's  action,  and  in  any  question  of  doubt 
the  careful  examination  of  the  chest  should  not  fail  to  give  evidence, 
through  the  stethoscope,  of  the  complete  cessation  of  respiration.  The 
same  test  should  be  applied  to  the  action  of  the  heart,  inasmuch  as  it  is 
well  known  that  complete  arrest  of  the  respiration  need  not,  and  often 
does  not,  mean  the  cessation  of  life.  An  example  of  this  is  the  possibil- 
ity of  the  resuscitation  of  the  drowned  after  a  short  period  of  submersion. 
In  these  cases  often  there  is  no  respiration  to  be  detected,  though  the 
physical  signs  of  cardiac  movements  are  to  be  found. 

That  respiration  can  be  entirely  suspended  for  any  considerable  period 
without  the  consequent  cessation  of  heart  action  seems  incredible,  al- 
though it  has  been  claimed  by  some  authors  that  persons  who  have  been 
submerged  in  a  state  of  syncope  have  been  resuscitated  after  as  long  a 
period  as  half  an  hour,  or  even  an  horn*.  From  a  physiological  standpoint 
it  might  be  argued  that  as  long  as  the  blood  remains  fluid,  as  it  generally 
does  in  cases  of  asphyxia,  and  thus  capable  of  flowing  through  the  heart,, 
that  it  would  be  possible,  by  restoring  to  the  blood  the  oxygen  of  which 
it  has  been  deprived,  to  furnish  to  the  heart  that  stimulant  which  is 
necessary  for  its  action.  It  is  quite  clear,  nevertheless,  that  after  rigor 
mortis  is  established — and  this  occurs  very  soon  after  submersion,  par- 
tially owing  to  the  rapid  cooling  of  the  body — no  such  thing  as  restoring 
the  heart's  action  would  be  possible. 

While  a  person  who  has  been  submerged  in  a  state  of  syncope  would 
struggle  less,  and  in  consequence  of  this  absence  of  struggling  would  in- 
spire a  smaller  quantity  of  water,  and  therefore  would  be  in  a  somewhat 
more  favorable  condition  for  resuscitation,  it  is  difficult  to  believe,  all 
things  considered,  that  after  the  cessation  of  respiration  for  so  long  a 
period  as  thirty  minutes  life  would  not  be  extinct ;  and  while,  as  stated, 
a  few  such  cases  are  reported,  it  is  possible  that  the  face  was  not  wholly 
submerged.  At  all  events,  the  strongest  proof  as  to  the  completeness 
and  the  duration  of  submersion  should  be  required  before  such  cases  are 
removed  from  the  domain  of  the  apocryphal. 

The  condition  of  the  blood  at  the  immediate  approach  of  death  from 
disease,  and  the  rapid  change  which  occurs  after  the  cessation  of  systemic 
life,  namely,  its  coagulation,  would  obviously  prevent  any  possible  res- 
toration of  the  vital  processes  after  the  shortest  possible  period.  I  would 
not  deny  that  there  are  cases  where  the  death  appearances  have  been  so 
striking  that  even  physicians  of  ordinary  skill  have  been  deceived ;  but 
I  believe  had  there  been  a  very  careful  examination  of  the  organs  of 
circulation  and  respiration,  there  would  have  been  found  evidence  that 
those  processes  were  not  wholly  arrested,  though  proceeding  in  the  faint- 
est way. 

Two  cases  which  came  under  my  own  observation  illustrate  this  posi. 
tion.  Some  four  years  ago  I  was  called  to  examine  the  body  of  a  young 
woman  who  was  said  to  have  committed  suicide  by  the  self-administration 
of  a  solution  of  carbolic  acid.  On  arriving  at  the  room  where  the  body 
lay,  I  found  it  lying  on  the  bed  covered  only  with  a  sheet ;  the  eyes  were 
closed,  there  was  no  perceptible  respiration,  and  I  could  not  discover  anv 
pulsation  at  the  wrist,  though  it  must  be  admitted  that  I  did  not  make  a 
very  careful  examination  at  the  moment,  inasmuch  as  I  was  informed  1  >\ 
the  person  present  that  death  had  occurred  more  than  half  an  hour  pre- 
vious to  my  arrival,  and  I  was  making  inquiries  as  to  the  circumstances 


DEATH  IN   ITS   MEDICO-LEGAL  ASPECTS.  §9 

of  the  case.  The  body  was  cool  but  not  cold — a  condition  not  one  to 
attract  attention  at  so  early  a  period  after  death.  After  a  short  conver- 
sation with  the  attendant,  during  which  I  found  that  the  drug  had  been 
taken  early  in  the  morning,  and,  owing  to  the  suicide's  having  taken  the 
entire  contents  of  a  two-ounce  vial  of  the  solution,  the  strength  of  the 
solution  could  not  be  ascertained,  and  thereby  a  conclusion  formed  as  to 
the  actual  amount  of  acid  taken,  I  had  occasion  to  repeat  a  question  in 
an  unusually  loud  tone  at  a  moment  when  I  chanced  to  be  looking  at  the 
body.  I  noticed  a  slight  movement  about  the  eyelids,  and  on  addressing 
the  assumed  dead  person  by  her  Christian  name,  perceived  an  attempt  to 
raise  the  lids.  Although  the  physician  who  was  first  summoned  to  the 
case  had  some  hours  before  pronounced  the  woman  to  be  in  articulo 
mortis,  and  had  prognosticated  death  within  a  few  minutes,  I  succeeded 
after  a  long  time  in  getting  animation  so  far  restored  that  in  spite  of  her 
objection  I  administered  an  antidote,  and  eventually  secured  her  removal 
to  a  hospital,  where  she  recovered  without  even  a  sign  of  gastritis.  I 
am  quite  sure  that  had  I,  in  the  first  place,  instead  of  assuming  that  death 
was  present,  applied  my  stethoscope  to  the  lungs,  I  should  have  found 
ample  evidence  that  life  was  not  extinct.  It  is  quite  probable  that  the 
woman  might  have  eventually  recovered  without  medical  assistance,  as 
from  the  subsequent  history  of  the  case  it  is  improbable  that  a  large 
amount  of  the  acid  was  swallowed ;  but  at  all  events,  she  had  taken 
enough  to  reduce  her  to  a  condition  where  all  the  more  common  appear- 
ances of  systemic  life  were  obscured. 

Another  case  was  the  following :  In  the  winter  months,  seven  years 
ago,  a  young  unmarried  woman  was  a  patient  at  the  lying-in  hospital. 
When  in  the  month  of  January  she  was  discharged,  from  fear  of  the  re- 
ception she  would  meet  at  home,  where  her  condition  had  not  been 
known,  she  strove  ineffectually  to  place  the  illegitimate  child  in  sonic 
one  of  the  public  institutions.  She  then,  according  to  her  own  statement, 
reasoning  that  if  the  child  was  found  exposed  in  a  public  place  it  would 
be  taken  to  one  of  these  institutions  and  its  reception  there  follow  as  a 
matter  of  course,  placed  the  child,  with  such  clothing  as  was  furnished 
at  the  hospital,  in  a  basket,  and  placed  it  in  an  alley  near  a  platform 
erected  for  the  reception  of  goods  into  the  rear  entrance  of  a  store  on  a 
principal  street.  Her  idea  as  to  its  being  immediately  found  was  falla- 
cious, for  the  child  was  deposited  in  the  afternoon  of  Saturday,  at  a  time 
when  there  chanced  to  be  no  teams  sent  to  this  place.  The  child  re- 
mained in  this  alley  till  the  afternoon  of  the  following  day,  there  having 
meanwhile  occurred  a  severe  snowstorm.  It  was  then  discovered- by  a 
policeman,  who,  on  examination,  decided  that  it  was  dead,  and  it  was 
taken  to  the  rooms  of  a  neighboring  undertaker,  instead  of  being  taken 
to  the  morgue,  as  was  the  usual  custom. 

After  the  body  had  remained  at  the  rooms  of  this  undertaker  for 
many  hours  I  was'  called  to  examine  the  body.  After  talking  with  the 
undertaker  and  policeman  in  another  room  for  a  while,  the  attention  of 
all  was  attracted  by  an  unusual  sound  proceeding  from  the  rear  room. 
After  an  interval  of  two  minutes  the  sound  was  repeated,  and  on  inves- 
tigation it  was  found  that  the  sound  was  the  very  faint  cry  of  the 
supposed  dead  child.  There  was  absolutely  no  pulse  to  lie  found. 
Respiration  occurred  at  intervals  of  yiore  than  ;i  minute,  and  auscul- 
tation showed  the  faint  sound  of  the  heart.      Prompt  and  energetic 


go  A    SYSTEM   OF  LEGAL  MEDICINE. 

measures,  covering  more  than  two  hours,  finally  resulted  in  the  complete 
resuscitation  of  the  child.  The  babe  was  then  taken  to  a  public  institu- 
tion, and  subsequently  placed  in  the  charge  of  the  mother,  and  lived  for 
a  period  of  months,  though  it  eventually  died  of  natural  causes. 

in  this  ease  there  can  be  no  doubt  that  animation  was  so  far  suspended 
and  t  he  vm\  of  life  so  near,  that  had  it  not  been  for  the  chance  placing  of  the 
child  in  a  warm  room  instead  of  the  morgue,  which  then  was  not  warmer 
1  han  t  he  external  air,  life  would  have  ceased  altogether.  It  is  reasonable 
to  suppose  thai  had  an  examination  of  the  chest  been  made  at  the  time 
of  the  discovery  of  the  child  it  would  have  resulted  in  the  failure  to  dem- 
onstrate respiratory  movements,  and  even  the  beat  of  the  heart  might 
have  escaped  notice.  Such  cases  as  the  foregoing,  however,  are  of  the 
rarest,  and  if  attention  is  paid  to  the  other  signs  of  death  there  should 
be  no  occasion  for  doubt  as  to  its  actual  presence. 

There  was  an  additional  sign  present  in  the  last  case  mentioned, 
namely,  the  coldness  of  the  body,  which  emphasized  the  probability  of 
the  case  being  one  of  real  death.  This  brings  us  to  the  consideration  of 
one  of  the  earliest  sigus  of  death,  namely,  change  in  temperature. 

Cooling  of  the  Body. — As  is  well  known,  the  normal  temperature  of 
the  living  body  is  98.4°  F.,  while  in  many  forms  of  fever,  such  as  typhoid 
and  scarlet  fever,  the  temperature  rises  to  a  very  considerable  degree, 
sometimes  reaching  the  mark  of  113°  F.  So,  too,  in  cases  of  septicaemia 
the  temperature  will  run  up  very  rapidly  at  the  approach  of  death,  and  a 
further  rise  has  been  noticed  after  death  has  occurred,  even  when  the 
presence  of  death  has  been  demonstrated  by  the  unmistakable  signs  of 
decomposition,  which  supervenes  with  the  greatest  rapidity  after  death 
from  this  cause. 

In  ordinary  cases  of  death  from  disease  the  loss  of  the  natural  temper- 
ature of  the  body  takes  place  with  a  rapidity  proportioned  to  the  sur- 
rounding media.  If  a  body  remains  in  a  warm  room  and  is  covered 
with  clothing,  the  cooling  is  somewhat  retarded,  while  if  exposed  to  the 
air  of  a  cool  room,  especially  if  there  be  a  current  of  air  passing  through 
the  room,  it  cools  with  great  rapidity.  A  body  which  has  remained  in 
water,  as  after  death  by  drowning,  will  also  cool  with  great  rapidity ;  on 
the  other  hand,  the  bodies  of  those  who  have  died  suddenly  from  shock, 
or  from  apoplexy,  or  of  acute  disease,  cool  with  less  rapidity,  and  as  the 
temperature  of  the  body  approaches  that  of  its  surrounding  media  the 
cooling  process  is  more  slow.  The  experiments  of  Goodhart,  as  quoted  by 
Taylor,  showed  that  on  the  average  the  rate  of  cooling  for  the  first  three 
hours  was  4°  F.  per  hour ;  in  the  next  six  hours  the  rate  was  three  degrees 
per  hour ;  and  at  a  later  period,  in  excess  of  one  degree  per  hour.  The 
cooling  of  the  body  is  a  less  certain  sign  of  death  than  some  others, 
because  it  allows  of  so  many  variations.  As  has  been  already  stated, 
certain  forms  of  disease  and  accident  are  followed  by  a  comparatively 
slow  loss  of  animal  heat.  Casper  has  fixed  upon  the  average  time  of 
ten  to  twelve  hours  for  the  cooling  of  the  body  in  ordinary  cases,  yet 
in  eases  of  asphyxia,  cases  of  submersion  excepted,  the  cooling  is  more 
gradual;  cases  of  asphyxia  present  great  variation,  however,  some  fatal 
eases  being  followed  by  complete  cooling  in  the  same  time  as  in  eases  of 
death  from  natural  causes,  while  in  others  the  heat  has  been  known  to  be 
retained  for  as  long  as  forty-eight  hours. 

In  one  case  of  death  from  septicaemia,  where  the  temperature  imnie- 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  $\ 

diately  before  death  reached  112°  F.,  I  found  the  viscera  perceptibly  warm 
at  time  of  autopsy,  something  more  than  twenty-four  hours  after  death. 
On  the  other  hand,  the  bodies  of  persons  who  have  died  of  chronic  dis- 
eases, and  where  the  death  has  been  slow,  cool  with  great  rapidity,  not 
more  than  four  or  five  hours  being  required  to  reduce  the  temperature 
to  that  of  a  body  which  had  died  under  other  circumstances,  and  which 
had  required  nearly  a  day  to  cool.  The  body  in  such  cases  manifests 
a  decided  lowering  of  the  temperature,  especially  that  of  the  extremities, 
for  a  considerable  time  before  death.  The  fact  is,  that  under  similar 
circumstances  the  dead  human  body  cools  practically  like  any  other 
mass  of  animal  matter.  The  body  of  a  child  will  cool  more  rapidly 
than  of  an  adult,  that  of  a  thin  person  than  that  of  a  fat  one,  and,  as 
before  stated,  an  exposed  body  than  one  invested  with  wrappings. 

Although  the  time  that  a  body  will  take  to  cool  may  form  an  impor- 
tant element  in  a  capital  trial,  the  opinion  of  the  medical  jurist  should  be 
given  with  a  large  degree  of  caution,  and  with  a  careful  review  of  all  the 
facts  of  the  case  as  indicated  in  the  essential  particulars  enumerated  above. 

This  caution  is  emphasized  by  the  cases  and  experiments  reported  in 
the  works  of  writers  on  this  subject,  notably  those  of  Tidy  and  Ogston. 
The  former  author  cites  M.  Laborde  in  demonstration  of  the  fact  that  in 
five  to  eight  hours  the  temperature  of  the  deeper  tissues  falls  to  80.6° 
to  82.4°  F.,  while  Dr.  F.  Niederkorn  shows  that  in  six  cases  taken  in- 
differently the  rectal  temperature,  taken  six  to  eight  hours  after  death, 
averged  90.6°,  and  in  nine  cases  where  the  temperature  was  taken  twelve 
to  fourteen  hours  after  death  the  rectal  temperature  was  89.2°  F. 

The  same  authors  quote  the  observations  of  Wilks  and  A.  S.  Taylor 
from  Guy's  Hospital  Reports,  which  show  a  decidedly  lower  average  of  the 
temperature  at  corresponding  periods  after  death,  the  difference  being 
something  more  than  11°  F.  for  the  first  period  (six  to  eight  hours),  and 
something  more  than  eight  degrees  for  the  latter  period  (twelve  hours  or 
more).  It  is  to  be  observed  that  the  temperatures  taken  by  Drs.  Wilks 
and  Taylor  were  taken  by  simply  applying  the  bulb  to  the  abdomen, 
while  those  of  Niederkorn'  (as  stated  by" Tidy),  were  taken  either  in  the 
axilla  or  rectum. 

The  chief  value  of  this  sign  of  death,  however,  lies  rather  in  the 
continuous  and  progressive  cooling  than  in  any  absolute  temperature. 
A  case  cited  by  Ogston  corresponds  with  my  observation  in  septicsemic 
cases.  He  was  called  to  inspect  the  body  of  a  seaman  who  had  died  sud- 
denly from  (as  it  proved)  a  sudden  effusion  of  serum  into  the  pleural 
cavities,  while  suffering  from  scorbutus.  He  found  the  heat  of  the  trunk 
and  limbs  little,  if  any,  below  the  normal  temperature,  btit  on  the  next 
day  putrefaction  had  so  far  advanced  as  to  leave  no  doubt  of  the  reality 
of  'death,  the  heat  being  greatest  in  the  chest,  where  the  decomposition 
was  farthest  advanced.  At  another  time  he  was  called  to  see  the  body 
of  a  lad  who  had  died  suddenly  when  apparently  in  good  health  and 
spirits.  Perceiving  that  the  lad  was  dead,  he  left  the  house,  only  to  be 
recalled  on  the  afternoon  of  the  same  day  because  of  the  belief  of  the 
mother  that  the  lad  was  about  to  come  to  life  again,  inasmuch  as  the 
body  did  not  become  cold,  there  was  no  rigidity,  and  the  color  had  re- 
turned to  the  cheeks.  Dr.  Ogston  assured  her  that  these  phenomena 
were  only  those  of  rapidly  approaching  decomposition,  which  was  fully 
developed  on  the  next  day. 


92  A   SYSTEM  OF  LEGAL  MEDICINE. 

This  return  of  color  to  the  cheeks  has  been  frequently  observed  in 
the  bodies  of  those  who,  for  the  purpose  of  preservation,  have  been  frozen 
by  the  undertaker  and  on  the  day  of  sepulture  removed  from  the  freez- 
ing mixture  a  few  hours  before  the  funeral  rites.  The  return  of  a  flush 
of  color  closely  resembling  the  natural  hue  of  life  ensues  and  endures  for 
a  few  hours,  when  it  passes  with  great  rapidity  into  the  dusky  hue  of 
decomposition.  That  there  should  be  a  rise  of  temperature  to  something 
like  that  of  the  surrounding  atmosphere  is  of  course  natural,  but  it  is 
claimed  that  it  may  rise,  in  consequence  of  this  putrefactive  change, 
even  higher  than  that.  From  the  facts  stated  above  it  will  be  seen 
that  the  caution  to  be  observed  by  the  medical  expert  in  giving  an  opin- 
ion as  to  the  time  which  has  elapsed  since  death  occurred  should  be,  as 
before  stated,  very  considerable. 

Changes  in  the  Eye. — Immediately  after  death  the  eye  loses  its  luster 
in  the  great  majority  of  cases,  and,  in  addition  to  this  loss  of  luster,  the 
cornea  becomes  opaque,  milky,  and  sensibly  flattened,  the  globe  having 
lost  its  normal  tension,  and,  of  course,  there  is  no  response  to  light  by 
the  pupil.  I  have  said  that  this  condition  of  the  eye  obtains  in  the  ma- 
jority of  cases,  but  in  cases  of  death  by  carbonic  acid  and  carbonic  oxide, 
cyanide  of  potash  and  hydrocyanic  acid,  I  have  seen  this  change  in  the 
eyeball  wholly  wanting,  or  very  long  delayed. 

At  this  very  writing  I  Mas  called  to  view  the  body  of  a  man  who  had 
in  a  fit  of  melancholia  taken  an  indefinite  quantity  of  cyanide  of  pot- 
ash in  a  public  square  and  died  within  twenty  minutes.  Directly  after 
death,  and  again  two  hours  later,  the  eyeballs  were  prominent,  staring, 
glistening,  with  the  pupils  widely  dilated,  and  eighteen  hours  after  death 
the  same  condition  was  present. 

There  is  also  at  the  time  of  death  a  change  in  the  color  of  the  body, 
which,  with  very  few  exceptions,  such  as  in  the  cases  of  people  with  very 
florid  complexions,  becomes  an  ashy  white.  The  exceptions  above  men- 
tioned rest  on  the  statement  of  Casper.  I  have  never  seen  exceptions 
to  the  rapid  pallor  in  cases  of  death,  except  in  cases  of  death  from  burn- 
ing and  some  cases  of  suffocation.  But  while  certain  colors  will  dis- 
appear, such  as  the  redness  of  scarlet  fever,  on  the  other  hand  the  yellow 
of  jaundice,  the  purple  of  ecchymosis,  and  the  varied  colors  of  tattooing 
remain. 

There  is  also  at  the  time  of  death,  or  immediately  thereafter,  a  general 
relaxation  of  the  muscular  system — the  lower  jaw  drops,  the  joints  are 
flexible,  and  the  eyelids  lose  their  tension;  but  although  the  tonicity  of 
the  muscles  is  lost,  it  is  not  the  case  with  their  contractility,  inasmuch  as 
they  will  respond  for  a  certain  time  to  electrical  and  other  stimuli,  and 
moreover  muscles  that  are  contracted  by  living  force  at  the  time  of 
death,  as  in  the  case  of  poisoning  by  strychnine,  do  not  necessarily  be- 
come relaxed  in  death. 

According  to  Ogston,  the  persistence  after  death  of  the  muscular 
contractibility  in  different  parts  of  the  body  and  its  disappearance  fol- 
lows a  fixed  order,  the  first  parts  to  present  this  change  being  the  neck 
and  trunk,  next  the  lower  extremities,  and  lastly  the  upper,  while  its 
departure  follows  the  same  order. 

The  duration  of  this  phenomenon  is  shortened  by  its  exposure  to 
warmth  and  moisture,  and  to  ammoniacal,  carbonic,  "and  sulphureted 
hydrogen  gases ;  it  is  unaffected  by  carbureted  hydrogen,  hydrogen,  and 


DEATH  IX  ITS  MEDICO-LEGAL  ASPECTS.  93 

sulphurous  acid  gases,  nor  is  it  diminished  in  cases  of  asphyxia.  It  has 
been  found,  however,  that  the  continuance  of  this  property  of  muscular 
fiber  is  considerably  modified  by  the  nature  of  the  disease  of  which  the 
person  died.  Experiments  show  that  it  disappeared  from  the  muscles  in 
cases  of  peritonitis  in  three  hours ;  in  phthisis,  schirrus,  and  cancer,  in 
three  to  six  hours ;  in  death  from  mortal  lesions  of  the  heart  or  profuse 
hemorrhage,  in  about  nine  hours ;  in  apoplexy  with  paralysis,  in  about 
twelve  hours ;  and  in  adynamic  fevers  and  pneumonia,  in  from  ten  to 
fifteen  hours.     (Ogston,  Lecture  XXV.) 

So  far  as  the  signs  of  death  which  have  thus  far  been  mentioned 
(namely,  the  cessation  of  respiration  and  circulation,  the  loss  of  the  luster 
of  the  eye,  the  pallor  of  the  surface,  the  relaxation  of  the  muscles,  the 
loss  of  animal  heat,  and  the  loss  of  muscular  contractility)  indicate  the 
period  of  death,  it  is  practically  agreed  by  all  writers  on  this  subject  that 
a  body  in  which  all  these  phenomena  have  occurred  has  been  dead  for  a 
period  of  from  ten  to  twelve  hours  at  the  longest,  provided  there  are  no 
other  changes  to  be  noticed. 

Succeeding  the  changes  just  mentioned,  and  preceding  the  commence- 
ment of  decomposition,  are  certain  other  changes  originating  in  the 
physical  alteration  in  the  soft  solids. 

Softening  or  want  of  elasticity  of  the  tissues  of  the  bod}',  which 
comes  in  evidence  soon  after  death,  is  the  first  of  the  changes  result- 
ing from  the  destruction  of  their  physical  properties.  The  parts  of  the 
body  on  which  it  rests  will  be  flattened,  and  the  skin  will  present  the 
marks  of  any  peculiar  figure  upon  which  it  has  been  lying,  as  for  instance 
the  grating  of  a  dissecting-table,  and  the  skin  and  muscles  do  not  resume 
their  original  condition  upon  the  removal  of  the  pressure  which,  either 
by  the  weight  of  the  body  itself  or  from  external  sources,  has  been  applied 
to  the  parts  which  show  this  loss  of  elasticity.  This  flattening  of  the 
dependent  parts  has  been  considered  a  valuable  indication  of  the  reality 
of  death. 

Rigor  Mortis. — At  the  disappearance,  or  often  a  little  before  the 
disappearance,  of  the  softening  just  described,  comes  another  sign,  that 
is,  the  appearance  of  an  opposite  state  of  the  limbs  and  joints,  which  is 
known  as  cadaveric  rigidity,  or  rigor  mortis.  The  body  becomes  rigid, 
and  is  incapable  of  contraction.  The  muscles  acquire  a  brawny  firmness, 
and  it  requires  considerable  force  to  move  the  joints  from  the  position 
which  they  have  assumed.  This  phenomenon  is  not  an  active  process. 
but  the  limbs  become,  as  it  were,  fixed  in  the  position  which  they  had 
when  this  change  occurred.  This  cadaveric  rigidity  affects  not  alone  the 
external  muscles,  such  as  those  of  the  jaw  and  limbs,  but  also  is  to  be 
demonstrated  in  the  internal  organs,  especially  in  the  left  ventricle  of 
the  heart.  The  duration  of  this  state  is  variable.  It  usually  disappears 
with  the  approach  of  putrefaction,  but  I  have  seen  it  present  after  the 
abdomen  has  assumed  the  greenish  color  characteristic  of  that  condition. 
The  portions  of  the  body  to  be  consecutively  affected  by  this  change 
follow  practically  the  same  order  as  that  mentioned  in  regard  to  muscu- 
lar contractibility.  It  is  first  noticed  in  the  lower  jaw.  where  it  is  always 
most  pronounced,  and  where  the  greatest  force  is  required  to  overcome 
its  effects,  and  where  it  persists  the  longest,  according  to  my  own  experi- 
ence, though  I  am  aware  that  this  observation  does  not  coincide  with  the 
observations  of  some  other  writers.     It  next  appears  in  the  neck  and 


tJ4  .1    SYSTEM    OF  LEGAL  MEDICINE. 

trunk,  then  in  the  lower  extremities,  and  lastly  in  the  upper  extremities. 
When  it  is  ..nee  gone  it  does  not  return,  but  gives  place  to  a  softening 
of  a  kind  different  from  that  previously  mentioned,  which  is  not  only 
more  marked,  hut  proceeds  to  complete  putrescence. 

The  early  appearance  of  cadaveric  rigidity  is  modified  to  a  certain 
degree  by  the  causes  operating  immediately  before  death.  Under  the 
action  of  strychnine  and  those  alkaloids  which  cause  death  by  convul- 
sions, the  more  violent  and  frequent  the  convulsions  the  sooner  the 
rigidity  sets  in.  It  seems  to  be  accelerated  by  whatever  exhausts  the 
muscular  irritability  before  death.  In  cases  of  death  from  exhaustion  or 
from  septira-mia  it  has  been  observed  that  rigidity  sets  in  early  and 
passes  away  quickly,  and  is  very  speedily  followed  by  putrefaction. 

While  the  time  of  its  appearance  varies  considerably  in  different  cases, 
in  some  being  noticed  as  early  as  eight  to  ten  hours  after  death,  and  in 
others  being  delayed  for  more  than  thirty  hours,  and  wdiile  in  some  cases 
its  coming  and  going  is  so  speedy  as  to  leave  a  doubt  whether  it  occurred 
at  all,  as  in  death  from  lightning,  it  is  fair  to  state  that  the  mean  time  of 
its  occurrence  is  from  ten  to  twelve  hours. 

Two  cases  illustrative  of  this  long  duration  of  post-mortem  rigidity 
are  these.  A  man  died  suddenly  of  organic  disease  of  the  heart  in  late 
September.  On  the  exhumation  of  the  body  eight  weeks  later  there  was 
marked  rigidity  of  the  lower  extremities — so  marked  that  the  body  could 
be  carried  from  one  room  to  another  by  power  applied  to  shoulders  and 
feet  only.  The  rigidity  had,  however,  wholly  disappeared  from  the  arms, 
but  was  present  in  the  lower  jaw. 

The  arm  of  a  mutilated  body  was  recovered  from  a  river  in  which  the 
arm  had  lain  long  enough  to  have  the  skin  of  the  hand  quite  macerated, 
and  after  its  removal  was  kept  without  preservatives  for  a  period  of  at 
least  two  days  before  being  examined  by  the  deputy-coroner  of  the  dis- 
trict. At  time  of  examination  the  death  rigidity  was  very  pronounced 
in  the  elbow-joint.  A  case  like  this  must  be  considered  as  quite  excep- 
tional. It  is  also  to  be  borne  in  mind,  in  regard  to  the  former  case,  that 
the  loss  of  rigidity  noticed  in  the  arms  while  it  was  present  elsewhere 
may  have  been  due  to  the  forcible  flexing  of  the  joints  in  dressing  the 
corpse  shortly  before  burial. 

The  duration  of  the  rigidity  is  also  subject  to  considerable  variation. 
Generally  it  lasts  from  twenty-four  to  thirty-six  hours,  while  it  has  been 
known  to  last  for  several  days.  Cold  favors  the  continuance  of  this  con- 
dition, as  does  also  previous  vigorous  constitution,  and  in  cases  of  death 
from  accident  or  violence  its  duration  is  prolonged.  Its  duration  is  less 
in  the  young  and  those  in  advanced  life.  It  is  said,  as  before  mentioned, 
that  in  cases  of  death  from  lightning  the  rigidity  is  but  little  marked.  I 
have  seen  but  one  case  of  death  from  lightning,  and  though  the  deceased 
was  a  child  of  but  five  years,  the  rigidity,  though  not  strongly  marked, 
was  still  undoubted. 

Various  explanations  of  this  condition  of  rigidity  have  been  offered  by 
physiologists  and  writers  on  legal  medicine — such,  for  instance,  as  the 
coagulation  of  a  proteid  in  the  muscle-plasma  giving  rise  to  the  so-called 
myosine — but  though  its  seat  is  undoubtedly  the  muscular  system,  it 
cannot  lie  said  that  any  of  the  theories  advanced  are  wholly  satisfactory. 
The  importance  of  bearing  in  mind  the  fact  that  this  condition  affects 
internal  organs  is  demonstrated  by  the  mistakes  not  infrequently  made 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  95 

of  attributing  certain  appearances,  such  as  a  seeming  thickening  of  the 
left  ventricle,  to  pathological  change  during  life,  when  the  appearance 
was  wholly  due  to  the  presence  of  post-mortem  rigidity. 

Casper  states  that  after  death  from  narcotic  poisoning  this  rigidity 
either  does  not  occur,  or  is  of  so  short  duration  that  at  the  usual  time 
when  such  bodies  are  received  by  the  medical  jurist  for  observation  no 
trace  of  it  is  found.  This  does  not  correspond  with  my  observation. 
Indeed,  within  the  last  sixty  days  I  have  had  opportunity  to  examine 
the  bodies  of  two  persons,  both  cases  of  suicide  by  laudanum,  where  the 
rigor  mortis  was  quite  pronounced  at  the  time  of  autopsy,  more  than 
twenty-four  hours  after  death.  I  find  that  my  observations  in  this  re- 
spect are  in  accord  with  those  of  Tidy. 

When  a  joint  stiff  from  rigor  mortis  is  forcibly  bent,  the  stiffness  does 
not  return,  and  this  may  distinguish  real  death  from  certain  cases  of 
supposed  trance,  from  cases  of  cataleps}7,  and  from  the  rigidity  of  tetanus 
or  poisoning  by  strychnine,  and  some  other  poisons. 

There  are  several  so-called  tests  of  minor  importance  which  should  be 
mentioned  here,  although  if  the  signs  already  mentioned  are  present 
there  should  be  no  doubt  as  to  the  reality  of  death,  inasmuch  as  the  tests 
themselves  are  rather  tests  of  the  cessation  of  the  circulation  than  of 
anything  more.  The  first  of  these  tests  is  to  note  whether,  after  making 
an  incision  in  the  body,  blood  flows,  especially  if  it  flows  in  jets  instead 
of  a  continuous  dribbling.  A  dead  body  does  not  bleed  in  the  ordinary 
sense  of  the  word.  It  is  said  that  bright  steel  needles  inserted  anywhere 
in  the  skin  will  be  found  free  from  rust  even  after  some  hours ;  but  as 
this  test  depends  on  the  condition  of  the  body  as  to  cooling  and  moisture, 
it  is  not  trustworthy.  Another  test  is  the  attempt  to  produce  vesication 
by  heat  or  blistering  fluids,  it  being  assumed  that  as  the  formation  of  a 
blister  is  a  vital  process,  it  could  not  occur  after  death ;  yet  as  a  matter 
of  fact  it  has  been  found  possible  to  produce  a  certain  kind  of  blister 
upon  the  skins  of  young  persons  shortly  after  death.  Another  test  is  the 
observation  of  the  translucency  of  the  fingers  and  hands.  If  the  hand  of 
a  living  person,  especially  if  young  and  in  good  health,  be  held  in  front  of 
a  bright  light  with  the  fingers  closely  approximated,  there  will  be  observed 
a  pinkish  red,  almost  translucent  appearance,  while  after  death  the  hands 
become  opaque.  Yet  in  demonstrating  this  test  to  a  class  of  students, 
the  subject  being  a  girl  in  whom  the  unmistakable  signs  of  death  were 
present,  I  found  that  the  hand  was  still  translucent,  and  that  the  pinkish 
color  at  the  edge  of  the  approximated  fingers  was  quite  demonstrable. 
This  case,  however,  is  very  exceptional.  Another  test  is  the  production 
of  local  congestion  by  obstructing  the  flow  of  the  current  of  blood,  as, 
for  instance,  by  tying  a  string  around  the  finger.  The  usual  phenomena 
of  swelling  and  purple  discoloration  will  not  follow  this  constriction  in 
the  dead  body. 

Ogston  calls  attention  to  a  form  of  cadaveric  rigidity  which  I  believe 
to  occur,  though  I  have  never  chanced  to  see  an  instance.  It  is  what  is 
called  cadaveric  spasm.  It  consists  in  a  sort  of  spasmodic  contraction 
which  is  assumed  by  the  muscles  at  the  instant  of  or  immediately  before 
death,  and  which  is  retained  for  some  hours  after  death,  then  passing 
into  true  rigor  mortis.  It  has  usually  been  observed  in  forms  of  sud- 
den or  violent  death,  but  it  has  also  been  known  to  occur  after  death  by 
pneumonia  and  pulmonary  apoplexy.     Ogston,  in  addition  to  mentioning 


9(J  A    SYSTEM   OF  LEGAL   MEDICINE. 

eleven  cases  which  came  under  his  observation,  cites  a  striking  example 
of  this  kind  of  rigidity  which  occurred  at  the  battle  of  Balaklava.  Cap- 
tain Nolan,  while  riding  in  the  advance  of  the  cavalry,  had  his  chest  torn 
open  by  a  shell  from  the  Russian  battery.  The  arm  which  he  was  wav- 
ing in  the  air  at  the  time  remained  uplifted,  and  he  retained  his  seat 
upon  his  horse,  which  wheeled  round  and  retreated;  the  rider  gave  a 
death-shriek,  and  passed  through  the  ranks  in  the  same  attitude  before 
dropping  from  the  saddle. 

Inasmuch  as  the  hand  of  a  dead  person  cannot  be  made  to  grasp  a 
weapon,  it  is  of  importance  to  bear  the  possibility  of  this  kind  of  spasm 
in  mind,  as  suicide  would  be  indicated  where  the  weapon  was  found 
grasped  in  the  hands  of  a  corpse.  On  the  other  hand,  the  finding  of 
clothing,  or  fragments  thereof,  or  hairs  grasped  in  the  hand  after  death 
may  form  an  important  part  of  a  trial  for  murder.  It  is  to  be  noted  in 
this  connection  that  after  death  from  strychnine,  as  mentioned  before, 
the  rigidity,  if  forcibly  broken  down,  returns  after  a  time,  while  in  other 
forms  of  tetanic  spasm  it  is  bebeved  to  disappear  shortly  after  death.  I 
have  observed  this  return  of  rigidity  after  forcible  flexion  in  the  case 
of  a  man  who  had  partaken  of  some  cheese  which  had  been  plentifully 
covered  with  strychnine  for  the  purpose  of  poisoning  rats,  and  who  had 
died  from  asphyxia  from  the  spasmodic  fixing  of  the  muscles  concerned 
in  respiration.  But  in  the  case  of  a  middle-aged  woman  who  had  pre- 
pared a  fatal  dose  for  her  husband  and  had  by  mistake  taken  it  herself, 
and  who  died  from  exhaustion,  this  phenomenon  was  not  to  be  produced. 
Indeed,  the  former  case  was  the  only  one  of  many  cases  of  strychnine 
poisoning  in  which  I  have  noticed  a  return  of  rigidity  when  it  was  once 
broken  down  after  death. 

As  an  indication  of  the  period  at  which  death  has  occurred,  the  pres- 
ence of  rigor  mortis,  in  addition  to  the  signs  previously  mentioned,  and 
without  other  signs  to  be  mentioned  hereafter,  the  presumption  is,  ac- 
cording to  Casper,  that  the  person  has  been  dead  within  from  two  to 
three  days  at  the  longest. 

Soon  after  death,  sometimes  within  an  hour,  and  generally  within 
twelve  hours,  there  are  to  be  noticed  upon  the  exterior  of  the  body  cer- 
tain changes  in  color  due  to  the  gravitation  of  the  blood  in  the  capillaries. 
These  lividities  are  usually  found  upon  the  under  or  dependent  portions 
of  the  body.  If  the  body  has  chanced  to  remain  upon  the  face  and  ab- 
domen, it  is  upon  those  surfaces  that  the  color  changes  are  found.  The 
color  varies  from  a  light  pinkish  tinge  to  a  deep  purple,  and  not  infre- 
quently these  purple  discolorations  are  mistaken  by  the  inexperienced, 
especially  by  friends  and  relatives  of  the  deceased,  for  marks  of  violence 
inflicted  during  life.  If  the  body  has  rested  upon  the  back,  the  lividities 
will  be  found  there,  except  at  the  points  where  the  pressure  caused  by 
the  weight  of  the  body  has  been  greatest.  Here  the  skin  will  have  its 
usual  pallor. 

There  is  an  appearance  similar  to  this  which  I  have  observed  in  the 
eases  of  the  drowned  which  have  been  exposed  to  extreme  cold  imme- 
diately before  and  after  death.  I  had  occasion  to  examine  the  bodies 
of  four  sailors  who  were  wrecked  off  a  ledge  at  the  entrance  to  Bos- 
ton Harbor.  The  cold  and  the  action  of  the  waves  dashing  the  bodies 
against  the  shore  had  so  flattened  them  they  bore  a  grotesque  resem- 
blance to  the  cakes  in  a  pastry-cook's  shop  made  and  baked  in  the  form 


DEATH  IN  ITS  MEDICO-IEGAL  ASPECTS.  97 

of  a  human  being.  All  these  bodies  were  of  a  rosy  pink  color  over  their 
entire  surface.  This  was  probably  nothing-  more  than  a  frost  erythema, 
but  it  was  very  much  more  marked  than  I  have  observed  in  the  cases  of 
those  who  were  frozen  in  squalid  rooms  on  land. 

Again,  I  have  noticed  the  same  appearance  in  the  bodies  of  those  who 
have  died  of  poisoning  by  illuminating-gas,  especially  in  those  who  have 
inspired  the  mixed  form  of  gas  which  contains  a  large  proportion  of  so- 
called  water-gas,  where  the  percentage  of  carbonic  oxide  is  very  high. 
In  these  cases  there  was  not  only  the  bright  scarlet  color  of  the  blood  and 
muscles  and  internal  organs,  but  a  decided  pinkish  tint  to  be  seen  all 
over  the  surface.  This  color  in  the  cases  of  those  poisoned  by  this  gas 
is  much  modified,  and  in  some  cases  largely  wanting,  if  the  patient  has 
received  very  energetic  treatment  before  death,  especially  if  the  person 
has  had  a  large  amount  of  pure  oxygen  administered.  There  need  be  no 
necessity  for  confounding  these  conditions  of  color  if  attention  is  paid 
to  the  location  of  the  change.  The  post-mortem  hypostases  are  to  be 
found  in  the  dependent  parts  chiefly,  while  frost  and  carbonic  oxide 
affects  the  color  of  the  whole  surface,  the  superior  quite  as  strongly  as 
the  inferior. 

Hypostases  are  easily  differentiated  from  ecchymoses,  or  bruises  in- 
flicted during  life,  by  comparing  the  results  of  an  incision  in  the  dis- 
colored parts.  No  cut  in  a  post-mortem  lividity  will  ever  give  vent  to 
fluid  or  coagulated  blood ;  there  will  be  at  most  a  few  reddish  points ; 
while  an  incision  into  an  ecchymosis  discloses  immediately  the  true  blood 
effused  into  the  tissues. 

There  is  a  wide  difference  of  opinion  as  to  the  value  of  these  hypos- 
tases as  an  indication  of  the  reality  of  death.  Casper  puts  it  tersely : 
'•  They  are  of  themselves  a  sufficient  indication  of  death."  Ogston,  on 
the  other  hand,  maintains  that,  while  of  importance,  they  are  not  much 
to  be  trusted  as  indications  of  the  reality  of  death,  on  account  of  their 
liability  to  be  confounded  with  marks  produced  before  death.  He  claims 
that  the  term  "hypostases"  is  incorrect,  as  they  occur  not  alone  on  the 
dependent  but  on  the  non-dependent  portions  of  the  body  as  well ;  nor 
are  they  to  be  termed  cadaveric,  as  they  may  be  observed  in  certain  in- 
stances upon  the  living.  My  own  experience  leads  me  to  doubt  if  they 
are  ever  found  to  the  extent  upon  the  living  which  they  are  upon  the 
dead.  They  generally  are  to  be  seen  covering  the  larger  portion  of  the 
dependent  parts,  the  exceptions  being,  as  before  stated,  where  certain 
portions  have  been  subjected  to  pressure,  and  even  here  they  may  be 
noticed  after  a  time  if  the  pressure  be  removed.  Neither  have  I  observed 
on  the  non-dependent  portions  of  the  body  any  considerable  patches 
which  in  character  and  size  could  be  considered  as  lividities  from  settling 
of  the  blood.  Even  where  small  patches  of  this  sort  are  to  be  found  on 
the  limbs  of  the  aged,  and  in  typhus  and  other  adynamic  diseases,  it  is  a 
question  if  they  do  not  indicate  a  possible  putrefactive  change  locally. 
Believing  as  I  do  that  this  settling  of  the  blood  is  the  immediate  pre- 
cursor if  not  the  initial  process  of  decomposition,  it  seems  to  me  that  the 
presence  of  these  lividities  is  a  very  strong  indication  of  the  reality  of 
death.  It  may  be  well  to  wait  for  a  little  while  to  observe  the  extent  of 
the  lividities,  for  often  at  the  outset  of  the  process  they  are  in  irregular 
patches  small  in  extent;  but  after  a  few  hours  it  would  seem  impos- 
sible for  a  careful  observer  to  confound  these  with  the  result  of  a  vital 


98 


A    SYSTEM   OF  LEGAL  MEDICINE. 


process,  such,  for  instance,  as  the  effects  of  flogging,  where  there  would 
be  presented  on  incision  the  appearances  characteristic  of  ecchymoses. 

These  hypostases  occur  not  only  externally,  but  also  in  the  internal 
organs,  especially  in  the  brain,  the  lungs,  the  kidneys,  the  intestines,  and 

the  spinal  eord. 

In  the  brain  the  condition  is  noted  by  an  overloading  of  the  posterior 
poll  ion,  marked  by  a  fullness  of  the  veins  of  the  pia  mater,  and  is  to  be 
found  even  in  cases  of  anaemia  or  hemorrhage.  This  is  to  be  observed 
chiefly  where  the  body  rests,  as  is  usually  the  case,  upon  the  back.  Ex- 
periments have  shown  that  where  this  change  does  not  take  place  soon 
after  death  it  is  quite  doubtful  if  it  can  be  artificially  produced.  Care 
should  be  used  to  avoid  confounding  this  condition  of  the  veins  of  the 
posterior  hemisphere  with  the  pathological  condition  of  cerebral  hyper- 
emia, which  is  more  general  in  location  rather  than  restricted  to  the 
posterior  portion. 

In  the  lungs  these  hypostases  occur  oftenest.  They  manifest  them- 
selves at  a  much  earlier  period  than  is  usually  stated ;  indeed,  in  the  old 
and  feeble  there  is  a  process  very  like  it  during  life,  owing  to  the  extreme 
feebleness  of  the  circulation ;  but  after  death,  inasmuch  as  the  lungs 
generally  have  a  large  amount  of  blood  in  their  vessels,  this  fluid  gravi- 
tates with  considerable  rapidity.  An  incision  into  the  posterior  portion 
of  these  organs,  if  the  body  has  rested  on  the  back,  shows  marked  over- 
loading even  in  a  lung  otherwise  generally  anaemic.  This  condition  is 
very  readily  confounded  with  an  ante-mortem  congestion,  especially  as 
there  is  often  more  or  less  oedema  present  at  the  same  time. 

In  the  intestines  the  line  of  demarcation  of  the  portions  colored  by 
settling  of  the  blood  is  quite  pronounced,  whereas  in  a  case  of  inflamma- 
tion the  color  would  not  only  be  brighter  and  show  the  ramiform  in- 
jection of  the  blood-vessels  typical  of  that  process,  but  would  also  be 
continuous.  The  color  of  an  inflammatory  process  in  the  kidneys,  for 
instance,  would  be  continuous,  while  in  the  simple  condition  of  post- 
mortem change  in  the  intestines,  if  the  convolutions  be  pulled  forward, 
the  breaks  in  color  which  distinguish  hypostases  from  inflammatory 
process  are  readily  distinguishable.  The  same  remarks  which  have  been 
made  in  regard  to  post-mortem  congestion  of  the  posterior  hemispheres 
apply  to  the  hypostases  of  the  spinal  cord,  and  great  care  should  be 
exercised  by  the  medical  expert  that  he  may  not  confound  what  is 
merely  a  cadaveric  change  with  what  he  might  suppose  to  be  a  vital 
inflammatory  process. 

In  this  connection  it  is  well  to  mention  that  while  the  heart  does  not 
present  hypostases,  certain  changes  take  place  in  the  contents  of  the 
cavities,  namely,  the  coagulation  of  the  blood  and  the  formation  of  either 
red  or  white  clots,  the  so-called  cardiac  polypi.  These  clots  are  sometimes 
formed,  in  a  case  of  slow  death,  before  life  is  extinct ;  but  usually  they  are 
formed  after  death,  during  the  cooling  of  the  body.  Moreover,  the  ante- 
mortem  clots  are  more  difficult  of  removal,  because  they  are  mixed  up 
with  the  chordae  tendineae,  etc.,  while  the  post-mortem  clots  are  loose, 
and  simply  assume  the  shape  of  the  cavities.  The  establishment  of  the 
fact  of  the  coagulation  of  the  blood  after  death  has  a  bearing  upon  the 
question  of  the  formation  of  ecchymoses.  It  was  formerly  held  that  the 
presence  of  an  ecchymosis  upon  a  dead  body  was  evidence  that  the  vio- 
lence which  caused  it  must  have  been  inflicted  during  life ;  but  now  it  is 


DEATH  IN  ITS   MEDICO-LEG AL   ASPECTS.  yg 

known  that  violence  inflicted  upon  a  body  after  life  is  extinct,  but  before 
it  lias  cooled,  may  present  the  same  appearances  as  it  would  if  the  injury 
were  done  during  .life.  Although  generally  the  blood  remains  fluid  for  a 
considerable  period  after  death  from  suffocation  and  from  drowning  and 
from  other  forms  of  asphyxia,  I  have  found  it  in  many  cases  coagulated 
even  in  the  right  auricle. 

Putrefaction. — The  last  change  which  takes  place  in  the  body  after 
death  begins  with  the  occurrence  of  putrefaction,  where  chemical  changes 
take  place  in  the  human  body  as  in  any  other  kind  of  dead  animal  mat- 
ter, and  where  offensive  gases  are  evolved.  After  a  longer  or  shorter 
time  the  whole  organic  mass  is  changed  to  inorganic  matter,  chiefly 
water,  ammonia,  and  carbonic  acid,  and  in  the  transition  stage  compounds 
of  nitrogen,  sulphur,  carbon,  and  hydrogen  are  evolved. 

Generally  speaking,  this  change  succeeds  upon  the  disappearance  of 
cadaveric  rigidity ;  but,  as  said  before,  I  have  observed  cases  where  the 
putrefactive  process  was  demonstrated  by  the  discoloration  of  the  lower 
portion  of  the  abdomen,  while  the  death  rigidity  had  not  wholly  passed 
away. 

There  is  some  variation  as  to  the  region  of  the  body  primarily  affected 
by  putrefaction.  In  cases  of  drowning,  as  will  be  seen  later  when  dis- 
cussing that  mode  of  death,  it  generally  manifests  itself  first  upon  the 
head,  neck,  and  upper  portions  of  the  body ;  in  other  cases  it  usually  is 
first  noticed  as  a  green  or  greenish-yellow  discoloration  of  the  abdomen, 
accompanied  by  great  tumidity  thereof,  and  of  the  scrotum,  penis  and 
labia.  Subsecprently  this  discoloration  is  to  be  observed  upon  the  face 
and  neck,  and  lastly  upon  the  legs  and  arms.  A  somewhat  striking 
instance  of  the  manner  in  which  the  loose  connective  tissues  are  affected 
by  this  process  of  decomposition  was  observed  by  me  in  the  early  part 
of  the  present  year.  The  body  of  a  person  who  had  been  in  the  water, 
as  was  afterward  proved,  several  weeks  was  presented  for  inspection. 
On  the  afternoon  of  the  day  when  the  body  was  first  observed  there 
was  noted  the  marked  advance  of  decomposition  about  the  head  and 
neck,  while  the  rest  of  the  body  was  quite  free  from  the  appearances 
caused  by  putrefaction.  The  retraction  of  the  penis  commonly  observed 
in  cases  of  drowning  was  noted.  On  the  following  day,  as  the  body 
was  uncovered  for  purpose  of  autopsy,  it  was  noted  that  the  penis  had 
assumed  a  position  of  semi-erection,  and  was  of  nearly  the  same  size 
as  it  would  have  shown  in  erection  during  life.  Of  course,  here  the 
change  was  wholly  due  to  the  action  of  the  gases  of  decomposition. 
Ogston  states  that  the  discoloration  of  putrefaction  usually  commences 
at  the  center  of  the  belly  and  extends  toward  the  groins.  I  doubt  if  any 
general  rule  can  be  laid  down  as  to  this  order.  My  own  experience  lias 
been  just  the  reverse.  The  greenish  color  has  manifested  itself  at  the 
groins  first,  and  thence  extended  to  other  regions.  As  Ogston  was  a 
careful  observer  with  large  opportunities,  I  believe  that  it  is  safest  to  as- 
sume that  it  may  begin  anywhere  on  the  abdomen,  with  no  regular  order 
of  procedure. 

Iu  certain  forms  of  death  the  evidence  of  beginning  putrefaction  will 
be  found  in  other  regions  than  the  abdomen.  Take,  for  instance,  eases 
of  death  from  septicemia.  There  I  believe  it  to  be  the  rule  that  unless 
there  is  some  special  means  used  to  retard  putrefaction,  decomposition 
will  be  first  evidenced  by  the  purple  color  of  the  superficial  veins,  which 


100  A    SYSTEM   OF  LEGAL    MEDICINE. 

will  be  quite  distinctly  mapped  out  on  the  surface  of  the  arms,  neck,  and 
shoulders.  Some  stress  has  been  laid  upon  the  order  of  the  appearance 
of  these  signs  of  putrefaction  as  a  test  for  discriminating  bodies  winch 
have  begun  to  decay  in  the  water  from  those  which  began  to  decay  in 
the  air  or  earth.  Casper  and  Devergie  hold  this  opinion,  and  it  accords 
with  most  of  the  observations  made  by  me ;  and  when  we  consider  what 
especially  favors  decomposition,  there  seems  good  ground  for  believing 
that  the  bodies  of  the  drowned  should  show  the  marks  of  putrefaction 
most  st  ron gly,  as  well  as  earliest,  in  the  upper  regions  of  the  body,  inas- 
much as  the*  things  that  chiefly  favor  decomposition  are  moisture  and 
heat ;  and  as  we  shall  see  when  treating  of  death  from  drowning,  in  that 
form  of  death  usually  the  head,  chest,  and  upper  part  of  the  body  are 
much  overloaded  with  blood.  But  I  have  noted  one  case  which  coin- 
cides with  Ogston's  experience,  having  met  the  green  discoloration  of  the 
body  in  a  case  of  death  by  drowning  before  it  appeared  on  the  chest. 

I  had  occasion  some  ten  years  ago  to  examine  the  body  of  an  elderly 
man  who  was  found  in  the  water  just  within  reach  of  high  tide,  in  Boston 
Harbor.  The  man  had  been  missing  but  a  short  time,  less  than  thirty 
hours,  before  the  discovery  of  the  body.  The  clothing  was  thoroughly  wet, 
and  the  usual  appearances  of  a  body  which  had  lain  in  the  water,  such 
as  corrugation  of  the  skin  of  the  hands,  etc.,  were  observed.  There  were 
many  things  in  the  history  of  the  man's  recent  past  which  would  warrant 
an  opinion  of  death  from  suicide,  and  that  the  method  was  submersion : 
but  there  was  no  sign  of  putrefaction  about  the  head  or  chest.  A  mod- 
erate amount  of  rigor  was  present  in  the  lower  limbs,  and  the  lower  region 
of  the  abdomen  from  the  groins  nearly  to  the  umbilicus  was  of  a  green 
color.  The  section  of  the  body,  however,  showed  clearly  the  presence  of 
water  in  the  lungs  and  stomach,  a  moderate  congestion  of  the  solid  vis- 
cera, and  an  overloading  of  the  right  side  of  the  heart,  and  no  other  cause 
of  death.  Undoubtedly  the  appearances  in  this  case  were  modified  by 
the  fact  that  the  man  was  feeble  and  had  simply  lain  down  in  shallow 
water,  and  had  died  from  asphyxia  without  making  any  struggle. 

The  pressure  of  the  gases  evolved  in  putrefaction  is  very  considerable, 
and  is  not  only  sufficient  to  account  for  the  escape  of  the  contents  of 
the  alimentary  canal,  but  for  more  pronounced  phenomena,  such  as  the 
bursting  of  the  coffin  after  inhumation,  and  for  changes  of  position  in 
the  dead,  which  have  been  attributed  to  the  terrible  struggles  of  the 
prematurely  interred.  I  observed  during  the  intensely  hot  summer  of 
1887  a  striking  instance  in  point.  The  body  was  that  of  a  very  large 
and  fat  woman,  who  was  a  laundress.  She  lived  and  worked  alone  in  an 
upper  room  of  a  house  in  the  crowded  part  of  the  city,  where  she  was 
exposed  to  all  the  intensity  of  the  summer  heat  in  addition  to  that  of 
her  own  stove,  heated  for  the  purpose  of  her  occupation.  Her  absence 
was  not  noticed  till  the  second  day,  as  she  had  no  family.  The  ther- 
mometer had  registered  for  those  forty-eight  hours  from  85°  F.  to  92°  F. 
When  the  body  was  found,  it  was  swollen  to  a  third  more  than  its  natu- 
ral size.  The  tongue  was  black  and  protruding  from  the  mouth,  and 
the  large  intestine  was  inverted  like  a  glove  and  protruding  for  nearly 
two  feet  of  its  length  from  the  anus,  while  the  whole  of  the  exposed  parts 
of  the  body  were  covered  by  thousands  of  larvae. 

The  effect  of  these  same  gases  is  also  to  be  observed  in  the  flow  of 
blood  from  the  wounds  made  on  the  bodies  of  the  drowned  by  the  ravages 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  1Q1 

of  marine  animals.  From  the  effects  of  these  putrid  gases  upon  the  face 
there  may  be  such  a'change  in  the  features  as  to  render  an  identification 
of  the  body  by  the  physiognomy  a  difficult  if  not  an  impossible  matter. 
The  decomposition  of  the  upper  regions  of  the  bodies  of  the  drowned 
after  removal  from  the  water  and  exposure  to  the  air,  proceeds  with  the 
greatest  rapidity.  Features  which  were  quite  distinct  at  the  time  of  the 
recovery  of  the  body  may  become  quite  unrecognizable  after  the  lapse  of 
twenty-four  hours  in  the  summer. 

There  is  also  a  change  in  the  color  first  observed  as  a  sign  of  decom- 
position. The  red  of  the  superficial  veins  will  change  to  a  brownish 
black,  and  the  green  color  of  the  abdomen  and  other  parts  of  the  body 
changes  to  a  brown  and  even  to  a  black. 

Simultaneously  with  the  changes  produced  externally  by  putrefaction 
are  changes  in  the  appearances  of  the  viscera.  The  mucosa  of  the  larynx 
and  the  bowels  present  discolorations  which  might  be  mistaken  for' the 
signs  of  poison  or  disease.  The  mucous  membrane  of  the  stomach  pre- 
sents various  tints :  a  reddish  brown,  a  livid  purple,  or,  more  commonly, 
if  observed  a  considerable  time  after  death,  a  slate  color.  This  slate  color 
is  particularly  noticeable  in  the  brain  where  the  bodies  are  examined 
within  a  week  or  ten  days  after  death,  provided  no  means  have  been  used 
to  retard  decomposition. 

It  is  by  no  means  easy  for  the  medical  jurist  always  to  distinguish 
between  the  eft't'cts  of  poison  and  the  effects  of  decomposition  by  mere 
inspection.  In  both  cases  there  will  be  redness,  and  this  more  or  less 
circumscribed ;  and  an  additional  element  of  doubt  is  presented  when 
the  possibility  of  the  action  of  the  digestive  fluids  themselves  is  consid- 
ered. Taylor  lays  down  the  rule  that  the  change  has  taken  place  during 
life  if  it  is  met  in  an  examination  soon  after  death ;  yet  I  have  seen 
many  cases  where  the  stomach  presented  a  redness  suspiciously  like  that 
caused  by  irritant  poison,  when  death  had  occurred  from  natural  causes 
soon  after  the  ingestion  of  food.  When  the  redness  is  accompanied  by 
effusion  of  coagulated  blood,  mucus,  or  the  effects  of  xdceration,  corrosion, 
or  destruction  of  the  coats  of  the  stomach,  we  may  assume  that  it  was 
the  result  of  a  vital  process.  In  such  cases,  if  there  be  doubt,  the  well- 
known  effects  of  irritant  poisons  upon  other  organs,  notably  the  liver 
and  kidneys,  should  help  the  solution  of  the  problem,  and  at  all  events  a 
properly  made  chemical  analysis  of  the  viscera  should  absolutely  deter- 
mine the  question.  A  delay  in  expressing  an  opinion  till  the  facts  are 
definitely  ascertained  can  do  no  possible  harm,  while  the  opposite  course 
might  involve  the  physician  in  an  awkward  dilemma  at  a  later  period. 

Another  point,  which  will  be  of  service  in  the  differential  diagnosis 
of  irritant  poisoning  during  life,  and  the  reddening  of  the  mucous  mem- 
brane of  the  stomach  after  death,  is  that  this  redness  will  lie  observed 
in  all  the  other  viscera  as  well.  It  is  especially  noticeable  in  the  mem- 
branes which  naturally  have  no  color.  The  deep  staining  of  the  aorta 
and  of  the  respiratory  canals  is  an  instance  in  point.  It  is  true,  however, 
that  Trouseau  and  Roget  succeeded  in  producing  the  appearances  of  true 
inflammation  upon  the  bodies  of  the  dead,  so  far  as  these  appearances 
consisted  in  the  injection  of  the  vessels  rather  than  the  general  dyeing 
of  the  parts. 

As  a  consequence  of  the  progress  of  putrefaction  the  blood  becomes 
fluid,  and  the  action  of  the  gases  may  change  its  position  to  the  extent 


luo        •  J    STSTEM   OF  LEGAL  MEDICINE. 

that  it  may  be  forced  from  the  cavities  of  the  heart,  where  it  was  in 
large  quantity  a1  the  time  of  death.  It  is  propelled  toward  the  cap- 
illaries, and  gives  to  the  external  portions  of  the  bodies,  seen  some  weeks 
after  death,  a  diffuse  redness  differing  from  the  early  post-mortem  dis- 
coloration ;  and  this  redness  is  accompanied  by  alooseness  of  the  cuticle, 
which  presents  a  sort  of  blistered  appearance.  Moreover,  this  discolor- 
ation affects  the  true  skin,  and  the  subcutaneous  areolar  tissue  is  bathed 
in  reddish  serum,  and  the  back  part  of  the  scalp  presents  an  appearance 
appropriately  compared  by  Ogston  to  red-currant  jelly. 

In  the  cases  which  I  have  observed  I  have  found  that  the  suggestions 
made  by  Ogston  are  of  much  value  :  namely,  that,  first,  in  post-mortem 
redness  the  color  is  limited  to  the  course  of  the  vessels,  while  in  inflam- 
matory redness  the  parts  around  the  vessels  partake  more  or  less  of  the 
coloration  :  and  second,  that  in  inflammatory  redness  the  color  is  usually 
limited  to  the  inflamed  membrane,  while  in  the  redness  from  putrefaction 
the  color  pervades  the  whole  of  the  tissues  of  the  part. 

It  is  true  that  aside  from  obvious  changes,  such  as  the  presence  of 
clots,  tumors,  or  abscesses,  the  brain  gives  on  examination  very  little  that 
is  of  absolute  diagnostic  value,  especially  in  the  matter  of  differentiating 
between  inflammatory  and  putrefactive  alteration.  There  is  something 
in  favor  of  the  assumption  of  inflammatory  change  if  the  appearances 
are  found  at  the  superior  portion  of  the  brain  instead  of  at  the  base, 
where,  if  the  body  has  remained  in  the  usual  position,  there  would  be 
likely  to  be,  from  obvious  conditions,  the  greatest  amount  of  coloration 
in  a  location  provided  with  the  material  favoring  a  more  rapid  decom- 
position and  color  change. 

If  an  individual  tract  of  t  the  mucous  membrane  of  the  larynx  be  alone 
considered,  there  might  be  difficulty,  as  Casper  has  pointed  out,  in  dis- 
tinguishing between  the  effects  of  a  laryngitis  and  a  post-mortem  stain- 
ing, or  the  effects  produced  in  death  by  drowning.  After  all,  attention 
to  the  collateral  appearances  and  the  history  of  the  case  should  ordinarily 
be  sufficient  to  determine  the  question. 

The  fact  that  the  contents  of  the  gall-bladder  may  transude  through 
the  coats  of  the  duodenum  and  even  of  the  stomach,  and  thus  present 
appearances  simulating  those  produced  by  the  swallowing  of  nitric  acid 
during  life,  is  not  of  great  moment,  inasmuch  as  the  great  changes 
necessarily  produced  in  the  mouth  and  oesophagus  by  swallowing  acid 
would  prevent  any  error  in  diagnosis. 

Effusion  of  fluid  into  the  cavities  of  the  body  is  a  further  effect  ^f 
putrefaction.  The  blood  ferments,  becomes  full  of  bubbles,  and  is  driven 
onward  toward  the  capillaries,  and  ultimately  to  the  place  where  it  meets 
the  least  resistance.  In  the  serous  cavities  will  be  found  blood-tinged 
serum  in  greater  or  less  quantity.  The  amount  is  usually  less  in  the 
peritoneal  cavity  than  in  the  pleural.  The  odor  is  distinct,  and  the  color 
brownish  red.  This  effusion  is  seldom  met  with  in  the  earlier  period  after 
death,  probably  never  during  the  first  week — except  in  cases  of  death 
from  heart  disease  with  pulmonary  oedema  and  cases  of  death  from 
drowning — and  usually  not  till  after  the  lapse  of  several  weeks. 

Parts  that  have  been  affected  with  gangrene  in  the  living  and  parts 
that  have  been  the  seat  of  severe  injury  putrefy  more  rapidly  than  those 
which  have  not,  and  post-mortem  putrefaction  may  easily  simulate  the 
appearance  of  gangrene  in  the  living.     In  such  cases  caution  should  be 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  1();. 

observed  in  giving  an  opinion.  Testimony  of  those  who  have  seen  the 
condition  of  affairs  in  the  person  while  alive  would  be  con  elusive,  and  if 
no  other  part  of  the  limb  was  in  a  state  of  putrefaction,  the  probabilities 
would  favor  the  theory  of  gangrene  during  life  ;  but  even  then  allowance 
should  be  made  for  the  more  rapid  putrefaction  of  wounded  parts. 

Any  confusion  which  might  arise  as  to  the  origin  of  the  fluids  found 
in  the  cavities  of  putrefied  bodies  will  be  avoided  if  attention  be  paid  to 
the  character  of  the  fluid,  its  homogeneity,  its  freedom  from  pus,  lymph,  or 
false  membranes,  and  its  color,  which  is  not  so  dark  as  that  of  putrefying 
blood.  It  does  not  seem  necessary  here  to  speak  of  the  changes  produced 
in  the  body  after  death  by  purely  adventitious  means,  such  as  the  wounds 
made  by  the  striking  of  the  body  against  hard  substances  while  floating, 
or  the  ravages  of  marine  animals,  or  the  gnawing  of  squirrels  or  rats, 
which  often  leave  well-defined  marks  of  their  attacks  upon  the  bodies  of 
those  exposed  in  fields  or  even  in  the  dead-houses  of  cities. 

The  rapidity  with  which  decomposition  occurs  varies  considerably, 
according  to  several  factors  which  may  obtain.  It  is  favored  by  high 
temperature,  by  moisture,  as  exemplified  in  the  cases  of  the  dropsical 
and  the  decay  of  the  upper  portions  of  the  bodies  of  the  drowned,  by  free 
access  of  air,  absence  of  clothing,  previous  injuries,  sudden  death,  acute 
diseases,  especially  those  of  a  septic  character,  corpulence,  and  possibil- 
ity the  cause  of  death  having  been  poisonous  gases  or  animal  poisons. 
Whether  prussic  acid  favors  rapid  decomposition,  as  claimed  by  some 
authors,  or  not,  I  cannot  say  further  than  that  in  the  few  cases  which 
have  come  under  my  personal  observation  there  was  no  perceptible  in- 
crease in  the  rapidity  of  decomposition  within  the  first  three  days,  as 
compared  with  that  of  cases  of  death  from  other  causes. 

On  the  other  hand,  decomposition  will  be  retarded  by  low  temperature, 
or  very  high  temperature  where  the  body  has  been  thoroughly  cooked 
and  charred.  Also  profuse  hemorrhages,  which  diminish  the  amount  of 
fluid  in  the  body,  tend  to  retard  decomposition.  Continued  immersion 
in  water  and  burial  in  a  deep  grave,  by  keeping  the  body  at  a  low  tem- 
perature, also  retard  putrefaction,  though  the  process  of  decomposition 
g<  »es  on  with  the  greatest  rapidity  after  the  body  has  been  removed  from 
such  surroundings.  Burial  soon  after  death,  and  burial  in  dry  sand  or 
earth  and  in  dry,  elevated  ground,  is  said  to  retard  decomposition.  This 
does  not  correspond  with  my  observations  in  a  few  cases  of  exhumation, 
neither  does  the  claim  that  nitrogen  gas  and  the  residuum  of  ah*  in  air- 
tight coffins  retard  decomposition.  Certain  poisons,  especially  arsenic 
and  alcohol,  are  claimed  to  render  the  body  less  liable  to  rapid  putrefac- 
tion. I  have  found  that  the  cases  of  death  from  acute  and  chronic  alco- 
holic poisoning  differ  in  rapidity  of  decomposition  very  little  from  those 
of  death  from  other  causes ;  if  there  has  been  a  difference,  it  is  that  the 
bodies  seem  to  decay  with  rather  greater  rapidity  than  the  bodies  of 
those  where  death  has  residted  from  various  natural  causes,  which  seems 
only  reasonable  when  the  changes  produced  in  the  body  by  alcoholic 
narcosis  are  considered. 

I  may  say,  in  this  connection,  that  the  most  rapid  and  repulsive  c<  n- 
dition  of  putrefaction  which  I  have  seen,  a  case  where  the  body  was 
largely  lkmefied,  was  that  of  a  man  who  had  died  of  arsenic  poisoning, 
where  the  drug  had  been  administered  in  pretty  large  doses  for  a  period 
of  several  days,  and  where  the  body  had  been  buried  in  dry,  elevated  soil  iu 


1(J4  A   SYSTEM    OF  LEGAL   MEDICINE. 

a  nominally  air-tight  casket,  and  afterward  exhumed  and  transported  two 
days  1  »ef<  ire  examination.  Of  course,  leanness — and  old  age,  which  favors 
leanness — (aside  from  dropsical  conditions  or  corpulence),  favors  slow 
putrefaction  by  the  absence  of  an  excess  of  those  fluids  which  naturally 
hasten  this  process.  Since  writing  the  above  I  have  had  occasion  to  ex- 
amine the  body  of  a  man  exhumed  after  a  burial  of  eight  weeks.  The 
cause  of  death  was  organic  disease  of  the  heart,  This  body  was,  in  gen- 
eral, in  a  very  good  state  of  preservation.  Chiefest  to  be  noted  were  the 
large  spots  of  mold  upon  the  cheeks  and  chin  and  forehead,  while  the 
orbits  were  filled  with  a  white  fluffy  mold  presenting  quite  a  contrast 
to  the  greenish  tinge  of  the  mold  elsewhere.  There  were  some  vesicles 
as  large  as  an  English  walnut  upon  the  flanks,  purplish  in  color  and  full 
of  serum,  but  slightly  tinged.  The  brain  was  quite  soft,  but  preserved 
its  form  and  permitted  of  sections  with  a  thin,  very  sharp  knife,  and  the 
different  structures,  as,  for  instance,  the  corpora  striata,  were  in  condition 
to  be  fully  examined.  The  heart,  as  would  be  expected  of  an  organ 
which  resists  decay  among  the  longest,  admitted  of  clear  discrimination 
between  the  effects  of  post-mortem  change  and  the  fatty  infiltration  which 
had  occurred  during  life.  The  scalp  was  mummified,  rendering  its  re- 
moval rather  more  difficult  than  usual ;  but  all  the  organs  were  in  a  bet- 
ter state  of  preservation  than  I  have  seen,  twenty-four  hours  after  death, 
in  many  cases  of  septicaemia,  where  the  body  had  been  kept  in  a  moder- 
ately cool  room. 

Various  forms  of  so-called  embalming  are  supposed  to  prevent  putre- 
factive changes.  I  have  never  had  occasion  to  witness  the  condition  of 
a  body  at  any  long  period  after  the  injection  of  the  cavities  or  the 
arteries  with  the  various  so-called  preservatives,  but  in  many  cases  I  have 
noticed  that  putrefaction  proceeded  with  unusual  rapidity  after  this  pro- 
cess, while  in  none  have  I  seen  any  difference  in  the  putrefactive  change 
between  the  embalmed  and  non-embalmed  during  the  usual  period 
elapsing  between  death  and  burial.  Of  course,  much  may  depend  upon 
the  kiud  of  fluid  and  the  skill  of  the  operator ;  but  as  far  as  my  own  ex- 
perience goes,  this  process  of  embalming  tends  rather  to  the  obscuring 
of  signs  of  death  from  poisoning,  and  the  pecuniary  advantage  of  the 
undertaker,  than  to  anything  else. 

Any  consideration  of  the  subject  of  putrefaction  would  be  incom- 
plete without  allusion  to  a  change  which  occasionally  occurs  at  a  long 
period  after  death,  namely,  the  saponification  of  the  body,  or  the  forma- 
tion of  adipocere.  This  change  is  wholly  chemical,  and  consists  in  the 
union  of  the  fatty  acids  with  ammonia.  It  has  been  oftenest  observed 
in  bodies  that  have  lain  a  long  time  in  water  or  in  very  damp  soil,  where 
moisture  has  continuously  acted  upon  a  putrefying  corpse.  There  are 
some  other  conditions  under  which  adipocere  is  formed,  but  the  two  men- 
tioned are  the  only  ones  definitely  known.  Its  formation  to  any  consid- 
erable extent  usually  requires  a  long  time,  though  it  may  begin  to  form  at 
a  rather  early  period.  Casper  cites  the  case  of  one  child  where  adipocere 
was  observed  after  the  interval  of  only  three  weeks,  and  of  another  child 
where  it  was  noted  after  a  period  of  only  thirteen  weeks ;  but  usually  a 
period  of  three  to  four  months  in  the  water,  or  of  six  months  in  moist 
earth,  is  required  before  this  saponification  occurs.  It  is  not  necessary 
that  so  long  a  period  as  many  years  should  elapse  before  it  is  formed, 
as  was  at  one  time  supposed. 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  1Q5 

Adipocere  is  a  fatty  substance,  generally  of  a  yellow  color,  occasion- 
ally of  a  pure  white.  It  is  unctuous  or  soapy,  brittle,  and  soft  to  cut.  It 
melts  at  different  degrees  of  temperature,  some  requiring  no  more  than 
200°  F.  As  it  is  due  to  the  checking  of  the  colliquative  putrefaction,  it 
occurs  more  readily  in  the  bodies  of  fat  people  than  in  the  lean,  and 
children  present  the  change  more  readily  than  do  adults.  In  addition 
to  the  value  of  this  condition  as  an  indication  of  the  length  of  time  that 
has  elapsed  since  death,  it  is  of  importance  to  bear  in  mind  a  fact  to 
which  Glints  has  called  attention,  namely,  that  adipocere  is  always 
greater  in  volume  than  the  total  amount  of  fat  preexisting  in  the  body, 
and  therefore  in  weighing  the  body  of  a  new-born  child  for  the  pm-pose 
of  ascertaining  the  age  allowance  must  be  made  for  the  difference. 

This  saponification  of  the  body  has  also  been  termed  mummification, 
but  as  true  mummification  is  essentially  different  from  the  chemical  pro- 
cess by  which  adipocere  is  formed,  the  terms  shoidd  not  be  used  as  if  in- 
terchangeable. 

True  mummification  consists  in  the  rapid  evaporation  of  the  watery 
constituents  of  the  body.  This  change  is  favored  by  very  high  tempera- 
tures with  great  dryness  of  the  atmosphere,  and  by  atmospheric  draught. 
In  this  dried  state  the  soft  parts  are  retained,  and  the  features,  though 
distorted,  are  preserved,  and  present  a  rusty  brown  color.  The  internal 
organs  have  partly  disappeared,  or  are  blended  together  so  as  not  to  be 
distinguished  from  one  another,  and  they  present  an  odor  more  like 
cheese  than  that  of  a  putrefying  body. 

Whether  occupation  has  any  effect  on  the  process  is  not  known,  in 
spite  of  the  assertion  of  the  First  Clown  in  "  Hamlet,"  that  "  a  tanner 
will  last  you  nine  year."  It  must  be  admitted  that  his  assertion  that 
"  your  water  is  a  sore  decayer  of  your  whoreson  dead  body  "  is  confirmed 
by  medico-legal  observation. 

At  all  events,  the  value  of  the  process  of  mummification  to  the  medi- 
cal jurist  is,  as  Casper  says,  practically  confined  to  the  question  of  the 
mummification  of  the  umbilical  cord  in  the  new-born  and  the  mummifi- 
cation occurring  in  bodies  after  arsenic  poisoning. 

Chronological  Order. — Though  it  doubtless  is  true  that  the  medical 
jurist  should  never  refuse  to  perform  an  autopsy,  irrespective  of  the  time 
that  has  elapsed  after  death,  it  is  well  to  consider  what  the  relative  order 
of  change  is,  in  order  that  the  probability  of  obtaining  any  satisfactory 
data,  either  as  to  the  cause  of  death  or  any  other  ante-mortem  conditio]  is, 
may  be  properly  estimated.  It  is  well  known  that  certain  organs  resist 
decay  much  longer  than  others ;  and  in  a  body  where  there  would  be  no 
possibility  of  determining  whether  the  cause  of  death  may  have  been 
natural,  like  typhoid-fever,  or  a  poison,  like  hydrocyanic  acid,  it  might 
still  be  possible  to  determine  the  sex  by  the  discovery  of  a  uterus  or 
a  prostate  gland,  or  to  determine  the  question  of  pregnancy  in  the 
female.  Even  in  the  bodies  of  those  dead  for  a  number  of  years,  though 
pathological  changes  are  no  longer  to  be  perceived,  yet  the  remains  may 
afford  proof  of  the  presence  of  some  of  the  mineral  poisons  in  the  debris. 

Therefore  the  chronological  order  of  the  phenomena  of  putrefaction 
in  the  internal  organs  deserves  especial  attention.  There  is  practically 
little  difference  among  authors  as  to  this  order.  First  to  present  the 
changes  of  putrefaction  are  the  trachea  and  larynx.  Whether  due  to 
the  access  of  atmospheric  air  or  to  imbibition,  it  is  certain  that  in  from 


10G  A   SYSTEM   OF  LEGAL   MEDICINE. 

three  to  five  days  in  .summer,  and  six  to  eight  in  winter,  the  trachea  as- 
sumes in  its  mucosa  a  uniform  dirty  cherry -red  or  brownish-red  discolor- 
ation withoul  vascular  injection.  This  color  is  to  be  differentiated  from 
thai  biighl  color  which  obtains  in  cases  of  death  from  asphyxia  or  from 
laryngitis.  Bu1  in  these  cases  both  the  history  of  the  case  and  the  period 
after  death  at  which  the  examination  is  made  will  help  to  determine  the 
question.  As  putrefaction  goes  on  the  mucous  membrane  becomes  olive- 
green  and  the  cartilages  separate  from  one  another,  but  months  elapse 
before  they  disappear. 

Next  in  order  come  the  brains  of  new-born  children  and  those  under 
one  year  of  age.  The  contents  of  the  cranium  of  these  children  are  very 
soft,  the  access  of  air  is  easy,  and  they  are  not  affected  by  those  changes 
in  consequence  of  modes  of  life  which  sometimes  render  the  brains  of 
adults  more  durable,  as  in  the  case  of  extensive  supplanting  of  cerebral 
matter  with  connective  tissue  granulations,  and  their  subsequent  contrac- 
tion, which  is  so  often  observed  in  the  brains  of  chronic  alcoholic  subjects. 

The  stomach  putrefies  at  a  very  early  period,  generally  in  five  to  six  days, 
the  traces  of  the  change  being  observed  in  a  dirty  red  color  at  the  fundus, 
and  tins  color  is  at  first  noted  in  isolated  patches  and  on  the  posterior  wall, 
rapidly  appearing  afterward  on  the  anterior,  and  then  fading  into  a  dirty 
gray  with  patches  of  black,  while  later  the  coats  become  softened.  Next 
in  order  of  putrefaction  are  the  intestines,  and  the  changes  occurring 
there  are  similar  to  those  which  have  been  mentioned  as  happening 
in  the  stomach.  The  change  caused  by  bile-staining  has  already  been 
mentioned.  The  intestines  eventually  burst  and  discharge  their  contents, 
and  finally  become  a  pultaceous  mass. 

The  spleen  is  said  to  resist  decay  longer  than  the  organs  just  men- 
tioned, but  it  is  certain  that  it  softens  very  quickly,  and  especially  in 
cases  of  septicaemia.  It  softens  with  the  greatest  rapidity,  and  may 
become  almost  liquefied  in  some  cases,  while  in  others  it  assumes  a  steel- 
gray  color  with  rather  more  consistency. 

If  fairly  free  from  fat,  the  mesentery  and  omentum  resist  putrefaction 
for  a  period  of  several  weeks,  but  the  process  is  somewdiat  accelerated  if 
they  are  very  fat. 

In  new-born  children  the  liver  begins  to  putrefy  earlier  than  the  liver 
of  an  adult,  which  may  be  found  pretty  well  preserved  several  weeks  after 
death.  I  have  seen  it  in  a  fair  state  of  preservation  at  a  period  six  weeks 
after  death.  The  convexity  shows  the  greenish  change  first,  which  event- 
ually pervades  the  whole  organ,  and  as  time  passes  the  organ  becomes 
more  and  more  pultaceous.  The  gall-bladder  remains  for  a  much  longer 
time  recognizable. 

The  brain  of  an  adult  shows  the  change  of  putrefaction  first  at  the 
base,  and  a  greenish  color  pervades  the  whole  organ ;  but  the  color  is  not 
so  pronounced  as  elsewhere,  at  all  events  at  the  earlier  stages.  The  color 
is  more  of  an  ashy  gray,  and  the  brain  retains  this  color  even  after  it 
has  become  very  soft,  even  to  the  point  of  almost  liquefaction.  I  have 
never  observed,  as  a  result  of  putrefaction,  the  reddish  pulpy  condition 
which  is  to  be  observed  at  a  very  early  period  in  the  brain  of  the  new- 
born, although  that  such  a  condition  may  be  found  cannot  be  doubted, 
as  it  has  been  observed  by  many  writers  on  the  subject.  The  brains 
which  have  been  seen  by  'me  when  they  had  arrived  at  a  condition  of 
pi! refaction  have  been  cases  examined/  at  the  farthest,  three  months 


DEATH   IX  ITS   MEDICO-LEGAL   ASPECTS.  IQJ 

after  death.  These  were  uniformly  gray  and  soft,  some  even  to  lique- 
faction ;  and  I  admit  that  it  does  not  seem  clear  to  me  where  these  partic- 
ular brains  were  to  get  the  tinge  of  red  at  any  subsequent  period,  which 
Casper  says  putrefying  brains  do  months  after  death. 

The  heart  and  lungs  begin  to  putrefy  at  pretty  nearly  the  same  time. 
The  heart  will  be  found  empty  of  blood  and  somewhat  shriveled,  the  peri- 
cardial fluid  will  have  evaporated,  but  still  the  heart  muscle  will  be  clearly 
recognizable,  and,  in  general,  permitting,  months  after  death,  and  long 
after  the  other  organs  mentioned  have  passed  beyond  recognition,  a  pretty 
good  idea  to  be  formed  as  to  any  pathological  change.  The  same  is  true, 
in  a  measure,  of  the  lungs.  The  structure  may  be  demonstrable,  and  a 
differentiation  between  gray  hepatization  and  putrefactive  change  may 
be  possible  many  weeks  after  death.  The  diaphragm  is  a  muscular 
structure  like  the  heart,  capable  of  resisting  decay  for  a  long  time ;  but 
the  organ  which  presents  the  greatest  resistance  to  putrefactive  change 
is  the  uterus.  This  will  be  found  intact  after  the  destruction  of  the 
external  genitals.  Casper  cites  a  case  of  an  adult  whose  body  was  in  a 
very  advanced  state  of  putrefaction,  and  which  had  lain  in  a  privy  vault. 
a  condition  favoring  rapid  decomposition,  for  nearly  ten  months,  where 
the  uterus  was  of  a  bright  red  color,  firm  to  feel  and  cut,  its  form  per- 
fectly normal, and  recognizable. 

Though  I  do  not  find  it  mentioned  by  any  writer,  and  have  not  had 
opportunity  to  make  any  observation  in  the  matter  myself,  it  is  probable 
that  the  prostate  gland,  also,  like  the  heart  and  uterus,  long  resists  decay, 
a  not  unnatural  conclusion  when  its  dense  structure  is  considered.  Its 
examination  at  a  late  period  after  death  would  only  have  a  medico-legal . 
value  where  it  was  necessarv  to  determine  the  sex  in  a  mutilated  body. 

In  conclusion,  it  is  worth  while  to  present  a  risumi  of  periods  at 
which  some  idea  of  the  time  that  has  elapsed  since  death  may  be  gained 
from  external  inspection,  as  stated  by  Casper, 

(1)  The  greenish  discoloration  of  the  abdomen  and  the  softening  of 
the  eyeballs'  indicate  that  the  person  has  been  dead  from  twenty-four  to 
seventy-two  hours. 

(2)  After  three  to  five  days  the  green  discoloration  has  become  deeper, 
and  has  extended  over  the  entire  abdomen,  including  the  genitals ;  while 
similar  patches  have  begun  to  appear  on  other  parts,  especially  the  back, 
lower  extremities,  neck,  and  sides  of  the  chest. 

(3)  In  about  eight  days  the  greenish  patches  have  coalesced  and 
changed  to  a  reddish  green,  gaseous  products  have  become  developed  in 
the  abdomen,  the  cornea  has  become  concave,  the  sphincter  ani  lias  re- 
laxed, and  the  ramifications  of  the  subcutaneous  veins  can  be  traced  on 
the  neck,  breast,  and  limbs. 

(4)  After  fourteen  or  twenty  days,  blisters  have  appeared  upon  the 
skin,  and  the  development  of  gases  has  become  general,  distending  the 
whole  body. 

(5)  Lastly,  after  this  period  it  is  impossible  to  determine  the  date  of 
the  decease. 

These  data  refer  to  bodies  exposed  to  the  atmosphere,  and  it  is  as- 
sumed that  the  mean  temperature  between  summer  and  winter  was  main- 
tained. Of  course,  from  what  has  been  said,  it  will  be  understood  that 
these  data  must  be  much  modified  by  a  different  condition  of  things;  but 
as  a  general  ride  Casper  holds  that 'a  body,  after  lying  in  the  open  air 


lQg  A    SlSTEM    OF  LEGAL  MEDICINE. 

for  a  week  (or  a  month)  at  a  tolerably  similar  average  temperature,  cor- 
responds in  its  degree  of  putrefaction  to  that  of  a  body  lying  in  the  water 
twice  as  long,  or  after  lying  in  the  earth  in  the  usual  manner  for  a  period 
eight  times  as  long  (eight  weeks  or  months). 


DEATH   BY   SUFFOCATION. 

Death  by  suffocation  is  due  to  the  complete  arrest  of  the  respiratory 
functions,  and  the  consequent  interruption  of  that  exchange  of  the  gases 
of  the  external  air  and  the  blood  gases  of  the  lungs  which  is  necessary 
for  the  life  of  the  individual,  the  object  of  respiration  being  to  supply 
the  oxygen  necessary  for  tissue  metabolism,  and  to  remove  the  carbonic 
acid  formed  in  the  body. 

Suffocation  is  produced  in  two  ways — either  mechanically,  by  dis- 
turbing or  destroying  the  pulmonary  mechanism,  or  dynamically,  by 
depriving  the  blood  of  the  influence  of  oxygen. 

The  first  class  includes :  (a)  injury  to  the  chest  walls,  or  prevention 
of  their  movement  by  crushing  by  weights,  or  pressure  in  crowds,  or 
being  buried  alive  in  sand-pits,  hay,  etc.,  or  by  the  falling  of  walls  of 
buildings ;  (b)  any  cause  operating  on  the  mouth  and  nose  and  throat 
externally,  such  as  covering  the  face  with  bedclothes  or  plasters,  or  ex- 
ternal compression  of  the  throat,  or  a  cause  operating  on  the  throat,, 
windpipe,  and  air-passage  internally,  such  as  blocking  them  up  with 
food  and  plugs  of  various  kinds.  Disease  itself  may  furnish  another 
cause  of  suffocation,  such  as  the  complete  obstruction  of  the  larynx  in 
diphtheria,  oedema  of  the  glottis,  or  acute  laryngitis. 

The  second  class,  which  operates  dynamically,  includes  the  breathing 
of  irrespirable  and  poisonous  gases,  though  in  the  case  of  carbonic  oxide 
and  sulphureted  hydrogen  poisoning  the  death  is  not  due  to  asphyxia, 
but  to  the  direct  interference  with  the  oxygen-carrying  function  of  the 
blood-corpuscles. 

It  will  be  proper  first  to  consider  the  phenomena  of  asphyxia,  which 
are  usually  divided  into  several  stages. 

During  the  first  there  is  hyperpncea,  the  respirations  being  more 
frequent  and  labored,  the  extraordinary  muscles  of  inspiration  and  ex- 
piration being  used.  Next  the  condition  of  dyspnoea  is  rapidly  produced. 
The  oxygen  of  the  blood  is  used  up.  The  venous  blood  resulting  circu- 
lates in  the  medulla,  and  causes  violent  respirations  by  stimulating  the 
respiratory  center.  This  stage  usually  lasts  about  one  minute,  and  gives- 
place  to  the  second  or  convulsive  stage,  in  which  the  inspiratory  muscles 
are  less  active,  but  the  expiratory  muscles  are  very  violently  agitated 
and  the  whole  muscular  system  becomes  convulsed,  the  convulsions  being 
due  to  the  stimulation  of  the  respiratory  center  by  the  venous  blood. 
This  stage  is  short,  and  is  succeeded  by  the  third  stage,  that  of  exhaus- 
tion, the  respiratory  centers  being  now  paralyzed  by  the  venous  blood. 
Consciousness  is  abolished,  the  pupils  of  the  eyes  are  widely  dilated,  the 
muscles  flaccid,  reflex  acts  are  suspended,  and  the  only  signs  of  life  are 
a  few  feeble  inspiratory  efforts  at  longer  and  longer  intervals.  At  last, 
as  the  venous  blood  circulates  in  the  spinal  cord  the  extremities  and 
trunk  are  extended,  there  is  one  last  long  gasp,  and  breathing  entirely 
ceases.     After  this  stage  the  heart  becomes  paralyzed,  partly  by  over- 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  109 

distention  and  partly  by  the  action  of  the  venons  blood  on  its  walls,  the 
pulse  is  imperceptible,  and  the  heart  stops  a  few  seconds  after  the  cessa- 
tion of  respiration.  The  whole  series  of  phenomena  lasts  from  three  to 
five  minutes,  the  third  stage  being  the  longest. 

The  post-mortem  appearances  in  death  from  asphyxia  are  generally 
well  marked.  The  right  side  of  the  heart,  the  pulmonary  artery,  the 
vena  cava,  and  the  veins  of  the  neck  are  all  engorged  with  blood.  The 
left  side  is  comparatively  empty.  The  blood  is  fluid  and  almost  black, 
nearly  all  of  the  hemoglobin  being  reduced,  while  ordinary  venous  blood 
contains  some  oxy haemoglobin.  The  brain,  liver,  and  walls  of  the  intes- 
tines and  the  kidneys  are  full  of  black  fluid  blood.  The  mucosa  of  the 
larynx  and  trachea  are  injected,  and  the  lungs  engorged  with  dark  fluid 
blood.  Such  are  the  appearances  in  death  from  asphyxia  from  whatever 
cause.  Let  us  now  consider  the  appearances  which  are  generally  present 
in  death  from  suffocation,  and  are  especially  characteristic  of  this  form 
of  death. 

In  some  cases  of  death  by  suffocation  the  post-mortem  appearances 
may  differ,  inasmuch  as  the  immediate  cause  of  death  may  be  something 
other  than  asphyxia.  If  the  larynx  is  suddenly  constricted  or  blocked,  the 
death  is  very  sudden,  and  there  is  no  time  for  the  production  of  all  the 
phenomena  of  asphyxia-,  inasmuch  as  the  suddenness  with  which  the  larynx 
and  trachea  sometimes  become  impervious  causes  siich  a  shock  as  to  result 
in  a  very  speedy  death,  the  neuro-paralysis  of  Casper.  We  have,  therefore, 
to  consider  those  cases  by  which  shock  has  modified  or  shortened  the  mani- 
festations of  death,  and  the  alteration  in  the  post-mortem  appearances 
which  are  the  consequence  of  this  modification.  The  face  may  be  pale 
or  present  a  dusky  violet  tint,  the  eyes  are  congested,  with,  sometimes, 
protruding  eyeballs,  the  tongue  is  sometimes  clenched  between  the  teeth 
and  protrudes,  and  is  sometimes  behind  the  teeth.  The  mucosa  of  the 
larynx  and  trachea  are  invariably  injected.  The  lungs  may  or  may  not 
be  congested,  and  sometimes,  as  quoted  by  Taylor,  one  lung  may  be  con- 
gested and  the  other  not.  Tardieu  says  the  lungs  are  of  a  reddish  color, 
sometimes  pale,  not  distended,  and  only  congested  posteriorly.  One  sig- 
nificant sign,  especially  in  smothering,  observed  in  the  lungs  is  the  pres- 
ence of  small  subpleural  ecchymoses.  They  vary  in  size  from  a  pin's 
point  to  a  lentil,  in  number  from  five  or  six  to  a  considerable  number, 
and  are  due  to  small  effusions  of  blood  from  ruptured  blood-vessels. 
These  ecchymoses  are  said,  however,  to  be  found  in  cases  of  death  from 
asphyxia  other  than  those  by  suffocation,  though  admittedly  more  fre- 
quent in  the  latter.  (Legroux,  Ann.  d'Hygiene,  1878,  vols.  i.  and  ii., 
pp.  174,  335.)  They  have  also  been  seen  in  new-born  children  who  have 
never  breathed.  However,  Casper  explains  this  point  by  saying  that 
"  should  the  exchange  of  gases  necessary  for  the  child's  life,  which  takes 
place  in  the  placenta,  be  interrupted  by  a  separation  of  the  placenta,  or 
by  pressure  on  the  umbilical  cord,  or  by  the  death  of  the  mother,  then 
the  child  makes  instinctive  respiratory  movements  in  order  to  maintain 
this  exchange,  and  so  these  congestions  and  eechynioses  are  found  to 
occur  even  in  the  uterus."  These  ecchymoses  are  seen  in  other  parts 
than  the  visceral  pleura?,  and  in  one  remarkable  case  of  death  by  smoth- 
ering, which  happened  in  the  writer's  experience,  the  ecchymoses  were 
scattered  over  the  visceral  pericardium,  over  the  surface  of  the  liver,  and 
markedly  over  both  kidneys  as  well  as  on  the  lungs. 


HO  A    SYSTEM    OF  LEGAL   MEDICINE. 

Both  Tardien  and  Ogston  noticed  such  eeehymoses  on  the  surface  of 
the  neck,  and  Ogston  lias  seen  them  on  the  thymus  gland  and  pericra- 
nium. The  more  rapidly  suffocation  takes  place,  the  more  marked  are 
these  eeehymoses,  and  sometimes  in  addition  to  these  signs  there  are  rupt- 
ures of  the  air-cells  and  emphysematous  patches  on  the  anterior  portion 
of  the  lungs. 

There  is  generally  a  little  bloody,  frothy  mucus  in  the  air-passages. 
It  is  obvious  that  as  the  appearances  here  described  are  also  found  in 
other  forms  of  death  we  must  not  lay  too  much  stress  on  any  single 
one.  but  consider  it  as  one  point  only  in  the  determination  of  the  cause 
of  death.  The  presence  of  eeehymoses  on  the  surface  of  the  lungs  would 
justify  an  opinion  that  death  was  due  to  suffocation  in  the  absence  of 
other  signs,  especially  when  it  is  remembered  that  they  are  most  marked 
in  the  more  rapid  deaths  from  this  cause. 

We  may  not  find  the  heart  greatly  engorged  with  the  black  fluid  blood 
of  asphyxia,  for  in  cases  of  sudden  death  from  shock  the  organ  may  be 
flaccid  and  nearly  empty,  the  action  having  ceased  in  diastole.  In  such 
cases  the  other  organs  would  not  be  markedly  hyperasmic. 

There  are  some  external  appearances  seen  in  death  from  suffocation, 
though  common  also  in  death  from  convulsions,  and  these  are  the  car- 
popedal  contractions,  the  thumbs  being  strongly  opposed  and  flexed,  and 
the  fingers  flexed  over  them,  and  the  toes  showing  similar  contractions, 
with  only,  however,  slight  opposition  of  the  great  toes.  After  this  form 
of  death  rigor  mortis  is  said  to  be  slight,  or  to  rapidly  pass  off. 

In  a  terrible  catastrophe  which  occurred  in  Sunderland  in  1883,  about 
two  hundred  children  lost  their  lives  by  suffocation.  By  the  accidental 
closing  of  a  door,  the  children,  pouring  down  a  staircase  and  pushed 
from  behind,  trampled  on  those  in  front,  and  the  bodies  were  heaped  up 
to  a  height  of  several  feet.  The  same  appearance  was  seen  in  each  case, 
namely,  a  congested,  puffy  face,  purple  turgescence  of  the  vessels  of  the 
neck,  closed  eyelids,  protruding  eyeballs,  pupils  widely  dilated,  with 
bloody  froth  issuing  from  the  nose  and  mouth,  giving  the  appearance  of 
great  suffering  and  anxiety ;  yet  after  twenty-four  hours  much  of  this 
passed  off,  aud  the  face  appeared  placid,  with  a  slight  smile  as  if  in  sleep. 

It  is  important  to  insist  on  the  fact  that  when  the  larynx  itself  is 
suddenly  occluded  or  compressed,  death  occurs  so  quickly  that  the  post- 
mortem appearances  described  above  are  not  so  pronounced. 

So  far  we  have  described  the  post-mortem  appearances  in  those  cases 
where  death  has  resulted  from  suffocation  by  mechanical  interference 
with  the  principal  organs  of  respiration,  the  lungs  ;  for  although  the  skin 
is  classified  as  an  organ  of  respiration  by  physiologists,  yet  in  the  annals 
of  medical  jurisprudence  death  by  complete  obstruction  of  the  pores  has 
never  been  recorded.  There  is  one  case  quoted  by  Foster  {Physiology), 
where  an  Italian  boy  was  covered  with  gold-leaf  to  represent  an  angel, 
ami  died  a  few  minutes  after  the  whole  body  was  enveloped,  with  the 
signs  of  asphyxia. 

The  case  of  the  children  suffocated  by  crowding  in  a  narrow  stair- 
case, above  quoted,  is  a  good  illustration  of  the  signs  observed  after 
death  from  mechanical  compression  of  the  chest,  with  perhaps  the  addi- 
tional cause  of  vitiated  air. 

Other  instances  are  frequently  seen,  where  the  walls  of  a  building 
have  fallen,  or  where  people  have  been  buried  under  a  load  of  hay  or 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  m 

straw.  In  the  famous  series  of  murders  by  Burke  and  Hare,  the  victims 
were  suffocated  by  fastening  a  plaster  tightly  over  the  mouth  and  nose 
while  in  a  state  of  intoxication.  The  bodies  were  then  sold  to  surgeons 
for  dissection. 

Smothering  is  that  form  of  suffocation  which  is  produced  by  closing 
the  external  apertures  of  the  lungs.  This  is  by  no  means  an  infrequent 
cause  of  death  of  infants  and  young  children,  sometimes  by  accident, 
sometimes  by  intent.  It  may  be  caused  by  wrapping  the  head  up  in 
shawls  or  clothing,  as  occurred  in  a  case  at  Ayr,  where  a  young  woman 
was  charged  with  the  murder  of  a  child  by  closely  investing  its  head  in 
a  shawl.  She  was  acquitted  on  the  defense  that  she  was  protecting  it 
from  the  cold.  In  large  cities  many  cases  come  under  the  notice  of  the 
medical  jurist  in  which  children  have  been  overlain  in  bed  and  suffocated 
by  the  breasts  or  body  of  the  mother  or  by  the  bedclothes.  In  three  cases 
described  by  Canton,  and  in  most  of  the  cases  seen  by  me,  the  features 
were  placid,  lips  congested,  eyes  slightly  prominent,  hands  clenched,  but 
no  ecchymosis  of  the  skin.  Internally,  the  lungs  were  congested,  and 
there  were  ecchymoses  over  pericranium,  pia  mater,  pleura?,  pericardium, 
and  thymus  gland. 

Homicide  by  suffocation,  except  in  the  cases  of  young  children  or 
those  helpless  from  disease  or  narcotics,  is  very  rare.  The  case  of  a 
nurse-girl  named  Norman,  fifteen  years  old,  quoted  by  Taylor,  is  worthy 
of  mention.  She  was  charged  with  the  murder  of  three  children  and 
the  attempted  murder  of  a  fourth.  The  three  children  showed  signs  of 
death  by  suffocation.  The  fourth,  a  boy  of  ten,  was  awakened  by  feel- 
ing the  girl  lying  upon  him  and  closing  his  mouth  and  nose  with  her 
hands,  and  this  was  probably  the  means  she  employed  in  the  other  cases. 
but  the  children,  being  younger  and  weaker,  could  not  resist  as  did  the 
boy. 

Accidental  suffocation  may  occur  in  people  helpless  from  intoxica- 
tion or  debility,  and  the  mouth  covered  over  or  the  throat  externally 
compressed.  I  am  indebted  to  Dr.  Hebbert  for  the  report  of  the  follow- 
ing cases — one  a  case  which  happened  in  London  in  1889,  and  known 
as  the  Poplar  mystery.  A  woman  was  found  dead  in  an  alley.  The 
post-mortem  signs  were  those  of  death  from  asphyxia,  The  larynx 
was  much  congested,  and  both  aryepiglottic  folds  were  ecchymosed. 
Dr.  Hebbert  thought  that  the  death  was  due  to  compression  of  the 
throat  and  closing  the  mouth,  as  there  were  bruises  on  both  cheeks  and 
scratches  on  the  throat,  and  the  larynx  was  so  markedly  ecchymosed ;  but 
Mr.  Bond,  the  well-known  English  expert,  thought  the  compression  was 
caused  bv  the  head  falling  forward  while  helplessly  drunk,  and  being 
compressed  bv  a  tight  collar.  And  though  the  jury  brought  in  a  verdict 
of  murder,  it  did  not  follow  that  Mr.  Bond's  opinion  was  wrong. 

The  cases  of  death  from  internal  occlusion  of  the  air-passages  are 
probablv  mostlv  accidental,  and  frequently  due  to  the  impaction  of  food 
in  the  glottis  or  larynx.  In  these  cases  death  is  generally  very  sudden. 
A  case  of  this  nature  which  occurred  in  London  is  to  the  point,  The 
body  of  a  young  man  was  found  in  the  Thames,  but  there  was  no  evi- 
dence, on  section  of  the  body,  of  death  from  asphyxia  by  drowning.  On 
examining  the  larynx  it  was  found  blocked  by  a  large  piece  of  partly 
cooked  potato,  and  some  smaller  pieces  were  in  the  trachea.  The  heart 
was  flaccid  and  nearly  empty,  and  the  lungs  uncongested,  so  it  was  con- 


112  A   SYSTEM    OF  LEGAL  MEDICLNE. 

•chilled  that  the  man  died  of  that  form  of  asphyxia  coming  under  the 
head  of  nerve  shock,  or  neuro-paralysis. 

Another  English  case  is  this  (Lancet,  1850,  vol.  i.,  p.  313) :  Two  men 
quarreled  and  fought,  and  fell  to  the  ground.  Two  hours  later,  one  of 
them,  rising  from  the  dinuer-table,  was  taken  suddenly  ill  and  died  in 
a  few  minutes;  the  other  was  accused  of  manslaughter,  but  the  post- 
mortem revealed  the  cause  of  death  to  be  suffocation  from  a  large  piece 
of  meat  wedged  in  the  throat. 

A  child  was  brought  into  the  Westminster  Hospital  in  the  second 
stage  of  asphyxiation.  Tracheotomy  was  immediately  performed,  but 
though  the  tube  was  inserted  no  ah-  passed  through,  and  the  child  died 
without  relief.  On  examining  the  body  the  larynx  was  found  to  be  filled 
up  by  the  wooden  end  of  a  whistle  to  which  a  thin  elastic  bag  was  attached. 
This  bag  was  in  the  trachea,  and  prevented  the  tracheotomy  tube  from 
passing  down.     Death  was  from  acute  suffocation. 

A  dangerous  practice  is  common  among  nurses,  who  give  little 
children  bags  filled  with  sugar  to  suck,  or  even  thrust  them  into  their 
mouths.  The  children  are  thus  gagged  and  respire  only  through  the 
nostrils,  and  if  these  become  obstructed  suffocation  might  easily  result. 

A  case  is  described  by  Littlejohn  which  illustrates  homicide  by  suffoca- 
tion. He  examined  the  body  of  a  woman  who  died  suddenly,  and  found 
the  cork  of  a  quart  bottle  tightly  wedged  in  the  larynx.  The  sealed  end 
was  uppermost,  and  the  opinion  was  that  it  was  forcibly  inserted  while 
the  woman  was  helplessly  drunk,  and  that  murder  was  deliberately  con- 
templated.    Her  ribs  were  also  fractured. 

The  following  case  illustrates  death  from  vitiated  air :  Two  years  ago 
three  children,  the  eldest  six  years,  were  playing  in  a  house  which  was  in 
process  of  construction.  The  workmen  had  gone  away,  and,  in  sport, 
these  children  entered  a  small  closet  beneath  a  sink,  which  had  sufficient 
space  to  barely  contain  them.  They  pulled  to  the  door  of  the  closet.  It 
fastened  with  a  spring  catch  which  could  only  be  opened  from  the  out- 
side. The  children  were  missed,  and  search  was  made  for  them,  but 
they  were  not  discovered  for  many  hours.  When  discovered,  two  of  the 
children  were  dead,  and  the  third,  barely  alive,  was  resuscitated  with  con- 
siderable difficulty.  They  were  exposed  to  no  noxious  vapors,  and  the 
only  cause  appearing  was  the  vitiated  condition  of  the  air  caused  by  the 
exhaustion  of  the  oxygen  from  the  air  in  the  closet  by  their  own  respi- 
ration. 

Five  years  ago  I  had  occasion  to  examine  the  body  of  a  man  who  had 
died  with  the  following  history:  He  was  a  vigorous  laboring-man  who 
was  eating  his  dinner  hastily  in  a  public  restaurant,  when  he  was  noticed 
to  suddenly  turn  exceedingly  pale,  and,  rising  from  the  table,  imme- 
diately fell  to  the  floor,  and  expired  within  less  than  two  minutes.  The 
autopsy  showed  very  great  cerebral  congestion  and  engorgement  of  the 
lungs.  There  was  no  froth  in  the  air-passages,  but  an  examination  of 
the  posterior  fauces  and  larynx  showed  the  presence  of  a  piece  of  beef- 
steak measuring  two  inches  by  one  and  a  half  inches,  without  the 
slightest  appearance  of  having  'been  masticated,  and  which  served  as  a 
wedge  to  thoroughly  occlude  the  air-passages,  and  to  cause  death  by 
sudden  and  great  congestion  of  the  brain. 

A  clergyman  had  come  from  the  country  for  the  purpose  of  having  a 
comparatively  trifling  surgical  operation  performed,  and  was  advised  "by 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  113 

his  physician  to  be  etherized.  The  physician  had  neglected  to  caution 
him  about  dining  before  the  operation,  and  as  the  man  was  coming 
fairly  well  under  the  influence  of  the  anaesthetic  he  had  an  attack  of 
vomiting,  and  then  expired  almost  immediately.  In  this  case  the  autopsy 
showed  the  presence  in  the  larger  bronchi  of  two  pieces  of  asparagus 
stalk,  and  in  the  smaller  bronchi  whole  peas  mixed  with  some  fragments 
of  food ;  there  was  also  great  hyperemia  of  the  brain  and  of  the  lungs, 
part  of  which  was  undoubtedly  due  to  the  effect  of  the  ether;  the 
death,  however,  resulted  entirely  from  the  prevention  of  the  entrance  of 
atmospheric  air. 

In  consequence  of  the  burning  of  a  tenement-house  in  the  city  of 
Boston,  a  number  of  Italians,  male  and  female,  adults  and  children,  per- 
ished. The  post-mortem  examination  of  these  bodies  showed  varying 
appearances.  In  some  there  was  extensive  charring  of  the  exterior  of 
the  body,  accompanied  by  numerous  vesicles  which  were  filled  with  serum ; 
distinctly  marked  burns  inside  of  the  mouth  and  intense  redness  of  the 
larynx  and  trachea,  but  without  any  marked  degree  of  cerebral  or  pul- 
monary hyperemia.  In  others  the  burns  were  few  in  number  and  slight 
in  degree,  but  the  larynx,  trachea,  and  bronchi  were  reddened  throughout, 
and  fine  particles  of  black  soot  were  found  even  as  far  as  the  base  of  the 
lungs.  The  lungs  were  highly  engorged,  and  there  was  marked  conges- 
tion of  the  brain.  In  the  first-mentioned  cases  death  was  undoubtedly 
due  to  the  effects  of  burning.  In  the  other  cases  death  was  due  to 
suffocation  by  the  inhalation  of  smoke,  and  was  not  influenced  in  any 
degree  by  the  burns  on  the  surface  of  the  body. 

The  term  "dynamical  asphyxia"  is  used  by  Casper  to  denote  those 
cases  in  which  death  is  brought  about  by  the  respired  air,  charged  with 
some  noxious  gas,  acting  directly  on  the  lungs.  Death  may  occur  by 
this  means  in  three  ways  : 

First,  the  gas  may  cause  spasm  of  the  glottis,  or  by  entering  the 
larynx  cause  inflammation,  swelling,  and  occlusion  of  the  tubes.  This 
may  properly  be  called  a  mechanical  cause,  but  is  best  considered  under 
the  second  heading  of  dynamical  causes  of  asphyxia,  as  the  action  may 
be  twofold.  Such  gases  are  the  pungent  vapors  of  hydrochloric,  nitric, 
nitrous,  sulphurous,  or  other  acids.  The  post-mortem  signs  woidd  be 
those  of  death  from  asphyxia. 

Second,  the  gas  may  destroy  life  by  acting  in  the  blood,  either  by 
displacing  oxygen,  such  as  CO,  carbonic  oxide,  and  HCN,  hydrocyanic 
acid,  or  by  reducing  the  haemoglobin  and  robbing  the  corpuscles  of  oxy- 
gen, as  in  the  case  of  H2S,  sulphureted  hydrogen,  where  sulphur  (S)  and 
water  (H.,0)  are  formed. 

Third,  the  cases  in  which  the  air  is  wanting  in,  or  has  been  deprived 
of,  the  oxygen  sufficient  for  continued  life,  as,  for  instance,  in  vitiated  at- 
mosphere, when  the  COo,  carbonic  acid,  is  increased  in  quantity  cither  by 
over-production,  or  by  the  oxygen  being  gradually  used  up,  ten  percent, 
of  COo  in  atmospheric  air  endangering  life. 

As  the  first  division  consists  of  gases  rarely  causing  death,  it  will  be 
well  to  pass  on  to  those  which  are  more  frequently  met  with.  These  arc  : 
(  O,  carbonic  oxide,  as  the  result  of  charcoal  vapor,  or  as  a  constituent  of 
illuminating-gas ;  H2S,  sulphureted  hydrogen,  in  sewer-gas ;  and  C02, 
carbonic  acid,  in  mines,  ill-ventilated  rooms,  or  as  a  product  of  combustion. 

Prussic  acid  vapor,  HCN,  kills  rapidly  by  displacing  the  oxygen  of 


114  A  SYSTEM   OF  LEGAL   MEDICINE. 

the  blood-corpuscles,  and  then  paralyzing  the  respiratory  centers.  The 
blood  at  lirst  appears  bright  red  and  then  black.  Death  is  from  rapid 
asphyxiation,  the  post-mortem  signs  being  similar  to  those  of  death  when 
the  liquid  acid  is  swallowed.  In  poisoning  with  pure  CO,  carbonic  oxide, 
there  is  qo  dyspnoea,  the. coma  not  being  very  marked.  There  is  also 
temporary  but  pronounced  paralysis  of  the  limbs,  followed  by  spasms. 
After  death  the  heart  and  brain  are  congested  with  intensely  florid  blood. 
In  poisoning  with  the  mixed  vapors  of  CO  and  C02  there  is  a  varying 
degree  of  eoma.  There  is  dyspnoea,  muscular  spasms,  and  gradual  paraly- 
sis and  asphyxia.  After  death  the  blood-vessels  are  filled  with  a  bright 
cherry-colored  fluid  blood,  while  the  lips,  muscles,  and  viscera  have  the 
same  color.  The  brain  is  soft,  the  liver,  kidneys,  and  spleen  are  hyperae- 
ni ie.  The  post-mortem  hypostases  are  bright  red.  The  effects  of  CO 
on  the  body  are  very  insidious,  and  one  of  the  first  results  is  profound 
languor  and  loss  of  muscular  strength.  It  is  said  that  after  recovery 
there  may  be  paraplegia  or  disturbances  of  the  cerebral  activity. 

The  external  appearances  after  death  are  quite  unlike  those  of  death 
from  gradual  asplryxia  by  choking,  the  face  being  usually  pale  and 
placid,  the  eyes  bright  and  not  prominent,  the  pupils  dilated,  and  the 
tongue  not  necessarily  protruding.  Such  cases  were,  and  probably  still 
are,  common  in  France,  where  charcoal-stoves  are  burned  in  the  sleeping- 
rooms,  but  they  are  also  very  frequent  in  American  cities  and  towns, 
where  the  illuminating-gas  contains  a  high  percentage  of  carbonic  oxide. 
The  following  cases  illustrate  the  death  from  what  is  sometimes  called 
asphyxia,  but  what  is  really  carbonic  oxide  poisoning,  due  to  the  inhala- 
tion of  illuminating-gas. 

In  the  first  case  the  individual  was  a  domestic  in  the  employ  of  a 
family  in  the  city  of  Boston,  who  had  retired  in  her  usual  health  and  was 
found  dead  in  bed  in  the  morning.  There  was  not  the  slightest  sign  of 
any  struggle,  and  the  room  presented  a  distinct  odor  of  illuminating-gas. 
The  bracket  which  furnished  the  supply  was  found  to  be  partially  open. 
It  was  supposed  that  the  girl  had  turned  the  gas  down  so  that  there  was 
but  a  small  flame  present,  and  had  left  her  window  partially  open,  and 
during  the  night  a  high  wind,  which  had  arisen,  extinguished  the  flame 
without  cutting  off  the  supply  of  gas.  The  autopsy  showed  fluid  and- 
bright  crimson-colored  blood  throughout  the  body,  and  the  same  color  of 
lungs,  liver,  and  kidneys.  The  gas  was  of  the  kind  known  as  water-gas, 
which  contains  a  very  high  percentage  of  carbonic  oxide ;  and  the  fact 
that  the  room  was  not  entirely  closed,  but  that  there  was  a  window  open, 
and  that  the  amount  of  gas  which  must  have  escaped  was  small,  shows 
the  speed  and  certainty  with  which  this  agent  acts,  and  its  deadly  nature. 

A  man  coming  into  the  city  from  the  country  registered  at  a  hotel, 
and  a  room  was  assigned  to  him.  He  retired  about  nine  o'clock  in  the 
evening,  and  at  one  o'clock  in  the  morning  the  night-watchman  on  his 
rounds  noticed  a  distinct  odor  of  gas,  and  traced  it  to  the  room  of  this 
man.  A  forcible  entrance  was  effected,  and  the  room  was  found  to  be 
filled  with  gas,  the  man  having  either  blown  the  gas  out  or  having  turned 
the  stop-cock  too  far  in  shutting  off  the  gas.  The  man  himself  was  uncon- 
scious, and  breathing  heavily.  Surgical  treatment  was  promptly  afforded 
him,  and  he  was  removed  to  the  hospital,  where  he  was  given  large 
quantities  of  pure  oxygen  and  exposed  to  a  full  current  of  outdoor  ah*, 
but  within  twenty-four  hours  he  died.     The  autopsy  in  this  case  showed 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  H5 

in  general  no  crimson  color  of  the  blood,  which,  however,  was  fluid.  The 
lungs  were  dark  in  color  in  general,  but  in  the  middle  of  each  of  the 
lobes  of  each  lung  there  were  found  circumscribed  patches,  varying  in 
size  from  that  of  a  dime  to  that  of  a  half-dollar,  of  the  bright  crimson 
color  characteristic  of  the  action  of  carbonic  oxide. 

Sulphureted  hydrogen,  H2S,  has  a  very  powerful  action  on  the  body. 
It  is  said  to  be  instantly  fatal  when  breathed  pure,  but  the  cases  which 
come  under  the  notice  of  the  medical  jurist  are  those  in  which  the  gas  is 
diluted,  as  in  the  foul  air  from  sewers.  The  victims  are  usually  night- 
men.  The  physiological  cause  of  death  is  due  to  the  rapid  destruction 
of  the  blood-corpuscles,  first  by  robbing  them  of  oxygen,  and  then  decom- 
posing the  haemoglobin.  The  blood  becomes  dark  brown  to  black  in 
color,  and  under  the  microscope  shows  remarkable  and  complete  destruc- 
tion of  corpuscles.  (Casper.)  The  symptoms  before  death  are  said  to 
be  giddiness,  nausea,  loss  of  strength,  and  paralysis,  then  convulsions 
preceding  coma  and  insensibility,  or  sometimes  tetanus  with  delirium. 
The  skin  is  cold,  pulse  feeble,  and  breathing  labored. 

The  post-mortem  signs  in  six  cases  examined  by  Casper  were  as  fol- 
lows :  In  two  the  faces  were  of  a  greenish-yellow  tint,  in  the  other  four 
they  were  pale,  with  anaemic  lij)s ;  in  each  case  the  brain  was  firm  and 
anaemic,  the  cortical  substance  being  of  a  dirty  gray  color,  and  the  choroid 
plexuses  pale  and  livid.  The  lungs  were  hyperaemic  and  of  the  color  of 
black  ink,  and  the  blood  from  the  lungs  showed  the  destruction  of  the 
corpuscles  before  mentioned.  The  heart  was  collapsed,  the  right  ven- 
tricle containing  only  a  few  drops  of  blood,  and  the  left  side  was  empty. 
There  was  no  froth  in  the  larynx  or  trachea,  and  the  mucous  membranes 
were  of  a  dark-brown  crimson  color. 

In  the  cases  of  four  men  who  lost  their  lives  in  the  Fleet  Street  sewer 
in  London  cited  by  Taylor  (Lancet,  1861,  vol.  i.,  p.  187),  the  blood  was 
black  and  fluid  throughout  the  body,  but  the  lungs  and  heart  were  gorged 
with  blood,  and  there  was  froth  in  the  air-passages.  The  bodies  rapidly 
decomposed.  Probably  the  difference  in  the  post-mortem  appearances 
in  the  two  series  of  cases  arose  from  the  difference  in  time  of  the  occur- 
rence of  death,  the  more  protracted  death  giving  rise  to  the  greater  con- 
gestion. 

In  the  third  class  of  cases,  in  which  the  respired  ah'  is  wanting  in  or 
has  been  deprived  of  oxygen,  the  cause  of  death  is  due  to  the  inhaling  of 
C02,  carbonic  acid  gas.  This  kills,  not  as  in  the  foregoing  cases  by  dis- 
placing oxygen,  but  by  preventing  its  being  inspired  in  sufficient  quan- 
tity to  maintain  life.  The  result  may  come  about  by  over-production  of 
the  gas,  as  in  fires  in  houses  or  in  mines,  or  by  the  oxygen  in  the  air 
being  exhausted  by  its  inhalation  by  the  persons  or  animals  present,  and 
changed  in  the  body  to  C02,  the  air  being  in  this  way  overcharged  to 
an  amount  rendering  life  in  peril.  Such  a  catastrophe  happened,  for  in- 
stance, in  the  terrible  "  Black  Hole  of  Calcutta,''  where  during  the  Indian 
wars  several  hundred  women  and  children  were  incarcerated  in  <i  small 
prison,  and  many  died  of  asphyxia ;  and  there  is  the  historic  case  of  a 
bride  hiding  in  a  chest  in  Kenilworth  Castle,  Warwickshire,  where  the  lid 
of  the  chest  became  closed,  and  the  girl  was  found  dead,  with  her  body 
and  limbs  distorted  by  the  contractions  of  previous  convulsions. 

The  post-mortem  appearances  in  death  from  carbonic  acid  poisoning 
are  those  of  asphyxia  already  described. 


H(j  A   SYSTEM   OF  LEGAL   MEDICINE. 


DEATH   BY  HANGING  AND   STRANGULATION. 

Some  authors  treal  these  subjects  under  one  heading,  while  others, 
as  Tardieu,  think  they  should  be  considered  separately.  The  cause  of 
death  in  both  cases  is  similar,  and  brought  about  by  constriction  of  the 
throat  by  an  external  ligature  sufficiently  tight  to  prevent  the  ingress  of 
air  to  the  lungs.  This  interference  may  be  sudden  or  gradual,  but  the 
ultimate  result  is  the  same — that  is,  death  by  asphyxia. 

In  the  so-called  judicial  hanging  it  is  claimed  that  death  occurs  from 
the  dislocation  or  fracture  of  the  atlas  or  axis,  and  consequent  pressure 
by  the  bone  on  the  spinal  cord;  and  though  this  may  sometimes  obtain, 
these  eases  only  come  under  the  notice  of  the  judicial  jurist  in  his  official 
capacity,  as  the  death  is  known  to  the  authorities  to  be  necessarily  due 
to  hanging.  The  cases  in  which  he  is  consulted  are  those  in  which  he 
has  to  determine  the  cause  of  death,  unknown  to  any  one  but  the  victim 
or  the  culprit,  and  to  say  whether  it  may  be  due  to  strangulation  com- 
plete or  partial  by  suspension,  or  strangulation  by  forcible  constriction 
of  the  throat  without  suspension. 

In  considering  the  post-mortem  appearances  of  strangulation  by  sus- 
pension it  is  found  that  the  principal  differences  in  the  external  signs 
are  due  to  the  rapidity  or  slowness  of  the  death.  In  the  violent  form  of 
judicial  or  of  homicidal  hanging  there  is  lividity  or  swelling  of  the  face, 
lips,  and  eyelids,  the  eyes  are  red  and  protruding,  the  tongue  is  livid  and 
protruding  or  clenched  between  the  teeth,  and  there  is  bloody  froth  about 
the  nose  and  mouth.  There  is  a  deep-red  ecchymosed  impression  of  the 
•cord  around  the  hyoideal  region  of  the  neck,  sometimes  with  laceration 
of  the  muscles  and  ligaments,  or  great  injury  to  the  larynx  and  trachea ; 
indeed,  even  the  head  has  in  some  cases  been  nearly  torn  off.  The  hands 
are  livid,  with  clenched  fingers,  and  there  are  commonly  circumscribed 
patches  of  ecchymosis  about  the  upper  and  lower  extremities.  The 
urine,  faeces,  or  semen  are  sometimes  expelled  involuntarily,  and  there 
may  be  some  swelling  and  congestion  of  the  genital  organs  in  both  sexes. 

In  the  cases  of  suicidal  hanging,  where  death  occurs  more  slowly,  the 
face  is  generally  pale,  and  the  tongue  may  or  may  not  protrude ;  the 
hands  are  not  always  clenched.  The  mark  around  the  neck  is  a  simple 
depression,  acquiring  a  parchment-like  appearance  after  a  time.  The 
internal  appearances  are  those  of  death  from  asphyxia,  namely,  great 
engorgement  of  the  whole  venous  system  ;  the  lungs,  right  side  of  heart, 
liver,  and  especially  the  kidneys  and  brain,  being  very  full  of  dark,  venous 
blood;  sometimes,  indeed,  there  is  extravasation  of  blood  into  the  sub- 
stance of  the  brain.  The  mark  of  the  cord  on  the  neck  is  oblique,  being 
lower  in  front  than  behind,  and  may  be  interrupted  in  its  course.  The  skin 
is  commonly  depressed  and  brown,  hard,  or  of  a  parchment-like  consistency 
in  the  depression,  with  bluish,  ecchymosed  edges.  Naturally,  a  difference 
in  the  width  of  the  cord  would  produce  a  difference  in  the  appearance  of 
the  mark,  which,  consequently,  may  be  wide  and  superficial  or  narrow 
and  deep.  The  latter  may  be  accompanied  with  abrasions  of  the  skin  and 
subcutaneous  ecchymoses,  and  ruptures  of  the  more  superficial  muscles, 
e.g.,  sterno-mastoid  muscles.  The  condition  of  the  deeper  seated  parts, 
such  as  the  elevator  and  depressor  muscles  of  the  hyoid  bone,  the  arter- 
ies, nerves,  and  cartilages  in  the  neighborhood,  depends  on  the  amount 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  »  117 

of  force  used,  and  may  be  limited  to  ecchymosis  or  extend  to  tearing 
and  fracture  of  these  structures.  In  the  case  of  the  arteries  the  internal 
■coat  and  inner  layer  of  the  middle  coat  are  torn,  as  in  the  ordinary  liga- 
ture of  a  surgical  operation,  while  the  outer  coat  may  escape.  These 
more  serious  injuries  are  seen  commonly  in  judicial  executions,  while  in 
suicidal  hanging  the  signs  are  those  of  asphyxia  internally,  and  the 
external  indications  of  violence  slightly  marked. 

One  very  important  consideration  for  the  medical  jurist  is,  whether 
the  hanging  occurred  before  or  after  death.  It  has  been  pointed  out  by 
■Casper  that  a  non-ecchymosed  mark  similar  to  that  noticed  in  suicidal 
hanging  may  be  produced  two  hours  after  death.  Norman  Chevers,  in 
his  Medical  Jurisprudence  for  India,  says  that  usually  the  saliva  will  drib- 
ble from  one  corner  of  the  mouth  after  suspension  during  life  on  account 
of  the  drooping  of  the  body  to  one  side.  This  could  not  happen  if  the 
body  was  hung  after  death.  Strangulation  without  suspension  is  most 
frequently  homicidal.  The  post-mortem  appearances  are  similar  to  those 
by  hanging,  but  the  injury  to  the  parts  about  the  neck  may  be  greater. 
It  3 nay  be  said  in  regard  to  the  mark  of  the  ligature  that  it  is  generally 
circular,  and,  as  a  rule,  at  or  just  below  the  level  of  the  larynx,  while  in 
strangulation  with  suspension  the  mark  is  oblique,  and  most  often  above 
the  larynx.  The  damage  to  the  windpipe  and  the  vessels  and  muscles  in 
its  neighborhood  is  generally  considerable,  as  the  force  is  suddenly  and 
strongly  applied.  The  external  marks  may  not  show  so  plainly  as  in 
hanging,  for  in  the  garroting  period  in  England  the  choking  was  effected 
by  pressure  on  the  throat  by  the  forearm  of  the  assailant,  and  left  little 
evidence  externally ;  and  in  the  long  series  of  murders  by  the  Thugs  in 
India  the  strangulation  was  caused  by  a  soft  silk  handkerchief  twisted 
rapidly  around  the  throat,  and  often  causing  death  very  suddenly. 

In  most  cases  of  violent  death  by  strangulation  the  face  is  livid  and 
swollen,  the  eyes  prominent,  with  dilated  pupils,  the  tongue  swollen,  black, 
and  protruding,  and  the  mouth  and  nostrils  covered  with  bloody  froth. 
There  may  also  be  numerous  spots  of  ecchymosis  about  the  face  and  neck. 
The  internal  signs  are  those  before  described  as  due  to  asphyxia.  It 
must,  however,  be  remembered  that  any  sudden  application  of  force  to  the 
larynx  may  cause  a  rapid  death,  and  this  was  a  frequent  occurrence  in 
the  choking  by  the  Thugs.  In  such  instances  it  follows  that  the  post- 
mortem signs  are  much  modified,  and  the  heart  will  be  found  empty  and 
the  walls  flaccid,  the  lungs  not  markedly  congested,  and  the  abdominal 
organs  apparently  normal.  The  brain  is  almost  always  very  full  of  blood, 
a  condition  readily  explained  by  the  prevention  of  the  return  of  blood 
to  the  heart  in  consequence  of  the  compression  of  the  jugular  veins,  and 
it  is  this  hyperemia  which  is  the  immediate  cause  of  death.  A  relief 
of  this  congestion  of  the  blood-vessels  of  the  brain  is  the  proper  treat- 
ment in  cases  of  strangulation.  Chevers  quotes  a  case  of  an  English 
officer  throttled  by  the  Thugs,  who,  to  make  assurance  doubly  sure,  cut 
his  throat,  but  the  ensuing  hemorrhage  saved  his  life,  by  reducing  the 
blood-pressure  in  the  brain. 

It  will  be  easily  understood  that  tins  marked  increase  of  blood  in  the 
brain  occurs  whether  the  interference  of  the  flow  of  the  blood  to  and 
from  the  brain  is  sudden  or  gradual,  and  is  a  contrast  to  the  condition 
seen  in  asphyxia  from  suffocation  or  drowning.  A  laboring-man,  for 
some  time  despondent  because  of  ill  health,  suspended  himself  from  a 


118  A   SYSTEM  OF  LEGAL  MEDICINE. 

beam  iu  his  barn  and  kicked  over  the  stool  upon  which  he  had  stood  in 
fastening'  the  rope.  He  was  not  discovered  for  several  hours,  at  which 
time  life  was  extinct.  The  external  examination  showed  the  ordinary 
pallor  and  rigidity  of  the  body,  and  a  grooved  furrow  around  the  neck, 
perfectly  well  marked  in  front,  but  slightly  so  at  the  back  of  the  neck, 
and  this  furrow  corresponded  in  dimensions  to  the  rope  which  the  man 
had  used.  The  groove  was  in  the  region  of  the  hyoid  in  front.  The 
dissection  showed  minute  ecchymoses  on  the  inferior  surface  of  the  skin 
and  in  the  subcutaneous  connective  tissues.  There  was  no  fracture  or 
dislocation  of  the  bones  of  the  neck.  The  lungs,  brain,  and  other  internal 
organs  presented  the  ordinary  signs  of  death  from  asphyxia. 

A  prominent  business  man,  after  an  extended  indulgence  in  stimu- 
lants, was  found  in  a  room  in  a  hotel  with  life  extinct.  He  had  a  shawl- 
strap  around  his  neck.  The  strap  was  attached  simply  to  the  headboard 
of  his  bed,  his  knees  and  lower  part  of  legs  rested  upon  the  floor.  The 
furrow  around  the  neck  was  distinctly  marked,  and  corresponded  in  size 
with  the  strap.  In  this  case  there  were  no  ecchymoses  beneath  the  fur- 
row, but  there  was  a  general  engorgement  of  the  lungs  and  vessels  of  the 
brain,  and  dark,  fluid  condition  of  the  blood.  These  signs,  considered 
with  the  fact  that  there  were  no  other  physical  changes,  indicated  clearly 
that  death  had  resulted  from  strangulation. 

Another  case  very  similar  is  that  of  a  person  who  had  attached  his 
suspenders  to  the  post  of  a  very  low  bed,  and  had  fastened  them  about 
his  neck  and  lain  down  upon  the  floor  in  such  a  position  as  to  bring  by 
the  weight  of  the  body  a  stricture  about  the  neck,  and  thus  cause  death. 
Almost  the  entire  body  was  resting  upon  the  floor.  The  post-mortem 
appearances  were  similar  to  those  in  the  case  just  cited,  and  death  was. 
due  also  to  strangulation. 

The  appearances  of  death  by  hanging  may  occasionally  be  found  in 
persons  who  have  died  from  other  causes.  In  the  vast  majority  of  cases, 
however,  persons  that  are  found  dead  suspended,  or  partially  suspended,, 
may  be  considered  cases  of  death  from  suicide,  as  such  means  of  murder 
is  most  unusual.  An  interesting  case  illustrating  an  attempt  to  conceal 
a  crime  by  giving  the  outward  appearance  of  suicide  has  lately  been 
reported  in  London.  A  prominent  business  man  who  was  left  alone  in 
his  office  in  his  factory  was  seen  last  by  the  foreman  as  he  left  the  works 
at  the  close  of  the  day's  duties.  Shortly  afterward  fire  was  discovered  in 
the  building,  and  after  the  flames  were  extinguished  the  body  of  the 
gentleman  was  found  in  an  upper  room  suspended  near  the  fireplace  and 
thoroughly  charred ;  but  the  examining  surgeon  discovered  by  post- 
mortem examination  that  it  was  murder.  In  this  case  the  body  was 
borne  by  the  murderer  through  the  passage  up  a  staircase,  where  he 
deposited  his  victim  on  the  stairs,  then,  placing  a  piece  of  cord  around 
his  neck,  set  fire  to  the  place,  where,  if  any  of  the  body  was  left  at  all, 
the  rope  would  point  to  suicide.  The  fire  was  kindled  at  a  spot  adjoining 
a  chimney,  which  had  for  some  time  past  been  regarded  as  dangerous, 
being  partly  constructed  of  wood.  Strange  to  sav,  though  the  premises 
themselves  were  entirely  gutted,  the  chimney  'itself  was  left  intact. 
Moreover,  while  the  legs  and  thighs,  also  the  greater  portion  of  the  arms, 
of  the  victim  were  burned  away,  and  even  the  features  burned  beyond 
recognition,  the  neck  at  the  back  was  left  to  show  the  mark  of  the  rope  and 
the  traces  of  a  brutal  assault.    The  examination  was  made  by  Mr.  Thomas 


DEATH  IN  ITS   MEDICO-LEGAL   ASPECTS.  H9 

Bond,  who  reported  as  follows :  "  The  body  was  charred  by  fire,  both  legs 
and  thighs  had  been  burned  off,  and  both  forearms.  The  left  upper  arm 
was  the  only  part  of  the  body  which  was  uncharred.  This  was  extended 
at  right  angles  to  the  body,  and,  of  course,  stiff.  The  right  upper  arm 
was  in  a  sloping  position  downward.  The  head  and  neck  were  bent 
down  toward  the  left  side.  The  features  were  burned  away  and  quite 
unrecognizable.  The  hair  and  scalp  were  entirely  destroyed,  and  the 
bones  of  the  skull  were  charred  through  in  places.  On  the  upper  and 
back  part  of  the  skull,  on  the  right  side,  there  was  extensive  fracture  of 
the  bones,  and  just  over  the  right  ear  the  brain  substance  was  protrud- 
ing. On  moving  the  charred  and  fractured  fragments  of  bone  on  top  of 
the  head  I  found  a  good  deal  of  brain  protruding  from  the  dura  mater,  or 
fibrous  covering  of  the  brain.  The  brain  was  not  calcined,  but  fresh  and 
uninjured.  I  also  found  directly  under  the  fractured  and  calcined  bone 
a  large  quantity  of  dark-red  putty-like  substance.  It  was  quite  an  inch 
thick,  and  lay  in  contact  with  the  bone  on  the  outside  and  on  the  fibrous 
covering  of  the  brain  internally.  This  putty-lite  substance  extended  all 
over  the  top  of  the  head.  I  took  some  away  with  me,  and  I  have  since- 
analyzed  it  and  examined  it  microscopically.  I  find  that  it  is  blood  par- 
tially dried  by  heat.  On  the  right  side  of  the  head  below  the  ear  I  saw 
traces — in  fact  more  than  traces — I  saw  a  quantity  of  this  red  substance 
adhering  to  the  charred  remains,  but  of  course  quite  dry.  This  I  have 
ascertained  to  be  blood.  On  the  left  side  there  was  none  of  this  sub- 
stance :  the  part  was  simply  black  and  charred.  Around  the  neck,  espe- 
cially the  back  part  of  the  neck,  there  was  a  deepish  groove  an  inch  and 
a  half  in  width  and  half  an  inch  deep.  It  showed  the  indentation  of  a 
rope.  The  groove  was  quite  low  down  in  the  neck  near  the  shoulders, 
and  just  in  front  it  was  just  on  a  level  with  the  lower  part  of  the  larynx. 
Dr.  Becker  at  this  point  showed  me  four  strands  of  charred  rope,  which, 
he  informed  me,  he  had  removed  from  the  neck.  The  rope  appeared  to 
fit  the  groove  which  I  saw  around  the  neck.  He  told  me  it  lightly 
encircled  the  neck  and  was  tied  in  a  knot.  Then  I  found  three  or  four 
little  pieces  of  rope  like  that  produced  lying  under  the  charred  remains — 
under  the  neck,  in  fact.  The  groove  I  have  described  was  very  distinct 
behind  but  not  so  distinct  in  front.  Underneath  where  the  rope  had 
been  the  skin  was  protected  from  the  fire  and  was  not  charred,  though  it 
was  discolored  ;  and  on  making  incisions  through  the  skin  into  the  tissues 
underneath  I  found  there  was  entire  absence  of  any  extravasated  blood 
•or  of  congested  blood-vessels. 

"  The  remarkable  thing  which  I  found  was  the  extensive  effusion  of 
blood  between  the  skull-cap  and  the  fibrous  covering  of  the  brain.  The 
brain  was  also  white  and  soft,  and  seemed  little  affected  by  fire.  I  have 
no  doubt  that  this  blood  was  effused  during  life,  and  I  have  no  doubt 
either  but  that  it  was  caused  by  extensive  fracture  of  the  skull  during 
life.  The  injuries  I  found  were  quite  sufficient  to  cause  death,  and  also 
to  cause  death  very  quickly.  Then,  again,  I  am  able  to  say  that  the 
death  was  not  caused  by  strangulation.  In  death  from  strangulation  or 
hanging  there  woidd  be  extravasation  and  congestion  under  and  around 
the  mark  of  the  rope.  I  examined  the  larynx  also.  There  was  no  injury 
of  the  larynx,  no  extravasation  of  blood  about  it,  or  injury  to  its  external 
surface.  Then  the  condition  of  the  heart  and  lungs  did  not  point  to 
strangulation.     I  have  no  doubt  the  man  met  liis  death  from  violent 


2-_>0  A    SYSTEM    OF  LEGAL   MEDICINE. 

blows  inflicted  on  the  head  with  a  heavy  instrument,  and  they  were  ap< 
parently  caused  by  a  hammer  or  some  other  heavy  instrument." 

Cases  of  accidental  suspension  are  also  not  unknown,  as  where  per- 
sons have  been  caught  by  a  window  falling  upon  the  neck  while  the  in- 
dividual was  gazing  out  into  the  street;  and  cases  of  suspension  are  well 
known  where  children  have  hanged  themselves  in  sport,  and  where  they 
have  failed  to  let  themselves  down  before  consciousness  was  lost,  and 
have  expired  in  consequence  of  the  suspension. 


DEATH   BY   DROWNING. 

Death  by  drowning  is  perhaps  the  most  common  form  of  death  from 
asphyxia  with  which  the  medical  jurist  has  to  deal,  inasmuch  as  it  is  one 
of  the  most  common  forms  of  accident  occurring  to  pleasure-seekers, 
whether  in  the  yachting-season,  or  at  the  time  of  year  when  skaters 
venture  on  thin  ice,  or  when  the  hardy  sailor  is  lost  overboard  in  the 
discharge  of  his  duty,  or  because  of  attempts  to  board  his  ship  when  he 
has  yielded  to  the  influence  of  boon  companions  during  his  short  stay  on 
land";  and,  moreover,  it  is  one  of  the  easiest  and  most  frequent  forms  of 
suicide. 

We  say  that  death  is  due  to  drowning  when  it  has  occurred  in  conse- 
quence of  cutting  off  the  atmospheric  air  from  the  mouth  and  nose  by  a 
fluid,  irrespective  of  its  density.  It  may  be  the  water  of  a  lake  or  the 
contents  of  a  cesspool,  the  ooze  of  the  marsh  or  the  fluids  of  the  mother 
in  which  a  new-born  child  may  be  immersed.  The  quantity  of  the  fluid 
is  immaterial :  it  may  be  the  whole  ocean  or  it  may  be  the  merest  pool 
by  the  roadside  into  which  an  epileptic  has  fallen  during  a  seizure,  and 
where  there  is  depth  of  water  enough  to  barely  occlude  the  nose  and 
mouth.  In  any  case  of  death  from  drowning  the  real  cause  of  death  is 
the  presence  of  an  excess  of  carbonic  acid  in  the  blood,  due  to  the  con- 
tinuation of  the  process  of  elimination,  while  the  vivifying  effect  of  the 
mingling  of  the  oxygen  of  the  atmospheric  air  is  stopped  by  the  inability 
of  the  individual  to  respire.  In  this  respect  it  does  not  differ  from  any 
other  form  of  asphyxia. 

Death  may  occur  in  cases  of  drowning  either  by  hyperemia  of  the 
brain  or  of  the  lungs,  or  of  both  combined,  or  by  the  sudden  paralysis 
of  the  whole  nervous  system.  According  to  Casper,  the  form  of  death 
from  cerebral  hyperemia  is  of  the  rarest,  though  undoubtedly  most  cases 
of  death  by  drowning  are  accompanied  by  some  signs  of  engorgement  of 
the  vessels  of  the  brain;  but  these  appearances  have  been  given  undue 
weight  by  some  writers,  and  the  presence  of  an  unusually  large  amount  of 
blood  in  the  vessels  at  the  posterior  part  of  the  brain  has  been  attributed 
to  a  vital  process,  whereas  it  is  far  more  likely  that  it  was  due  simply  to 
post-mortem  change,  as  has  already  been  pointed  out. 

Casper  says :  "  It  is,  however,  certain  that  even  in  those  rare  cases  of 
drowning  in  which  cerebral  hyperemia  is  found  to  be  the  only  positive 
cadaveric  phenomenon,  except  one  other  special  appearance,  and  must 
therefore  be  recognized  as  the  cause  of  death,  this  hyperemia  is  always 
relatively  inconsiderable,  and  actual  hemorrhage  is  the  rarest  of  phenom- 
ena, and  is  only  observed  under  very  peculiar  circumstances."  In  this 
connection  this  author  cites  a  case  of  a  man  who  fell  into  a  swamp  while 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  121 

drunk.  In  this  case  the  autopsy  showed  the  presence  of  the  muddy  fluid 
of  the  marsh  in  the  trachea,  but  all  the  other  usual  signs  of  death  by 
drowning-  were  absent.  The  meninges  were  turgid  with  blood,  and 
beneath  the  dura  mater  was  an  extravasation  an  inch  in  diameter. 

The  other  two  forms  of  death  in  cases  of  drowning,  pulmonary  apo- 
plexy and  neuro-paralysis,  are  of  about  equal  frequency.  Just  why  death 
should  be  caused  in  different  individuals  by  one  or  the  other  of  these 
physiological  changes  cannot  be  certainly  determined,  but  individual 
tendencies,  temperature  of  the  water,  flight,  voluntary  or  involuntary 
passiveness  while  sinking,  must  have  some  influence. 

That  there  has  been  much  discussion  as  to  whether  a  decision  in  a 
doubtful  case  of  death  from  drowning  could  be  made  is  undoubtedly  due 
to  the  fact  that  there  is  no  absolutely  diagnostic  sign  which  is  never 
wanting ;  but  in  my  opinion,  the  difficulties  in  the  way  of  an  accurate 
diagnosis  are  much  overrated,  in  spite  of  the  undoubted  occurrence  of 
cases  more  or  less  puzzling,  and  where  such  observers  as  Devergie  and 
Casper  assert  that  they  could  "  in  nine  tenths  of  all  the  cases  declare 
with  a  clear  conscience  whether  the  submersion  had  been  during  life  or 
after  death,"  it  is  not  necessary  for  less  experienced  men  to  assume  the 
role  of  Thomas  and  demand  the  utmost  proofs  before  being  willing  to 
give  an  opinion.  A  priori,  when  a  body  is  found  in  the  water  it  may  be 
assumed  that  the  individual  died  by  drowning ;  and  though  such  a  death 
may  in  rare  instances  have  been  the  result  of  murder,  and  while  occa- 
sionally bodies,  especially  of  children,  are  thrown  after  death  into  the 
water  to  avoid  the  expense  of  sepulture,  the  total  number  of  all  these 
cases  is  the  very  small  minority. 

An  exploitation  of  the  various  appearances  claimed  by  various  writers 
as  characteristic  of  death  from  drowning  seems  unnecessary,  inasmuch 
as  most  of  these  have  been  found  to  be  untrustworthy  and  of  no  value 
as  certain  signs  of  death  from  this  cause.  I  will  simply  mention  them 
in  passing. 

Coldness  of  the  body  has  been  claimed  as  a  sign  of  death  by  drown- 
ing. The  fact  is  that  a  dead  body,  whatever  the  cause  of  death,  as  has 
been  mentioned  before,  soon  assumes  the  temperature  of  the  surrounding 
media,  whether  air  or  water,  and  bodies  submerged  in  cold  water  will 
cool  more  quickly  than  those  in  the  air  in  summer ;  but  the  thermometer 
has  as  yet  been  unable  to  show  any  difference  between  the  bodies  of  the 
drowned  aud  those  that  have  died  of  other  causes  after  a  certain  interval, 
other  things  being  equal.  It  seems  to  me,  therefore,  that  relative  tem- 
perature of  a  body  is  of  no  value  as  pointing  to  a  death  by  drowning. 

Paleness  of  the  body  is  also  mentioned  as  a  characteristic  of  the 
drowned.  I  have  not  only  seen  the  bodies  of  the  drowned  present  a  livid 
appearance,  but  also  a  peculiar  rosy  hue.  I  have  seen  the  bodies  of  sev- 
eral people  lying  side  by  side  in  the  morgue,  some  of  which  had  died  of 
natural  causes,  some  by  railway  accident,  one  by  hemorrhage  from  cut 
throat,  and  one  from  drowning,  and  it  would  have  been  impossible  for 
any  observer  to  select  the  body  of  the  drowned  man  by  any  difference  in 
color.  A  statement  that  there  was  no  difference  in  color  would  not  apply 
to  the  bodies  of  those  who  have  been  long  drowned,  when  the  evidence 
of  commencing  putrefaction,  either  in  the  water  or  after  exposure  to 
the  air,  is  to  be  seen.  Here  there  is  a  dusky  redness,  characteristic 
not  of  the  cause  of  death,  but  of  post-mortem  change,  and  it  is  only 


122  A   SYSTEM    OF  LEGAL   MEDICINE. 

the  localization  of  the  color  change  which  furnishes  a  suggestion  of  the 

cause  of  death. 

The  situation  of  the  tongue,  whether  it  be  behind  the  teeth,  or  whether 
it  protrude,  or  is  clenched  between  the  teeth,  is  of  no  importance  as  a 
characteristic  of  this  form  of  death.  Two  days  ago  I  had  occasion  to 
make  a  post-mortem  examination  of  the  body  of  a  child  who  had  been 
apparently  well  till  a  few  hours  before  its  death,  when  it  was  suddenly 
seized  with  diarrhoea  and  vomiting,  and  after  an  illness  of  hours  only 
had  some  convulsions  and  died.  The  child  was  a  negro,  and  the  history 
suggested  an  irritant  poison;  but  the  autopsy  developed  the  fact  that 
there  was  oedema  of  both  lower  extremities,  and  acute  nephritis  with 
cerebral  and  pulmonary  oedema  combined  with  organic  disease  of  the 
heart.  In  this  case  the  tongue  was  found  tightly  clenched  between  the 
teeth.  This  is  only  one  of  many  instances  where  I  have  observed  the 
incarceration  of  the  tongue  in  cases  where  the  death  did  not  result  from 
violence  of  any  form. 

The  same  lack  of  value  attaches  to  that  appearance  of  the  skin  known 
as  goose-flesh,  or  cutis  anserina.  I  had  attached  some  value  to  this  ap- 
pearance,  owing  to  the  instruction  in  the  text-books;  but  after  a  very 
short  time  I  found  that  the  appearance  was  to  be  noted  in  the  bodies  of 
those  who  had  died  from  almost  any  cause.  Indeed,  it  occurs  in  the 
living,  as  any  one  will  know  that  has  taken  a  cold  bath,  or  been  obliged 
to  make  his  toilet  in  a  room  in  the  country  where  the  conveniences  for 
heating  in  the  winter  time  do  not  obtain.  I  have  had  occasion  to  point 
out  this  appearance  of  goose-flesh  to  my  students  in  cases  of  death  from 
pistol-shot,  from  cut  throat,  and  even  from  pneumonia.  I  do  not  mean 
to  assert  that  this  phenomenon  is  wholly  due  to  the  effects  of  cold,  as  it 
may  be  observed  in  the  summer  as  well  as  in  the  winter.  It  is  probably 
largely  due  to  mental  or  nervous  shock,  of  which  sudden  exposure  to  cold 
may  be  one  cause. 

The  condition  of  the  hands  and  feet  is  of  importance  only  so  far  as 
the  livid,  blue-gray  color  and  the  maceration  of  the  epidermis  indicate 
that  the  body  has  lain  in  water.  Something  resembling  tins  appearance 
may  be  seen  in  the  hands  of  washerwomen  during  life,  and  any  body, 
whatever  the  cause  of  death,  which  has  been  allowed  to  lie  in  water  after 
death  will  present  the  same  change  of  color  and  the  same  maceration. 
On  the  other  hand,  this  process  requires  time,  and  the  body  of  a  person 
who  has  been  removed  from  the  water  within  a  short  time  after  death, 
say  six  to  eight  hours,  will  not  present  the  corrugation  and  maceration 
which  is  claimed  as  a  sign  of  death  by  drowning. 

The  absence  of  sand  or  gravel  from  under  the  finger-nails  of  the  body 
is  of  no  value,  as  such  appearance  is  not  usually  present,  and  is  only  to 
be  found  where  the  person  has  clutched  the  bank  or  bottom  in  efforts  to 
save  himself,  or  where  the  body  has  been  dragged  up  a  bank  in  the  pro- 
cess of  its  removal  from  the  water.  It  is  too  much  of  a  refinement  to 
suggest  that  a  murderer  would  endeavor  to  conceal  a  crime  by  attempt- 
ing to  imitate  this  appearance  of  the  nails. 

Casper  attaches  considerable  importance  to  the  retraction  of  the  penis 
in  cases  of  actual  drowning.  He  has  found  this  condition  frequently  in 
the  bodies  of  the  drowned,  and  rarely  after  death  from  other  causes.  He 
claims  that  even  the  distention  caused  by  putrefaction  does  not  prevent 
.this  longitudinal  shortness  from  being  distinctly  observed.     When,  how- 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  jL>;; 

ever,  the  very  great  variation  in  the  size  of  the  organ  in  different  indi- 
viduals is  considered,  a  very  careful  observation  combined  with  previous 
knowledge  of  the  anatomy  of  the  person  under  examination  is  required. 
An  instance  of  this  organ  assuming  more  than  natural  proportions  after 
death  from  drowning  in  consequence  of  putrefactive  changes  has  been 
previously  cited.  Casper  apparently  accepts  the  explanation  of  this  phe- 
nomenon offered  by  Brettner.     This  is  as  follows  : 

"  Bundles  of  unstriped  muscular  fiber  lying  in  the  upper  stratum  of 
the  true  skin  surround  the  sebaceous  glands  and  force  them  forward  by 
their  contraction,  thus  making  cutis  anserina.  Precisely  similar  un- 
striped muscles  are  found  in  the  subcutaneous  cellular  tissue  of  the 
penis.  They  run  parallel  to  the  long  axis  of  the  member,  but  very  often 
large  bundles  run  across  it.  (Kolliker.)  It  might,  therefore,  be  expected 
that  their  contraction  would  compress  the  spongy  tissues  of  the  penis, 
which  are  capable  of  little  resistance,  and  thus  reduce  its  dimensions  in 
length,  breadth,  and  thickness,  and  thus  produce  what  might  be  called  a 
contraction  of  the  penis ;  and  further,  that  irritants  capable  of  exciting 
the  contraction  of  ordinary  unstriped  muscle  might  also  be  capable  of 
inducing  the  contraction  of  these  unstriped  muscles  of  the  penis,  e.g., 
cold  and  fright."  It  is  difficult  for  me  to  understand  why  the  same 
objections  to  this  ingenious  explanation  which  are  raised  by  Casper 
himself  as  to  the  value  of  cutis  anserina  as  a  sign  of  death  by  drowning, 
and  which  have  been  previously  mentioned,  should  not  lie  against  the 
value  of  the  presence  of  a  contracted  penis  as  a  sign  of  this  form  of 
death. 

So  much  for  the  external  appearances.  On  internal  examination  we 
occasionally  find  cerebral  hyperemia.  As  has  already  been  said,  this 
condition  is  by  no  means  constant,  and  therefore  nothing  can  be  argued 
from  its  absence.  If  present  directly  after  death,  it  may  disappear  with 
putrefaction,  and  bodies  which  have  lain  in  water  any  considerable  time, 
or  which  have  been  exposed  to  the  ah'  after  a  short  immersion,  very  rapidly 
take  on  this  change. 

The  position  of  the  epiglottis  is  of  no  value,  inasmuch  as  the  upright 
position  may  exist  in  cases  of  death  from  other  causes,  or  may  be  pro- 
duced in  the  drowned  by  manipulation  during  the  course  of  autopsy. 

Of  much  greater  importance  is  the  vascular  injection  of  the  mucosa 
of  the  trachea  and  the  presence  of  mucous  froth  in  that  canal.  In  every 
form  of  death  from  suffocation,  except  that  of  nervous  apoplexy,  the 
mucous  membrance  of  the  larynx  and  trachea  is  found,  on  examination 
soon  after  death,  more  or  less  injected,  varying  from  isolated  patches  of 
a  cinnabar-red  color  to  a  uniform  coloration  of  the  whole  mucous  mem- 
brane. This  differs  distinctly  from  the  dirty-red  or  brownish-red  color 
of  decomposition,  and  there  is  also  usually  in  the  trachea  a  fluid  varying 
in  amount  from  a  few  frothy  bubbles  to  an  amount  of  foam  sufficient  to 
fill  the  entire  canal.  This  wells  out  of  the  nose  and  mouth  in  conse- 
quence of  the  evolution  of  gases  by  putrefaction,  and  even  when  absent 
in  the  trachea  may  be  forced  from  the  bronchi  by  gentle  pressure.  The 
amount  may,  and  probably  does,  depend  in  a  degree  upon  the  rapidity 
or  the  slowness  of  the  death  process.  In  general,  in  the  bodies  of  the 
drowned  this  appearance  of  froth,  both  externally  and  in  the  trachea,  is 
only  to  be  found  when  the  body  has  been  removed  from  the  water  within 
a  very  short  time  after  death,  and  it  would  not  be  found  in  cases  of 


124:  -1    SYSTEM    OF  LEGAL    MEDICINE. 

drowning  where  the  death  was  from  apoplexy  or  from  neuro-paralysis. 
Indeed,  I  have  seen  cases  of  pretty  sudden  death  from  organic  disease 
of  the  heart  where  the  amount  of  foam  in  the  lungs  and  trachea,  as  well 
as  externally  at  the  nostrils,  was  greater  than  any  I  have  ever  seen  in 
the  drowned,  and  which  in  appearance  could  in  no  wise  be  distinguished 
from  the  froth  of  the  drowned,  inasmuch  as  in  both  cases  the  foam 
is  simply  a  mixture  of  air-bubbles  with  the  fluid  either  involuntarily 
inspired*  or  present  because  of  pathological  process,  or  a  mixture  of 
air  with  the  mucus  naturally  contained  in  the  air-canals.  Casper  and 
Devergie  differ  in  opinion  as  to  whether  it  is  necessary  for  the  pro- 
duction of  this  froth  in  the  drowned  that  the  individual  should  have 
got  his  head  above  water  after  the  first  plunge.  Casper  claims  to 
have  found  this  froth  present  in  the  cases  of  those  who  have  gone  at 
once  under  the  water,  and  remained  there  in  consequence  of  coming 
up  under  the  bottoms  of  ships  or  sunken  logs,  while  Devergie  main- 
tains that  the  inhalation  of  atmospheric  air  is  necessary  for  the  pro- 
duction of  this  froth.  I  remember  the  case  of  a  longshoreman  who 
fell  from  the  side  of  a  ship  on  which  he  was  employed,  and  in  falling  ' 
struck  his  head  on  a  boom  beside  the  ship  and  never  rose  after  immer- 
sion. The  body  was  immediately  recovered,  but  life  was  extinct.  In  this 
case  there  was  no  considerable  amount  of  cerebral  hyperemia,  the  trachea 
and  larynx  were  injected,  and  there  was  froth  in  these  canals  and  in  the 
bronchi.  Therefore  it  must  be  admitted  that  in  rare  instances  such  a 
phenomenon  may  be  present  without  the  inspiration  of  air  after  submer- 
sion, the  froth  being  formed  of  the  inspired  water  mingled  with  the 
mucus  and  air  that  was  already  in  the  lungs  at  the  time  of  submersion ; 
yet  while  I  have  had  occasion  to  examine  the  bodies  of  many  persons 
who  have  died  under  similar  circumstances,  I  have  never  found  the  froth 
except  in  this  solitary  case.  I  am  inclined  to  believe  that  the  presence  of 
froth  in  such  cases  is  exceptional.  I  certainly  am  of  the  opinion  that 
the  amount  is  largely  proportionate  to  'the  length  of  the  struggle  and 
the  amount  of  combined  air  and  water  inspired.  It  is  unfortunate  that 
this  sign  disappears  so  quickly  in  consequence  of  putrefaction,  inasmuch 
as  the  opportunities  for  examination  of  bodies  of  persons  who  have  fallen 
into  the  water  stunned,  or  of  suicides  who  have  weighted  their  bodies 
with  stones,  or,  as  in  one  case  coming  under  my  observation,  with  chain 
armor,  do  not  come  to  the  surface  or  are  not  recovered  till  decomposition 
is  well  under  way.  If  the  foam  is  present,  however,  the  medical  jurist 
will  at  least  be  in  a  position  to  say  that  life  existed  at  the  time  of  its 
formation,  and  thus  dispose  of  the  question  whether  the  body  was  thrown 
into  the  water  after  death. 

No  value  is  to  be  attached  to  the  position  of  the  diaphragm.  It  is 
found  variously  arched  in  recent  cases  of  drowning,  and,  as  is  well  known, 
may  be  forced  higher  and  higher  by  the  gases  of  decomposition. 

The  increase  in  the  volume  of  the  lungs  is  a  very  important  sign  of 
death  from  drowning,  though  in  consequence  of  my  own  observation  I 
am  not  prepared  to  go  as  far  as  Casper,  who  declares  that  "  it  never  fails 
except  in  the  rarest  instances,  where  putrefaction  of  the  whole  body  and 
of  every  organ  is  already  far  advanced."  I  have  made  dissections  of 
bodies  where  the  decomposition  was  only  indicated  by  the  commencing 
putrefaction  of  the  soft  parts  of  the  head  and  a  moderate  greenish  dis- 
coloration of  the  surface  of  the  body,  and  in  these  cases  I  have  found 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  195. 

the  lungs  entirety  collapsed,  and  the  pleural  cavities  containing  a  very 
large  amount  of  reddish  fluid,  the  result  of  post-mortem  osmosis.  I  may 
add  that  in  several  of  these  cases  the  history  of  the  misadventure  was 
wholly  known,  and  there  was  no  question  as  to  the  real  cause  of  death. 
This  increase  in  the  volume  of  the  lungs,  however,  generally  occurs  in 
cases  of  death  by  drowning  even  where  death  occurred  as  a  result  of 
nervous  apoplexy,  and  is  caused  by  the  violent  attempts  to  breathe  as 
the  head  emerges  from  the  water,  and  also  by  the  inhalation  of  the  fluid 
in  which  the  drowning  occurs,  the  latter  probably  playing  the  chief  part 
in  the  production  of  this  phenomenon.  The  lungs  no  longer  have  the 
crepitant  feel  of  normal  lungs,  but  are  very  like  a  sponge,  and  when 
these  organs  are  incised  there  is  a  copious  flow  of  a  bloody  froth. 

It  is  of  little  moment  whether  water  can  get  into  the  lungs  after 
death,  a  point  which  is  much  in  dispute,  inasmuch  as  the  formation  of 
froth  is  essentially  a  vital  process,  and  cannot  occur  after  life  is  extinct. 
This  sign  of  death  by  drowning  is  wholly  incontrovertible  when  in  the 
lungs  is  found  a  fluid  of  peculiar  character,  and  of  the  same  nature  in 
which  the  body  has  been  found,  as,  for  instance,  liquid  manure,  or  liquor 
amnii.  I  had  occasion  to  make  a  section  of  the  body  of  a  man,  in  a  case 
of  suspected  murder,  where  the  body  was  found  in  a  barn  cellar  in  the 
manure-pit  of  a  stable  accommodating  a  great  number  of  animals.  It 
was  shown  that  the  man  had  come  there  with  a  companion  for  the  pur- 
pose of  carting  away  the  manure  at  a  very  early  hour  in  the  morning. 
Both  the  man  and  his  companion  were  somewhat  intoxicated.  After 
daylight  an  employee  of  the  proprietor  of  the  stable  found  the  cart  still 
there,  while  both  men  had  disappeared.  Search  revealed  the  presence 
of  one  of  the  men  in  the  half -liquid  manure  of  the  pit.  His  companion, 
when  found,  could  give  no  very  connected  account  of  what  had  hap- 
pened, claiming  that  he  had  left  the  man  there  when  he  went  away  for 
more  liquor,  and  as  he  did  not  find  him  on  his  return,  went  home  himself 
in  a  dazed  way,  leaving  the  team  at  the  stable.  External  examination 
showed  the  absence  of  all  bruises — in  fact,  there  was  nothing  unusual 
except  the  extreme  filth  of  the  clothing  and  body  from  its  environment 
since  death.  The  volume  of  the  lungs  was  very  much  increased,  and  in 
the  bronchi  even  of  the  smaller  size  there  were  particles  of  equine  fa?ces 
mingled  with  urine.  It  was  clear  that  the  man  had  come  to  his  death 
by  drowning  in  the  pit,  and  the  result  of  the  further  investigation  seemed 
to  make  it  probable  that  in  the  absence  of  his  companion  the  man  had 
opened  the  scuttle,  and  from  intoxication  fallen  into  the  pit  and  drowned. 

Overloading  of  the  right  side  of  the  heart  may  occur,  and  generally 
does  in  any  form  of  asphyxia,  and  is  not  characteristic  of  the  particular 
form  of  death  by  asphyxia  which  is  under  consideration.  It  might  be 
found  in  any  case  where  the  body  of  a  person  who  had  died  by  strangu- 
lation had  been  thrown  into  the  water  after  death.  Moreover,  in  the 
rare  cases  where  death  has  been  due  to  cerebral  hyperemia  or  to  neuro- 
paralysis, this  condition  of  the  heart  is  not  to  be  observed.  Congestion 
of  the  lungs  and  hypera?mia  of  the  pulmonary  artery  are  also  common  to 
various  forms  of  asphyxia  whatever  the  cause,  and  consequently  are  not 
peculiarly  characteristic  of  death  by  drowning.  The  dark  color  and  the 
fluidity  of  the  blood  is  always  present  in  cases  of  death  by  drowning, 
but  it  is  also  present  in  any  case  of  death  where  the  access  of  atmos- 
pheric air  is  prevented ;  and  indeed,  it  is  found  in  cases  of  death  from 


12G  A   SYSTEM  OF  LEGAL   MEDICINE. 

narcotic  poisoning  and  from  lightning  or  any  other  fatal  amount  of  elec- 
tricity. This  has  been  demonstrated  frequently  since  the  introduction 
of  this  fluid  into  general  use  for  power  or  light.  It  should  be  remarked 
that  this  condition  of  the  blood,  which  is  always  to  be  found  if  the  body 
is  examined  sufficiently  early,  disappears  entirely  when  putrefaction  is 
consideral  >ly  advanced. 

In  regard  to  the  congestion  of  the  solid  viscera  of  the  abdomen,  as 
well  as  the  overloading  of  the  vena  cava  and  the  mesenteric  veins,  the 
same  remarks  which  were  made  about  the  hyperemia  of  the  brain  and 
lungs  are  applicable.  These  parts  will  be  found  congested  in  most  cases 
of  drowning,  but  this  only  means  that  the  death  has  resulted  from  as- 
phyxia, though  not  necessarily  from  drowning.  Of  course  this  hyper- 
a?mia  is  not  likely  to  be  found  in  the  organs  of  those  who  have  died  in 
the  water  from  any  other  cause  than  drowning. 

Whether  the  bladder  is  full  or  empty  is  a  matter  of  no  diagnostic 
value.  I  have  frequently  found  the  bladder  very  much  distended  with 
urine  in  cases  of  drowning,  and  on  the  other  hand  I  have  also  found  it 
entirely  empty.  In  cities  with  a  water-front  it  is  not  at  all  uncommon 
to  see  cases  where  the  body  has  been  found  alongside  a  wharf,  and  where 
the  condition  of  the  clothing  and  the  emptiness  of  the  bladder  have  very 
strongly  suggested  that  the  deceased  had  gone  to  the  side  of  the  wharf 
for  the  purpose  of  voiding  urine,  and  in  so  doing,  or  immediately  there- 
after, had  lost  his  balance  from  intoxication  and  fallen  into  the  water 
and  drowned. 

The  presence  of  water  in  the  stomach  of  the  drowned  is  a  fairly  con- 
stant appearance.  Its  value  as  a  diagnostic  symptom  is  somewhat  in  dis- 
pute. Casper  thinks  that  it  is  always  present  in  fresh  bodies,  and  that 
where  it  is  apparently  absent  the  absence  is  rather  dependent  on  illusion 
than  reality.  Ogston  claims  to  have  found  water  present  in  the  stomach 
in  nearly  thirty-seven  percent,  of  his  cases.  In  at  least  fift}'  percent, 
of  my  own  cases  the  presence  of  water  in  the  stomach  has  been  ob- 
served. Ogston  further  states  that  in  ten  of  his  cases,  though  there 
was  no  water  in  the  stomach,  it  was  present  to  a  limited  extent  in  the 
abdominal  cavity,  never  to  an  amount  more  than  six  ounces.  This  sug- 
gests to  the  anatomist  the  question  as  to  how  it  arrived  in  this  serous 
cavity  in  the  process  of  drowning.  However,  as  it  gets  into  the  pleural 
cavities  by  osmosis  it  is  possible  that  it  reaches  the  abdomen  in  the  same 
manner.  This  presence  of  water  in  the  pleural  cavities,  which  I  have 
observed  in  a  very  large  proportion  of  the  cases  of  drowning  which  came 
under  my  observation,  is,  in  my  opinion,  a  very  important  sign.  It  is 
to  be  found  at  a  time  when  putrefaction  has  at  most  just  begun.  It  is 
tinged  with  the  coloring  matter  of  the  blood,  and  is  generally  altogether 
too  much  in  amount  to  be  accounted  for  by  the  serum  which  would 
naturally  come  from  the  blood  of  a  congested  lung,  and,  to  my  mind, 
indicates  the  presence  in  the  lung  of  a  considerable  amount  of  water  in- 
troduced during  the  death-struggle.  The  presence  of  other  pathological 
changes  would  of  course  settle  any  question  as  to  whether  this  fluid  was 
the  result  of  an  effusion  caused  by  pleuritic  inflammation  during  life. 
I  have  found  as  much  as  a  quart  of  this  fluid  in  each  pleural  cavity. 

To  return  to  the  question  of  water  in  the  stomach,  it  has  been  shown 
by  experiments  on  animals  that  water  enters  the  stomach  during  the 
process  of  drowning  by  the  act  of  deglutition  as  the  animal  comes  to 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  127 

the  surface  to  respire,  while  when  they  are  kept  continually  under  water 
till  life  is  extinct,  little,  if  any,  water  enters  this  cavity.  It  has  also  been 
found  by  experiment  that  water  does  not  enter  the  stomach  of  an  animal 
thrown  into  the  water  after  death.  The  power  of  swallowing  is  lost 
after  death,  and  the  walls  of  the  oesophagus  apply  themselves  too  closely 
together  to  permit  the  passage  of  water.  Nearly  all  writers  are  agreed 
that  water  cannot  enter  the  stomach  after  death,  at  any  rate  till  putre- 
faction is  far  advanced.  It  must  be  borne  in  mind  that  water  may  have 
been  swallowed  by  the  deceased  just  previous  to  immersion ;  but  such 
cases  are  the  exception,  and  if  the  fluid  found  in  the  stomach  should  be 
different  from  the  kind  of  water  which  would  naturally  be  drunk — sea- 
water  for  instance,  or  a  fluid  which  is  never  voluntarily  drunk,  as  liquid 
manure  or  liquid  mud — the  proof  is  positive  that  death  resulted  from 
drowning.  The  only  exception  to  this  is  the  case  of  a  new-born  child. 
It  has  been  shown  that  there  are  movements  of  deglutition  made  by  the 
foetus  while  in  the  membranes.  Consequently  if  liquor  amnii  or  uterine 
mucus  be  found  in  the  stomach  of  a  new-born  child,  it  would  not  show 
that  the  child  had  been  drowned,  as  these  substances  have  been  found 
in  the  stomachs  of  children  who  have  never  breathed.  Generally  speak- 
ing, however,  when  other  substances  are  found,  such  as  human  ordure,  it 
is  an  indication  that  the  child  has  been  drowned.  If  there  should  be  any 
doubt,  a  careful  examination  of  the  lungs  as  to  the  matter  of  their  having 
been  distended  by  natural  respiration  should  be  made. 

The  following  case  illustrates  a  manner  of  death  not  at  all  uncommon, 
but  which  has  given  rise  to  what  seems  an  unnecessary  amount  of  discus- 
sion. During  the  bathing  season  a  few  years  ago  a  man  was  wading  in 
the  surf  at  a  seaside  resort,  and  was  not  in  the  water  at  a  greater  depth 
than  his  hips.  A  female  friend,  who  was  swimming  at  some  distance 
farther  out  from  the  shore,  in  a  spirit  of  mischief  cried  for  help,  exclaim- 
ing that  she  was  drowning.  The  man  made  a  violent  attempt  to  reach 
the  woman,  but  after  a  few  steps  fell  forward  into  the  water  and  did  not 
rise.  He  was  immediately  taken  out,  but  all  attempts  at  resuscitation 
proved  unavailing.  The  dissection  showed  a  large,  very  fatty  heart,  dis- 
tended with  blood  on  both  sides,  no  unusual  darkness  or  fluidity  of  the 
blood,  and  no  cerebral  or  tracheal  injection,  and  entire  absence  of  froth 
in  the  air-passages.  Now,  although  this  death  occurred  in  the  water  and 
the  body  was  submerged,  the  case  was  clearly  one  of  death  from  syncope. 
Owing  to  the  fright  and  the  sudden  exertion,  a  heart  in  a  pronounced 
degree  of  fatty  infiltration  became  incapable  of  work.  This  might  equally 
have  happened  on  land.  Such  cases  ought  not  at  all  to  be  considered 
cases  of  drowning. 

During  the  same  season,  at  another  resort,  a  man  who  could  not 
swim  at  all  was  wading  in  the  water,  when  he  suddenly  fell  and  was 
submerged.  He  had  been  in  the  water  but  the  shortest  time  before  this 
happened,  but  he  had  just  previous  to  jumping  into  the  water  eaten  a 
very  large  meal  and  had  partaken  freely  of  stimulants.  The  autopsy  in 
this  case  showed  only  very  great  engorgement  of  the  cerebral  vessels 
without  actual  rupture.  This  case  should  properly  be  classed  as  a  death 
from  cerebral  congestion  and  shock  rather  than  as  a  death  from  drown- 
ing, although  the  death  did  occur  in  the  water,  and  it  is  possible  that  life 
was  not  wholly  extinct  at  the  time  of  submersion. 

Something  more  than  two  years  ago  I  was  called  to  investigate  the 


128  ^   SYSTEM  OF  LEGAL  MEDICINE. 

death  of  a  new-born  infant  in  one  of  the  outlying  districts  of  the  city  of 
Boston.  The  mother  was  a  domestic,  and  was  not  known  by  her  em- 
ployer to  be  pregnant  until  after  the  delivery.  She  was  alone  at  the 
time  of  the  birth,  and  claimed  that  the  child  had  never  cried  or  given 
any  sign  of  life,  and  that,  believing  that  it  was  dead,  she  had  put  it  into 
a  pail  containing  various  fluids,  water,  urine,  blood,  etc.  The  umbilical 
cord  had  been  cut  but  not  tied.  The  section  showed  that  the  child  had 
breathed,  as  the  lungs  were  fully  distended,  and  presented  a  number  of 
blebs  upon  their  surface  (emphysema),  and  were  wholly  buoyant  in  water, 
both  in  mass  with  the  thymus' attached,  and  also  in  small  sections  after 
being  subjected  to  great  pressure.  The  lungs  were,  however,  overloaded 
with  blood,  and  there  was  cerebral  congestion;  the  bronchial  tubes  con- 
tained a  little  froth,  and  in  the  stomach  was  found  a  reddish-brown  fluid 
with  an  odor  of  urine,  in  which  were  blood-corpuscles.  Although  this 
was  apparently  a  case  of  homicidal  drowning,  the  authorities  thought  it 
unlikely  that  a  conviction  of  an  ignorant  woman,  who  was  alone  in  her 
travail,  could  be  obtained. 

I  have  made  post-mortem  examinations  in  very  many  cases  of  new- 
born children,  which  were  said  by  the  parents — and  no  doubt  the  state- 
ment was  made  in  perfect  good  faith — to  have  been  still-born,  where  the 
section  has  shown  in  the  stomach  the  presence  of  the  uterine  fluids  mixed 
with  blood,  while  the  lungs  clearly  indicated  that  the  child  had  breathed, 
and  had  afterward  died  from  the  prevention  of  access  of  atmospheric  air. 
These  are  cases  where  the  mother  was  alone  at  the  time  of  birth,  and  the 
child  was  expelled  rapidly  into  a  pool  of  the  fluids  of  the  mother,  who 
may  have  been  in  a  half  swoon  herself,  and  where  the  child,  lying  face 
downward  in  this  mass  of  fluid,  was  drowned  before  anything  could  be 
done  to  remove  it  from  its  situation.  The  new-born  child  dies  in  a  very 
short  time  in  such  a  situation,  and  the  speed  with  which  death  ensues 
prevents  the  changes  which  are  seen  so  markedly  in  the  adult. 

The  question  whether  any  given  death  from  drowning  was  the  result 
of  accident,  suicide,  or  homicide  is  one  most  difficult  to  determine,  and 
very  little  aid  is  given  in  the  majority  of  cases  from  the  examination  of 
the  body  alone.  External  circumstances  must  be  carefully  weighed,  and 
an  opinion  given  with  a  great  deal  of  caution,  as  it  is  in  many  cases  im- 
possible for  the  medical  jurist  to  give  an  opinion  which  shall  be  exact. 
If  the  body  has  not  too  far  advanced  in  putrefaction  he  will  generally  be 
able  to  state  whether  the  body  was  alive  or  dead  when  it  went  into  the 
water.  In  the  latter  case  suicidal  drowning  would  be  out  of  the  ques- 
tion, and  the  question  of  the  homicide  by  drowning  of  a  new-born  child 
would  be  settled  in  the  negative  if  the  body  was  found  to  have  been 
dead  when  thrown  into  the  water.  This  is  of  importance,  inasmuch  as 
many  cases  come  up  for  investigation  every  year  where  the  body  has 
thus  been  disposed  of  to  escape  the  expense  of  burial.  That  the  body  of 
an  adult  should  be  thrown  into  the  water  for  such  cause  is  very  unusual. 
Injuries  of  various  kinds  may  be  found  upon  the  body,  and  they  may 
have  been  produced  both  before  and  after  death  in  various  ways.  A 
man  may  have  been  wounded  and  subsequently  fallen  into  the  water,  or 
a  suicide  may  resort  to  drowning  after  having  failed  in  other  ways. 

In  the  summer  of  1893  I  was  called  to  examine  the  body  of  a  man 
which  had  just  been  taken  from  tide-water  at  the  junction  of  the  river 
Charles.     The  body  had  evidently  been  in  the  water  but  a  short  time. 


DEATH  IN  ITS  MEDiCO-LEGAL  ASPECTS.  129 

The  post-mortem  examination  showed  all  the  characteristic  signs  of  death 
by  asphyxia  from  drowning.  Yet  in  the  right  side  of  the  head  were 
found  two  wounds  produced  by  pistol-balls,  both  bullets  having  been 
fired  into  the  head  at  short  range ;  but  as  they  were  of  the  smallest  cali- 
ber, and  therefore  fired  with  a  small  charge  of  powder,  they  had  buried 
themselves  in  the  skull  without  penetrating  it,  and  had  produced  no 
further  effect  upon  the  brain  than  a  trifling  ecchymosis  directly  beneath 
the  site  of  the  bullet.  In  this  case  it  was  clear  that  the  man  had  been 
shot  and  then  had  died  from  drowning,  and  would  not  necessarily  have 
died  from  the  effects  of  the  shooting.  Fortunately,  some  letters  left  by 
the  deceased,  and  an  investigation  of  his  financial  situation,  left  no  doubt 
that  the  case  was  one  of  suicide. 

A  body  in  running  water  may  be  subjected  to  injuries  by  being 
hurled  against  floating  ice,  the  piers  of  bridges,  or  by  being  mutilated 
by  the  propellers  or  paddle-wheels  of  steamboats.  In  such  cases  great 
care  must  be  used  in  the  investigation  to  determine  as  far  as  possible 
whether  these  wounds  show  any  signs  of  vital  reaction  indicating  that 
they  were  inflicted  during  life.  Moreover,  the  medical  expert  must  be 
careful  not  to  mistake  post-mortem  changes  from  putrefaction,  such  as 
the  presence  of  swelling  of  the  scalp,  or  blood  beneath  it,  for  a  process 
occurring  before  death.  Bodies  are  often  much  crushed  when  lying  in 
tide-water  by  the  weight  of  a  ship  settling  upon  the  body  as  the  tide 
ebbs.  Such  injuries,  however,  are  so  great  as  to  leave  little  doubt  that 
they  were  not  inflicted  during  life. 

Collateral  circumstances  may  often  throw  some  light  on  the  question 
of  homicide,  or  suicide,  or  accident.  Certain  people,  from  the  nature  of 
their  occupation,  are  liable  to  accidents  of  this  sort,  such  as  sailors,  long- 
shoremen, dyers,  icemen,  and  railroad  employees  who  are  required  to 
walk  over  trestlework.  Weights  of  any  kind  attached  to  the  body  sug- 
gest suicide  in  the  case  of  the  adult.  The  case  previously  cited  of  a 
young  man  who  was  found  with  a  suit  of  chain  armor  attached  by  a 
belt  to  the  body  is  illustrative.  No  one  knew  that  the  man  was  inclined 
to  self-destruction ;  but  the  fact  that  he  was  an  actor,  and  that  this  suit 
was  a  part  of  his  own  wardrobe,  and  some  subsequently  ascertained  facts, 
clearhy  demonstrated  suicide. 

A  celebrated  case  occurring  in  a  county  of  Massachusetts  some  two 
years  or  more  ago  is  of  especial  interest  in  this  connection.  On  or  about 
Christmas  eve  a  young  woman  disappeared  from  her  home,  and  some 
months  later  her  body  was  discovered  in  tide- water  near  a  bridge  con- 
necting the  town  where  she  had  lived  with  an  adjoining  city.  It  was 
asserted  that  on  the  night  of  her  disappearance,  which  was  very  stormy. 
she  was  seen  to  get  into  a  buggy  with  a  man  who  was  assumed  to  be  her 
lover  and  the  father  of  her  unborn  child.  There  were  some  letters  which 
pretended  to  have  been  mailed  by  her  after  the  time  of  her  disappear- 
ance, which  were  written  in  a  hand  resembling  that  of  the  accused,  and 
these,  together  with  other  circumstances,  led  to  the  arrest  and  trial  of 
this  man.  The  autopsy,  which  was  very  carefully  conducted  by  Drs. 
Durell  and  Swan,  was  witnessed  by  myself.  The  appearances  showed 
nothing  of  external  violence,  and  only  a  moderate  degree  of  putrefac- 
tion. There  was  engorgement  of  the  lungs,  and  the  blood  was  dark  and 
fluid.  Both  chest  cavities  contained  a  large  amount  of  reddish  fluid, 
and  the  mucosa  of  larynx  and  trachea  were  stained  a  dark  red.     There 


130  A   SYSTEM   01    LEGAL  MEDICINE. 

was  about  a  pint  of  water  in  the  stomach.  There  was  nothing  indicat- 
ing any  other  cause  of  death.  In  the  uterus  was  a  foetus  of  the  fifth 
month.  The  examination  of  the  body  showed  nothing  to  indicate 
whether  the  death  was  one  of  homicide  or  suicide  except  the  moral 
evidence  afforded  by  the  pregnancy  suggestive  of  a  motive  for  suicide. 
The  contention  of  the  government  was  that  this  was  also  a  sufficient 
motive  for  murder  on  the  part  of  the  alleged  father.  It  was  claimed 
that  because  he  was  for  a  long  time  deaf  to  her  entreaties  to  marry 
her,  at  last,  to  rid  himself  of  her  importunity,  he,  under  the  pretense 
of  taking  her  away  to  be  married,  had  driven  to  this  bridge,  and 
there  had  taken  her  out  of  the  carriage  and  thrown  her  over.  The 
defense  claimed  that  it  would  have  been  impossible  for  the  man  to 
have  taken  this  girl,  in  the  full  possession  of  her  senses  (and  there  was 
nothing  to  indicate  she  was  not ;  indeed,  the  government  claimed  that 
she  shrieked  when  thrown  in),  and  tin-own  her  over  the  high  rails  of  a 
bridge  into  the  water  without  using  sufficient  force  to  have  left  marks 
on  her  body ;  and  again,  that  the  physical  relations  of  the  buggy  and 
the  bridge  did  not  admit  of  his  attaining  a  position  where  he  coidd  have 
thrown  her  over  either  with  or  without  great  force;  that  murder  by 
drowning  in  the  case  of  an  adult  was  most  unusual;  and  that  the  mo- 
tive was  entirely  insufficient,  inasmuch  as  under  the  laws  he  would  have 
had  to  submit  to  the  penalty  only  of  supporting  the  child  under  the 
Bastardy  Act;  that  suicide  of  women  pregnant  with  an  illegitimate  child 
is  of  very  frequent  occurrence  ;  and  that  the  throwing  the  girl  into  the 
water  where  there  was  the  possibility  of  her  floating  to  the  bank  of  the 
river,  or  of  her  being  rescued,  was  not  the  probable  act  of  a  man  who 
was  ingenious  enough  to  have  planned  the  scheme  as  outlined  by  the 
government,  a  man  who  would  not  have  been  so  shortsighted  as  to  take 
such  a  chance. 

To  show  how  much  the  matter  was  in  doubt,  it  may  be  stated  that 
there  were  two  trials  of  the  case,  in  the  first  of  which  the  jury  promptly 
convicted,  and  on  the  second,  and  with  the  same  evidence  practically,  the 
jury  with  equal  promptness  acquitted  the  prisoner.  It  must  be  admitted 
that  the  entire  absence  of  any  marks  of  violence  upon  the  body  in  the 
way  of  scratches  or  bruises  lent  a  certain  sort  of  moral  weight  to  the 
claim  of  the  defense. 

The  nature  and  depth  of  the  fluid  should  be  considered,  though  great 
caution  should  be  used  in  forming  an  opinion  of  homicide  because  of  the 
shallowness  of  the  water.  An  epileptic  might  have  a  seizure  on  the  edge 
of  a  shallow  pool  of  water  and  die  of  drowning  because  of  his  inability 
to  assist  himself. 

In  the  summer  of  1877  I  had  occasion  to  examine  the  body  of  a  man 
who  was  found  in  a  very  shallow  ditch  of  water  in  a  town  near  Boston. 
At  the  time  of  finding  the  body  there  was  scarcely  water  enough  to  cover 
the  half  of  the  body  when  lying  prone.  The  physical  signs  were  clearly 
those  of  drowning,  and  it  was  ascertained  that  he  had  left  a  resort  where 
he  had  spent  the  evening  in  drinking,  quite  late  on  the  previous  night, 
and  that  his  route  homeward  was  over  a  low  trestlework  crossing  the 
ditch  where  the  body  was  found,  and  which,  though  often  dry,  was  ac- 
cessible to  tide-water,  and  at  about  the  time  that  he  started  for  home  the 
tide  was  high.  All  of  his  valuables,  including  money  and  a  costly  gold 
watch,  were  found  on  his  person,  and  the  conclusion  was  warranted  that 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  ];J1 

in  a  state  of  intoxication  he  had  fallen  from  the  trestle  and  drowned, 
and  by  the  incoming  tide  the  body  had  been  carried  a  little  farther  inland. 
The  answer  to  the  question,  How  long  has  this  body  been  in  the 
water  ?  is  of  importance,  but  it  can  rarely  be  answered  with  exactness,  as 
has  been  shown  in  the  part  of  this  article  which  treats  of  putrefaction. 


DEATH  FROM  COLD  AND  HEAT. 

While  cases  of  death  from  extreme  cold  are  of  comparatively  rare 
occurrence,  they  are  still  worthy  of  some  passing  mention  in  a  work  of 
this  character.  Of  course  the  cases  will  occur  only  in  the  winter  time, 
in  the  northern  part  of  temperate  climates,  and  in  those  zones  which  are 
known  as  frigid.  The  rarity  of  the  occurrence  of  these  cases  has  left 
the  medical  jurist  with  insufficient  data  from  which  to  draw  accurate 
conclusions  as  to  the  post-mortem  appearances  characteristic  of  death 
from  cold. 

Out  of  some  four  thousand  cases  of  death  from  violence  which  have 
come  under  my  own  observation,  there  was  only  one  case  which  could 
be  in  any  way  attributed  to  the  effect  of  extremely  low  temperature,  and 
even  in  this  case  the  history  was  such  as  to  render  rather  obscure  the 
question  whether  the  death  was  not  caused  primarily  by  the  narcotic 
effect  of  alcohol,  the  freezing  occurring  immediately  after  death. 

From  an  observation  of  some  nineteen  cases,  Dr.  Ogston  says  that 
the  peculiar  appearance  in  the  bodies  of  adults  who  are  frozen  are :  first, 
an  arterial  hue  of  the  blood  generally,  except  when  viewed  in  masses 
within  the  heart;  second,  an  unusual  accumulation  of  blood  on  both 
sides  of  the  heart  and  in  the  large  vessels,  and  both  arteries  and  veins 
above  the  chest ;  third,  a  pallor  of  the  general  surface  of  the  body,  an 
anaemia  of  the  viscera  largely  supplied  with  blood;  fourth,  the  irregular 
and  dusky  red  patches  on  limited  portions  on  the  exterior  of  the  body  in 
parts  not  dependent,  and  which  contrast  visibly  with  the  pallor  of  the 
skin  and  general  surface.  On  the  other  hand,  Casper  says:  "There  is 
not  one  appearance  which  can,  with  any  certainty,  justify  the  assumption 
of  death  from  cold."  He  mentions  also  that  in  cases  where  the  ears,  the 
points  of  noses,  and  the  fingers  are  readily  broken  off,  such  appearances 
have  been  proclaimed  as  signs  of  death  from  freezing.  But  this  condi- 
tion only  proves  that  these  parts  of  the  deceased  had  possibly  been  frozen 
before  death.  Of  course  it  is  not  an  infrequent  occurrence  to  find,  in 
winter  time,  on  post-mortem  examination  of  bodies,  in  the  hollow  organs 
fluids  which  have  been  converted  into  masses  of  ice.  He  further  says 
that  the  overloading  of  the  vessels  of  the  brain,  lungs,  and  heart,  and 
large  venous  trunks,  any  or  all  of  them,  is  of  no  real  value  in  the  way 
of  demonstrating  death  from  cold,  since  this  condition  is  found  after 
other  kinds  of  death ;  so  that,  really,  the  diagnosis  is  only  to  be  made  by 
considering  the  whole  picture  in  connection  with  the  history  of  the  case, 
and  the  absence  of  evidence  of  death  from  any  other  cause.  But  Casper 
calls  atenttion  to  one  point  of  negative  evidence,  which  is  this  :  if  ;i  body 
found  frozen  is  in  a  state  of  commencing  or  advancing  putrefaction,  it 
is  quite  clear  that  the  individual  did  not  die  from  cold,  but  that  the  body 
had  already  begun  to  putrefy  before  the  freezing,  inasmuch  as  ice  itself 
is  a  preservative. 


132  ^   SYSTEM    OF  LEV.AL   MEDICINE. 

In  regard  to  the  points  made  by  Dr.  Ogston,  it  is  said  that  the  arte- 
rial hue  of  the  blood  is  to  be  found  after  death  in  other  cases,  notably 
in  cases  of  death  from  carbonic  oxide  poisoning.  As  to  the  unusual 
accumulation  of  blood  in  both  sides  of  the  heart,  it  is  well  known  that  this 
may  be  found  in  cases  of  death  from  other  causes,  as,  for  instance,  in 
some  cases  of  heart  disease.  Pallor  of  the  general  surface  of  the  body 
is  common  to  all  kinds  of  death ;  but  as  to  the  dusky  red  patches  which 
are  found  in  parts  other  than  those  dependent,  it  may  be  said  they  are 
of  a  certain  diagnostic  value,  but,  without  corroborating  circumstances, 
would  not  be  in  themselves  sufficient  to  warrant  an  absolute  opinion  that 
the  death  was  caused  by  cold. 

It  may  be  said  with  regard  to  the  persons  who  most  readily  succumb 
to  exceedingly  low  temperature,  that  they  are  naturally  those  people 
whose  vital  powers  are  the  feeblest — that  is,  in  the  very  young  and  the 
very  old,  and  those  who  are  narcotized  from  excessive  indulgence  in 
alcohol.  And  it  may  also  be  stated  that  in  the  case  of  the  habitual 
drunkard  the  pathological  changes  which  have  taken  place  in  the  tis- 
sues of  the  heart  render  the  circulation  more  feeble,  and  consequently 
render  the  individual  himself  less  able  to  withstand  the  effects  of  the 
cold. 

The  diagnosis  of  death  by  freezing  must  rather  depend  upon  common 
sense  than  upon  specific  changes  found  on  dissection ;  and  although  there 
have  been  exceptionally  rare  cases  where  death  from  this  cause  has  been 
attributed  to  the  intentional  act  of  another,  in  the  vast  majority  of  cases 
such  deaths  must  be  looked  upon  wholly  as  the  result  of  accident. 

Death  from  the  other  extreme  of  temperature — excessive  heat — is,  on 
the  other  hand,  of  fairly  common  occurrence.  And  while  the  human 
body  is  capable  of  resisting  for  a  brief  period  a  high  degree  of  tempera- 
ture, a  long-continued  exposure  to  a  moderately  great  elevation  of  tem- 
perature, or  the  exposure  a  short  time  to  excessively  high  temperature, 
results  in  the  destruction  of  life. 

There  are  notable  instances  of  people  who  are  able  to  bear  high  tem- 
perature for  an  extended  period — the  firemen  or  stokers  in  the  engine- 
rooms  of  the  ocean  steamers,  where  the  temperature  is  often  from  145° 
to  150°  F.  In  the  Turkish  bath  the  temperature  is  sometimes  from  180° 
to  200°.  In  both  of  these  situations  deaths  ha^e  occurred.  The  first 
effect  of  heat  is  to  stimulate  tremendously  the  action  of  the  heart,  fol- 
lowed by  a  feeling  of  giddiness  and  suffocation  and  death  by  coma ;  or 
if  the  person  does  not  die  immediately,  it  may  lead  to  congestion  of  the 
lungs  with  the  attendant  fever.  Excessive  heat,  aside  from  actual  burn- 
ing, kills  by  producing  apoplexy,  and  the  post-mortem  examinations  in 
cases  of  death  from  sunstroke  have  shown  that  the  appearances  were 
those  of  apoplexy. 

According  to  Dr.  Tidy,  when  death  has  occurred  from  excessive  heat 
rigor  mortis  comes  on  quickly,  putrefaction  sets  in  very  rapidly,  and  livid 
spots  and  petechia?  are  often  found  on  the  body.  The  brain  and  its 
membranes  are  injected,  and  serum  will  be  found  in  excess  in  the  ven- 
tricles. The  lungs  are  especially  dark  and  injected,  particularly  the  cen- 
tral and  posterior  parts  and  the  bases.  There  are  often  large  pulmonary 
apoplexies.  The  heart  is  generally  filled  with  liquid  blood,  especially  on 
the  right  side,  and  the  entire  venous  system  is  usually  congested ;  and 
yet  these  appearances  are  by  no  means  constant. 


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DEATH  IN  ITU   AIED1CU-LEGAL   ASPECTS.  133 

Death  in  Consequence  of  Burning.— Under  this  head  I  shall  not 
consider  the  cases  where  death  is  from  suffocation  by  smoke  or  by  the 
spasm  of  the  glottis  in  consequence  of  inhalation  of  flame.  The  effects 
of  heat  upon  the  body  vary  in  proportion  to  the  severity,  from  simple 
reddening  to  an  entire  charring  of  the  body  and  destruction  of  the  deep- 
seated  parts.  Death  takes  place  in  two  different  ways :  severe  and  ex- 
tensive burns  may  destroy  life  from  the  depression  of  the  nervous  sys- 
tem,  owing  to  the  number  of  superficial  nerves  that  are  affected ;  or  the 
victims  may  suffer  from  inflammatory  reaction  and  from  suppuration 
and  fever  at  a  later  period,  and  they  may  die  from  the  effects  of  the  de- 
struction of  the  skin  (although  the  burn  may  be  superficial,  yet  covering 
a  very  large  area  of  the  body),  the  chief  gland  of  the  body. 

The  question  as  to  the  connection  of  certain  pathological  changes  in 
the  interior  of  the  body  with  alleged  burns,  which  have  not  during  life 
attracted  special  attention,  is  not  likely  to  give  rise  to  a  great  deal  of 
trouble.  It  is  in  cases  where  the  appearance  of  the  exterior  of  the  dead 
body  is  suggestive  of  burns  that  the  question  might  be  raised  as  to 
whether  the  burns  were  inflicted  in  life,  or  whether  after  death  for  the 
purpose  of  concealment  of  crime. 

The  researches  of  Christison  and  Taylor,  which  are  practically  in 
agreement,  show  that  the  appearance  which  follows  immediately  upon 
the  application  of  heat  to  the  living  body  is  a  flush  of  redness  around  the 
burned  part,  removable  by  gentle  pressure,  disappearing  in  time,  and 
not  permanent  after  death.  Next  to  this  in  order,  following  almost  im- 
mediately after  the  injury,  is  a  narrow  line  of  deep  redness,  separated  by 
a  line  of  deep  whiteness  passing  into  a  blush,  but  not  capable  of  being 
removed  by  pressure.  This  line  of  redness  may  be  seen  after  the  applica- 
tion of  the  actual  cautery.  The  next  phenomenon  is  the  appearance  of 
blisters,  which  may  generally,  when  the  agent  is  a  scalding  fluid,  appear  in 
a  very  few  minutes,  as  in  young  children,  or  may  be  delayed  for  hours. 

Christison  considers  that  a  line  of  redness  not  removable  by  pressure, 
followed  by  blisters  containing  serum,  is  a  certain  sign  that  the  burn  was 
inflicted  during  life,  while  blisters  containing  only  air  may  be  produced 
by  heat  after  death.  In  bodies  dead  thirty  minutes  he  failed  to  produce 
such  an  effect  by  boiling  water  or  cauterizing-irons.  Dr.  Taylor  arrived 
at  the  same  results  and  same  conclusions,  though  he  warns  us  that  the 
absence  of  these  blisters  does  not  certainly  lead  to  a  conclusion  that 
death  was  not  caused  by  burning. 

Casper,  after  repeated  experiments,  says :  "  It  is  quite  impossible  to 
confound  a  burn  inflicted  during  life  with  one  inflicted  after  death." 
The  vesicles  produced  after  death  are  of  very  small  size,  do  not  contain 
serum,  and  quickly  burst. 

Ogston's  criticisms  on  these  conclusions  are,  that  we  not  only  occa- 
sional!}' fail  to  produce  vesication  by  burning  during  life,  but  sometimes 
even  any  redness  at  all  of  the  burned  part  is  not  perceptible ;  and,  more- 
over, that  vesication  without  redness  on  a  dead  body  would  not  be  suffi- 
cient to  warrant  the  conclusion  that  the  burn  had  occurred  during  life, 
as  such  blisters  may  come  from  other  causes,  as  was  illustrated  in  the 
article  on  putrefaction. 

In  regard  to  the  matter  of  so-called  spontaneous  combustion,  al- 
though its  occurrence  has  been  claimed  by  as  eminent  an  authority  as 
Orfila,  the  possibility  of  such  an  occurrence  is  extremely  doubtful. 


134  -^   SYSTEM  OF  LEGAL  MEDICINE. 


DEATH   BY   ELECTRICITY. 

Death  from  lightning  is  well  known  to  occur  during  thunderstorms 
in  the  summer  time,  and  in  tropical  climates ;  but  now  that  electricity  is 
so  largely  in  use  for  furnishing  power  and  light,  accidental  deaths  from 
this  fluid  are  more  than  ever  common. 

In  some  of  the  States  of  the  Union  this  agent  is  used  for  the  purpose 
of  execution  of  criminals.  The  post-mortem  appearances  in  these  cases 
are  not  particularly  marked.  There  is  usually,  in  death  from  electricity 
when  used  for  mechanical  purposes,  a  charring  and  burning  of  the  parts 
of  the  skin  which  have  come  in  contact  with  the  wires  conveying  the 
fluid.  An  internal  examination  shows  little  beside  a  general  fluid  con- 
dition of  the  blood,  and  death  in  the  majority  of  cases  is  due  to  shock  or 
neuro-paralysis. 

In  a  suburban  town  some  years  ago  I  was  cognizant  of  the  case  of  a 
young  man  who  had  just  been  acquitted  on  a  charge  of  attempt  to  kill, 
and  as  he  was  retiring  for  the  night  and  sitting  on  the  edge  of  the  bedr 
a  bolt  of  lightning  from  a  thunder-cloud  struck  the  house.  Directly 
afterward  the  young  man  was  found  dead.  The  bolt  entered  his  room, 
making  a  small  hole  as  if  from  a  bullet,  directly  above  his  head,  and  the 
only  mark  upon  his  person  was  a  small  purple  spot  on  the  top  of  his  head. 

The  apparent  resemblance  to  the  tree  under  which  the  deceased  had 
been  standing  at  the  time  of  receiving  a  fatal  shock  of  lightning  found 
on  the  body  is  fancied  rather  than  real,  and  is  only  doe  to  the  rapid 
coming  on  of  putrefaction  and  the  showing  of  the  superficial  veins. 

A  case  occurring  in  the  year  1892,  which  was  examined  by  Dr.  Sted- 
man,  has  the  following  history :  This  man  was  an  employee  in  the  power- 
house of  an  electric-light  company.  He  had  occasion  to  leave  his  post 
of  duty  and  walk  across  the  room,  when  his  foot  slipped.  He  grasped 
an  adjacent  wire  to  save  himself ;  the  wire  was  heavily  charged  with  elec- 
tricity, and  the  man  expired  almost  immediately.  The  autopsy  showed 
a  remarkable  fluidity  of  the  blood,  and  slight  charring  of  the  hand  which 
had  grasped  the  wire.  Otherwise  there  was  an  entire  absence  of  any 
pathological  change  to  account  for  the  death. 


DEATH   BY   STARVATION. 

Cases  of  death  from  starvation  are  comparatively  rare  in  this  coun- 
try, aside  from  cases  of  atresia  of  the  oesophagus  and  cases  of  so-called 
"baby  farming,"  where  the  child  is  either  insufficiently  or  improperly 
fed,  and  death  results  either  from  an  absence  of  food  or  from  inability  of 
the  child  to  assimilate  the  food  with  which  it  is  provided. 

In  foreign  countries,  and  in  rare  instances  in  America,  cases  have 
been  reported  where  attempts  at  prolonged  fasting  for  pecuniary  gain 
have  resulted  fatally,  or  where  persons  have  lain  in  apparent  trance,  or 
sleep,  for  such  a  long  period  that  death  has  sometimes  resulted.  The 
cases  of  prolonged  fasting  where  there  has  been  no  apparent  diminution 
in  the  weight  of  the  body  are  always  tainted  with  suspicion,  and  the 
imposture  has  often  been  exposed. 

In  cases  where  death  has  occurred  from  starvation  the  post-mortem 


PLATE  IV. 


'~1'Z7''--.  :'i;V^r*'?' 


■'  testeaass 


ARBORESCENT  MARKING  PRODUCED  BY  LIGHTNING  STROKE. 

(mackay.) 


DEATH  IN  ITS  MEDICO-LEGAL  ASPECTS.  13J 

examination  should  show  a  great  diminution  in  weight,  a  dryness  and 
shriveled  condition  of  the  skin,  and  the  absence  of  fatty  tissue  in  gen- 
eral. Especially  the  entire  absence  of  omental  fat.  The  separation  of 
the  skin  from  the  muscles  is  attended  with  difficulty.  The  muscles  them- 
selves are  much  wasted,  the  stomach  and  intestines  are  generally  found 
collapsed,  contracted,  and  empty,  and  their  mucous  membrane  is  thin  and 
almost  transparent.  According  to  Dr.  Martin,  the  intestines  in  some  cases 
are  not  only  contracted,  but  shrunken  in  length  as  well  as  caliber,  and 
appear  like  a  mere  cord,  as  if  the  canal  were  obliterated.  The  solid 
viscera  are  small,  shrunken,  and  anaemic.  The  large  blood-vessels  are 
comparatively  empty.  The  gall-bladder  is  generally  full  and  there  is 
a  cadaveric  exudation  of  bile ;  the  urinary  bladder,  on  the  contrary,  is 
generally  empty. 

As  minor  signs  may  be  noted  the  sunken  appearance  of  the  face,  the 
fades  hippocratica,  the  open,  staring  eyes,  generally  with  dilated  pupils, 
the  conjunctivae  sometimes  red.  The  mouth,  anus,  and  other  outlets  are 
red  and  inflamed-looking.  Such  faeces  as  are  contained  in  the  intestines 
are  hard  like  bullets,  and  of  dark  color.  Dr.  Woodman  has  found  the 
thymus  gland  unusually  large  and  persistent  in  infants  who  have  been 
badly  fed.  (Tidy,  Joe.  tit.)  This  author  cites  a  number  of  illustrative  cases, 
which  are  of  interest  as  showing  how  long  life  can  be  prolonged  without 
food. 

One  is  a  case  of  a  prisoner  at  Toulouse,  who  voluntarily  starved  him- 
self to  death.  He  lingered  till  the  fifty-eighth  day,  he,  however,  did 
drink  water  and  urine,  and  died  after  struggling  hours  in  convulsions. 
The  autopsy  revealed  unusual  pallor  of  the  brain,  natural  lungs,  contrac- 
tion of  the  oesophagus,  but  not  of  the  stomach,  which  contained  a  little 
fluid ;  reddening  and  softening  and  injection  of  the  lower  portions  of 
the  small  intestines,  distention  of  the  gall-bladder  with  thick,  black  bile, 
and  attenuation  of  the  muscles. 

In  the  case  of  Sarah  Jacob,  the  "  Welsh  fasting  girl,"  who  died  after 
a  total  abstinence  from  food  for  at  least  seven  days,  and  who  was  be- 
lieved to  have  been  an  impostor  at  the  outset  of  her  apparent  fasting, 
but  who  continued  the  deception  for  the  purpose  of  making  money  until 
death  ensued  from  her  being  unable  as  formerly  to  obtain  food  surrep- 
titiously, the  post-mortem  appearances  were  not  so  marked.  They  were 
these:  the  body  was  plump  and  well  formed,  with  signs  of  incipient 
puberty.  There  was  a  layer  of  fat  three  fourths  of  an  inch  in  thickness 
on  the  average  beneath  the  skin  of  the  chest  and  abdomen.  The  brain 
was  healthy  and  firm,  but  the  membranes  were  much  injected.  The 
thoracic  viscera  were  healthy,  but  contained  little  blood.  The  stomach 
contained  about  three  teaspoonfuls  of  dark  gelatinous  fluid  having  slight 
acid  reaction.  The  small  intestines  were  empty,  but  the  colon  and  rec- 
tum contained  about  half  a  pound  of  faeces  in  a  hard  state.  The  gall- 
bladder was  distended  and  the  urinary  bladder  was  empty,  and  there 
was  nothing  else  unusual  noted. 

In  the  cases  of  death  from  baby  farming  which  I  have  seen,  the 
appearances  have  corresponded  very  closely  with  the  general  signs  as 
described  by  Tidy:  great  emaciation,  absence  of  fatty  tissue,  fullness 
of  the  gall-bladder,  and  emptiness  and  contraction  of  the  aJimentary 
canal.  The  eyes  were  also  sunken,  open,  and  staring,  though  the  condi- 
tion of  the  pupils  has  been  variable. 


BLOOD  AND  OTHER   STAINS. 

BY 

JAMES  F.  BABCOCK. 


In  many  trials  for  homicide,  especially  in  cases  where  the  evidence  is 
circumstantial,  questions  arise  concerning;  spots  or  stains  found  upon 
clothing,  weapons,  furniture,  carpets,  walls,  or  other  objects,  and  the 
scientific  witness  is  expected  to  answer  whether  or  not  the  stains  are  of 
blood  or  some  other  substance.  If  blood,  are  the  stains  old  or  com- 
paratively recent?  What  was  their  origin?  Are  they  human,  or  from 
some  domestic  animal?  Are  they  stains  of  venous,  arterial,  or  men- 
strual blood?  Was  the  blood  from  a  living  or  a  dead  body?  Male  or 
female  ?     Adult  or  child  ? 

To  some  of  these  questions  answers  may  be  given  which  are  perfectly 
definite  and  reliable,  but  as  to  others  it  cau  only  be  replied  that  our  pres- 
ent knowledge  furnishes  insufficient  data  for  any  certain  conclusions. 

In  giving  the  results  on  these  matters  to  which  science  leads  us,  we 
shall  first  briefly  state  the  various  physical  and  chemical  properties  of 
blood  as  it  is  found  in  man  and  animals,  and  then  fully  explain  the  appli- 
cation of  these  facts  to  the  practical  operations  necessary  for  the  solu- 
tion, so  far  as  possible,  of  the  different  questions  we  have  stated. 

CHEMICAL  AND  PHYSICAL  PROPERTIES  OF  BLOOD. 

Fresh  blood  is  an  opaque  and  somewhat  viscous  fluid  slightly  heavier 
than  water.  Its  specific  gravity,  on  the  average,  is  in'normal  blood  1.055, 
but  it  is  slightly  less  in  women  and  children.  In  the  higher  animals  the 
gravity  is  substantially  the  same  as  in  man. 

The  color  of  blood  varies  from  a  bright  scarlet  to  a  deep  purple,  ac- 
cording as  it  flows  from  an  artery  or  a  vein.  In  very  thin  films  as 
observed  in  the  microscope,  it  is  transparent  and  nearly  colorless.  The 
variations  in  color  of  venous  and  arterial  blood  are  due  to  the  degree  of 
oxidation  of  the  coloring  matter,  called  haemoglobin  ;  hence,  venous  blood 
on  exposure  to  the  ah*  becomes  brighter,  and  arterial  blood  in  certain 
diseases  dependent  upon  a  reduction  in  the  supply  of  oxygen  (asphyxia, 
etc.)  is  dark.  On  leaving  the  body  the  blood  becomes  gelatinous  (coagu- 
lation), the  change  taking  place  in  from  three  to  fifteen  minutes.  Grad- 
ually, certain  portions  (coagulum)  shrink  in  volume,  and  after  a  period 
of  from  twelve  to  forty  hours  there  is  a  complete  separation  into  thick 
red  clots  and  a  yellowish  watery  fluid  (serum).     The  coagulation  of  the 

139 


140  A   SYSTEM    OF  LEGAL   MEDICINE. 

blood  may  be  hastened  or  retarded  by  a  variety  of  circumstances.  Mod- 
erate warmth  accelerates,  while  cold  retards  coagulation.  Access  of  air 
promotes  coagulation,  hence  1)1  ood  in  thin  layers  thickens  more  rapidly 
than  when  it  exposes  a  more  limited  surface.  Coagulation  takes  place 
more  readily  when  the  blood  flows  upon  rough  surfaces ;  on  cloth  blood 
becomes  clotted  quicker  than  upon  a  smooth  marble  floor  or  polished 
furniture. 

Chemical  Composition  of  Blood. — 1000  parts  of  blood  contain,  on 
the  average,  795  parts  of  water  and  205  parts  of  solids.  The  solids  consist 
of  albumen,  fibrin,  coloring  matter  containing  iron,  called  haemoglobin, 
rhob'sterin,  and  fatty  bodies,  various  salts  and  extractive  matters.  The 
salts  contain  chlorin,  sulphuric,  phosphoric,  lactic,  oleic,  stearic,  uric,  and 
hippuric  acids,  combined  with  potassium,  sodium,  calcium,  and  magne- 
sium. The  extractive  matters  contain  small  amounts  of  sugar,  leucin, 
tyrosin,  xanthin,  creatin,  and  other  substances.  When  examined  by 
the  microscope,  blood  is  seen  to  consist  of  a  colorless  fluid  (liquor  sangui- 
nis) in  which  are  suspended  large  numbers  of  cell-like  bodies  called  blood- 
corpuscles. 

One  thousand  parts  of  the  liquor  sanguinis  and  of  the  blood-cor- 
puscles contain : 

Blood-Corptiscles.  Liquor  Sanguinis. 

Water 688.00  parts.       Water 902.90  parts. 

Solid  constituents 312.00     "  Solid  constituents  ....     97.10     " 


1000 .  00  parts.  1000 .  00  parts. 

The  solid  constituents  of  each  of  these  portions  consist  of : 

Haemoglobin 298 .  97  parts.       Albumen 78 .  84  parts. 

Fat 

Extractive  matters. . 
Mineral  salts 


2.31     " 

Fibrin 

4.05     " 

2.60     " 
8.12     " 

Extractive  matters . . . 
Mineral  salts 

3.94     " 
8.55     " 

Fat 

1.72     " 

312.00  parts. 

97.10  parts. 

The  blood-corpuscles  in  their  moist  condition  constitute  about  fifty 
percent.  (47.2  to  54.2)  of  the  total  weight  of  the  blood,  and  have  a  spe- 
cific gravity  of  1.088.  The  specific  gravity  of  the  liquor  sanguinis  is 
1.028. 

Of  the  various  bodies  entering  into  the  composition  of  blood,  there 
are  only  two  which  are  of  interest  or  importance  to  the  medical  jurist 
in  his  study  of  blood  and  blood-stains — luemoglobin,  which  contains  the 
coloring  matter,  and  the  blood-corpuscles.  The  chemical  and  spectroscopic 
phenomena  produced  by  haemoglobin  afford  positive  evidence  of  the  pres- 
ence of  blood,  from  whatever  source  it  may  have  been  derived ;  and  the 
microscope,  aided  by  the  micrometric  measurement  of  the  diameters  of 
the  blood-corpuscles,  gives  all  that  may  be  determined  concerning  the 
origin  of  the  blood,  and  whether  it  be  human  or  otherwise. 

Haemoglobin. — The  coloring  matter  of  blood,  now  generally  called 
hcemoglobin,  was  first  described  by  Le  Canu  under  the  name  of  haematin. 
(Nouvelles  Etudes  Chimiques  sur  U  Sang,  Paris,  1852.)  Stokes  called  it 
cmorin,  and  showed  that  it  was  capable  of  existing  in  two  forms  or  states 


BLOOD  AND  OTHER   STAINS.  141 

of  oxidation.  Scarlet  crnorin  was  the  name  given  to  the  product  found 
in  arterial  blood,  and  purple  crnorin  to  that  found  in  venous  blood. 
(Stokes,  Proc.  Roy.  Soc,  1864,  p.  355.)  Sorby  described  an  intermediate 
body  under  the  name  of  brown  cruorin.  (Sorby,  Monthly  Micros.  Jour., 
London,  vol.  vi.,  p.  9.)  Thudicum  and  Kingzett  adopted  the  name  hcem- 
ato-crystallin.     (Jour.  Cliem.  Soc,  London,  September,  1876.) 

When  blood  defibrinated  by  whipping  is  mixed  with  a  3i-percent. 
solution  of  common  salt,  the  corpuscles  are  gradually  deposited,  and  the 
supernatant  liquor  may  be  decanted.  On  washing  the  deposit  with  a 
fresh  portion  of  the  salt  solution  the  corpuscles  are  obtained  free  from 
serum.  They  consist  of  a  stroma  or  colorless  skeleton  containing  haemo- 
globin, a  little  cholesterin,  paraglobulin,  fatty  matters,  and  mineral  salts. 
If  the  washed  corpuscles  are  shaken  with  water  and  ether,  the  stroma, 
cholesterin,  and  fatty  matters  are  taken  up  by  the  ether,  while  the  color- 
ing matter  of  the  blood  passes  into  solution  in  the  water.  On  exposure 
to  a  low  temperature  a  deposit  of  crystals  is  formed.  They  consist  of 
haemoglobin.  One  half  its  volume  of  alcohol  may  be  added  to  the  aque- 
ous solution  to  promote  crystallization.  Haemoglobin  thus  obtained  con- 
sists of  several  proximate  principles :  an  albuminous  substance,  which, 
when  separated,  is  amorphous  and  colorless,  and  a  crystalline  body,  called 
hcematin,  having  a  formula  C3oH32FeN406.  (Kingzett.)  Haemoglobin 
is  perfectly  and  freely  soluble  in  water  and  dilute  alcohol.  By  the  action 
of  acids  or  alkalies,  or  of  any  reagent  capable  of  coagulating  albumen,  it 
is  separated  into  haematin  and  the  albuminous  body  above  mentioned. 
The  same  change  is  produced  by  long  exposure  to  the  air,  or  by  a  shorter 
exposure  to  air  containing  considerable  moisture  or  impurities  such  as 
are  found  in  the  atmosphere  of  cities.  Exposure  for  a  shorter  period 
produces  a  brown  substance  intermediate  between  haemoglobin  and  haem- 
atin, called  met-hcemoglohin. 

Haematin. — Haematin  is  insoluble  in  water  and  ether,  but  is  very 
slightly  soluble  in  alcohol.  It  readily  dissolves  in  ammonia  water  and 
in  solutions  of  sodium  and  potassium  hydrate.  It  is  soluble  in  dilute 
acids,  and  especially  in  dilute  citric  acid.  It  is  a  very  stable  body,  and 
when  once  formed  may  remain  unchanged  for  years.  If  haematin  or 
dried  blood  is  heated  with  glacial  acetic  acid  and  a  small  amount  of  com- 
mon salt,  and  the  solution  evaporated,  a  new  combination  is  produced. 
It  is  generally  considered  to  be  haematin  hydrochloride,  but  was  named 
hcemin  by  Teichmann,  its  discoverer,  and  it  is  by  this  name  that  it  is 
generally  called.  It  crystallizes  readily  from  its  solution  in  hot  acetic 
acid.  Haemin  crystals  are  insoluble  in  water,  alcohol,  ether,  and  dilute 
acids,  but  are  sparingly  soluble  in  ammonia  water,  and  freely  soluble  in 
solution  of  sodium  or  potassium  hydrate. 

Recapitulation. — Fresh  and  unaltered  blood  yields  crystals  of  haemo- 
globin. 

Oxidized  blood  or  dried  blood  contains  hcematin. 

Dried  blood  or  blood  treated  with  glacial  acetic  acid  and  salt  yields 
haemin. 

Fresh  blood-stains  are  bright  scarlet,  and  yield  their  coloring  matter  very 
readily  to  cold  water.  Hot  water  renders  the  stain  more  or  less  insoluble, 
on  account  of  the  coagulation  of  the  albumen,  while  soap  and  water  have 
a  tendency  to  fix  the  color,  from  the  conversion,  in  consequence  of  the 
presence  of  the  alkali,  of  haemoglobin  into  haematin. 


142  A    SYSTEM    OF  LEGAL    MEDICINE. 

Less  recent  stains  are  reddish  brown  or  darl-  brown  in  color.  They  con- 
tain m«  t-ha  mogloMn.  They  yield  but  little  of  their  coloring  matter  to  water, 
whih  very  old  stains  yield  no  coloring.  Such  stains  are  soluble  in  dilute 
citric  acid,  and  give  up  their  coloring  to  ammonia  water. 

Optical  Properties  of  Blood=Coloring  Matter. — When  a  solution  of 
the  coloring  matter  of  blood  is  examined  by  the  spectroscope,  certain 
dark  spaces  called  absorption-hands  are  observed.  These  bands  in  num- 
ber and  position  vary  according  to  the  degree  of  oxidation  of  the  blood- 
coloring  matter  or  the  presence  of  reagents.  The  study  of  the  absorption- 
bands  under  different  conditions  has  led  to  the  discovery  of  a  method 
(spectrum  analysis)  which  may  be  relied  upon  with  absolute  certainty 
for  the  identification  of  blood  and  for  distinguishing  it  from  all  other 
substances.  A  brief  description  of  the  principles  involved  in  this  method 
and  the  apparatus  employed  for  the  purpose  is  here  given. 

Spectrum  Analysis  and  the  Spectroscope. — When  a  beam  of  light 
is  passed  through  a  narrow  slit  of  1-100  to  1-1000  of  an  inch  in  width,  and 
then  through  a  prism  and  allowed  to  fall  upon  a  white  screen,  an  elongated 
colored  image  is  produced  containing  all  the  brilliant  hues  of  the  rainbow. 

If  the  light  be  passed  through  several  prisms  no  additional  colors  are 
produced,  but  the  image  is  lengthened  and  the  colors  more  widely  sep- 
arated. This  image  is  called  the  spectrum.  If  it  be  observed  through  a 
magnifying-lens  or  a  small  telescope,  it  is  found  to  be  crossed  at  right 
angles  by  numerous  dark  lines.  These  lines  were  first  carefully  observed 
by  Fraunhofer  in  1815,  and  have  since  been  called  Fraurihofer's  lines. 
This  observer  found  that  the  lines  always  kept  their  position,  provided 
the  same  prism  and  lenses  were  employed,  and  he  made  a  map  or  chart 
of  them.  He  selected  eight  of  those  which  appeared  wider  than  the 
others,  and  named  them  by  the  letters  of  the  alphabet  from  A  to  H. 
These  lines  have  been  adopted  as  standards  of  comparison  for  denoting 
the  position  of  any  set  of  colored  rays  which  may  be  submitted  to  exam- 
ination. Lines  A  and  B  are  in  the  red  portion  of  the  spectrum ;  C,  in 
the  red,  near  the  orange ;  D,  between  the  yellow  and  the  orange ;  E,  in 
the  green ;  F,  on  the  borders  of  the  green  and  blue  ;  CI,  in  the  dark  blue  ; 
and  H,  at  the  extreme  end  of  the  violet.  Kirchoff  in  1859  proved  that 
Fraunhofer's  lines  were  due  to  the  presence  of  certain  gases  in  the  solar 
atmosphere  which  have  the  power  of  absorbing  the  same  rays  of  light  as 
those  emitted  by  the  heated  body  producing  them.  Later  it  was  found 
that  various  colored  solutions  had  a  similar  property,  so  that  light  passed 
through  them  produces  a  spectrum  crossed  by  dark  bands  (absorption- 
bands),  which  vary  in  position  and  intensity  according  to  the  nature  of 
the  substance  or  its  strength  of  solution.  An  instrument  adapted  to  the 
examination  and  study  of  the  spectrum  or  its  absorption-bands  is  called 
a  spectroscope.  The  ordinary  form  of  instrument  such  as  is  used  in  lab- 
oratories for  the  analysis  of  colored  flames  is  not  adapted  to  the  exami- 
nation of  the  absorption-bands  of  blood,  although  it  may  be  used  in  the 
absence  of  one  specially  designed  for  this  purpose,  called  the  microspec- 
troscope,  and  sometimes  described  as  the  spectruin-)nicroscop)e.  It  consists 
of  a  series  of  prisms  so  arranged  that  they  may  be  attached  to  the  micro- 
scope either  above  the  eye-piece  or  in  the  ordinary  position  of  the  object- 
glass.  The  best  forms  are  provided  with  a  scale,  which  enables  the  exact 
position  of  the  bands  to  be  determined,  and  a  supplementary  stage,  by 
which  the  spectrum  of  one  body  may  be  compared  with  another,  the  two 


BLOOD  AND  OTHER   STAINS. 


143 


spectra  being  visible  side  by  side  at.  the  same  time.  Sorby  in  1866  sug- 
gested the  form  of  instrument  generally  used.  Its  essential  features  are 
shown  in  the  accompanying  outline. 

Two  rectangular  prisms  of  flint-glass  are  separated  from  each  other 
by  a  prism  of  crown-glass,  and  two  other  similar  prisms  are  attached 
one  on  each  end  of  the  combination.  These  are  cemented  with  Canada 
balsam.  This  compound  prism  is  mounted  in  a  tube,  F,  having  a  cap 
with  an  elongated  opening  at  A  and  a  circular  stop  at  B.  The  tube  is 
constructed  so  that  it  may  be  slipped  over  the  upper  lens  of  the  eye-piece. 
The  upper  lens,  G,  is  compound  and  achromatic,  and  is  mounted  so  that 
the  focus  may  be  adjusted  by  suitable  rackwork  or  by  turning  the  milled 
head,  H.     At  I  is  a  slit  capable  of  being  adjusted  to  a  wider  or  narrower 


,^.. 


Fig.  9.    The  Microspectroscope. 


Fig.  10.    Zeiss's  Microspectroscope, 


opening,  and  a  right-angled  prism,  C,  is  fixed  half-way  over  it.  By  this 
means  light  passing  through  an  opening  at  E  is  reflected  through  half  of 
the  slit,  while  light  coming  through  the  field-glass  from  the  object  passes 
through  the  other  half.  In  this  way  may  be  seen  side  by  side  the  spec- 
trum of  the  light  passing  from  the  object  under  examination  and  that 
produced  by  the  light  coming  from  the  stage  E,  which  holds  the  stand- 
ard for  comparison.  The  supplementary  stage  has  an  adjustable  slit  by 
which  the  two  spectra  may  be  made  to  appear  of  ecpial  brilliancy.  The 
solution  or  object  to  be  examined  is  placed  upon  the  stage  of  the  miscro- 
scope  and  strongly  illuminated  by  the  mirror ;  the  standard  for  compari- 
son is  contained  in  a  sealed  tube  held  by  springs  on  the  stage  E. 

Fig.  10  represents  the  spectroscopic  eye-piece  made  by  Zeiss.     In  this 


144 


A   SYSTEM  OF  LEGAL  MEDICINE. 


instrument  the  tube  containing-  the  prisms  may  be  turned  to  one  side 
while  the  object  is  being  adjusted  upon  the  stage.  It  has  also  a  scale, 
an  image  of  which  is  projected  upon  the  field  of  the  spectrum.  It  has 
the  disadvantage  of  being  unprovided  with  the  supplementary  stage  for 
the  comparison  of  spectra.  Messrs.  R,  and  J.  Beck  of  London  construct 
a  microspectroscope  which  is  attached  below  the  eye-piece  in  the  position 
of  the  object-glass.  This  form  has  been  highly  recommended  as  being- 
more  simple  in  its  arrangement  and  more  easily  manipulated,  particularly 
in  cases  where  two  similar  spectra  are  to  be  compared. 

For  the  examination  of  liquids,  glass  cells  like  thoseshowniiiFig.il 
may  be  employed.  The  form,  A,  is  made  from  thick  tubing  like  that 
used  for  barometers.  About  one-half  inch  in  length  is  cut  off,  the  ends 
ground  to  a  square  surface,  and  the  tube  cemented  to  an  ordinary  glass 
slide  with  Canada  balsam.     Tubes  of  varying  lengths  are  convenient  for 

giving  greater  or  less  depth  of  liquid 
according  to  its  intensity  of  color. 
Sorby  recommends  wedge-shaped 
cells  like  B.  In  these  cells  the  thick- 
ness of  the  solution  may  be  about 
one-fourth  inch  on  one  side  and  one- 
fortieth  on  the  other.  The  effect  of 
varying  thickness  of  the  solution  is 
then  readily  observed.  The  cells 
should  have  a  thin  cover  placed  over 
them,  and  be  completely  filled  with 
the  fluid  under  examination.  The 
cover  readily  adheres  by  capillary  at- 
traction. A  reduction  of  the  amount 
of  light  transmitted  through  the  slit 
is  equivalent  to  an  increase  in  thick- 
ness of  the  fluid,  so  that  by  varying  the  width  of  the  opening  in  the  stage 
attached  to  the  eye-piece  the  spectrum  is  modified  as  much  as  if  a  change 
were  made  in  the  depth  of  liquid.  Various  methods  have  been  devised 
for  measuring  the  exact  place  of  the  absorption-bands.  This  is  some- 
times useful,  but  it  is  advisable  in  the  examination  of  blood-stains  to 
compare  the  spectrum  of  the  suspected  stain  with  that  produced  by 
specimens  of  known  origin,  rather  than  rely  upon  the  position  of  the 
bands  with  reference  to  the  projected  scale,  since  this  is  liable  to  varia- 
tion by  various  adjustments  of  the  instrument. 

Spectroscopic  Appearance  of  Haemoglobin  and  its  Derivatives. — 
When  a  concentrated  solution  of  haemoglobin  is  examined  by  the  spec- 
troscope, all  light  is  excluded  except  the  red.  On  diluting  the  solution 
with  water,  green  and  blue  light  passes,  while  in  the  yellow  and  the  be- 
ginning of  the  green  portion  of  the  spectrum  a  dark  space  makes  its 
appearance.  Still  further  dilution  effects  the  resolution  of  this  dark 
space  into  two  absorption-bands  near  the  lines  D  and  E  of  the  spectrum : 
the  one  nearest  D  is  narrower,  darker,  and  better  defined  than  the  other. 
The  band  at  E  has  more  than  double  the  width  of  the  other,  and  is  some- 
what weaker.  These  bands,  called  oxy-hcemoglobin  bands,  were  discovered 
by  Hoppe-Seyler  in  1862.  A  proper  dilution  is  one  part  of  defibrinated 
blood  in  eighty  parts  of  water  viewed  through  a  depth  of  one-half  inch. 
(PL  V.,  No.  1.    Absorption-bands  of  oxy-hcemoglobin.) 


Fig.  11.  Cells  for  the  Microspectroscope. 


Plate    V. 


J.  F  B.Del. 


OXYHEMOGLOBIN. 


REDUCED 
HEMOGLOBIN. 


ACID  H/EMATIN 


BLOOD 
AFTER  EXPOSURE. 


BLOOD   AFTER 
LONGER    EXPOSURE. 


REDUCED  H/EMATIN, 


AMMONIATED 
CARMINE. 


GAST  LITH.CO.N.Y. 


ABSORPTION  SPECTRA. 


BLOOD  AXD  OTHER   STAINS.  147 

If  to  the  solution  of  blood-coloring  matter  used  in  the  last  experi- 
ment there  be  added  a  drop  or  two  of  solution  of  ferrous  ammonium  sul- 
phate (double  sulphate  of  iron  and  ammonia),  or  a  solution  of  ferrous 
sulphate  mixed  with  a  small  amount  of  potassio-sodic  tartrate  (Ro- 
chelle  salt),  and  then  a  very  little  ammonia  water,  the  haemoglobin  is 
altered  chemically  (deoxidized),  and  is  called  reduced  haemoglobin.  An 
examination  of  the  spectrum  of  this  new  product  shows  but  one  broad 
band  in  the  place  of  the  former  two.  This  band  was  discovered  by 
Stokes  in  1864,  and  is  called  the  reduction-band  of  haemoglobin.  It  is  also 
sometimes  referred  to  as  Stokes'  band.  {PI.  V.,No.2.  Absorption-band  of 
reduced  haemoglobin.)  Agitation  with  air  causes  the  two  bands  to  reap- 
pear. The  spectrum  showing  two  bands  is  characteristic  of  arterial  or 
oxidized  blood,  and  the  single-banded  spectrum  is  peculiar  to  venous  or 
deoxidized  blood. 

A  solution  of  haematin  in  a  little  alcohol  to  which  a  small  crystal  of 
tartaric  acid  has  been  added  shows  a  very  broad  band  in  the  red  (C), 
another  in  the  green  between  D  and  E,  and  by  very  careful  management 
of  the  light  a  third  very  faint  band  in  the  blue  between  E  and  F.  If 
the  solution  be  made  strongly  alkaline  with  ammonia  the  band  at  C  dis- 
appears. The  subsequent  neutralization  of  the  ammonia  by  acid  does 
not  restore  it.  These  bands  are  called  the  acid  and  alkaline  bands  of 
haematin.  They  vary  somewhat  in  number  and  position,  according  to 
the  kind  and  quantity  of  acid  used.  (PI.  V.,  Ao.  3.  The  acid  band  of 
haematin.) 

A  solution  of  the  coloring  matter  of  blood  obtained  from  a  stain 
which  has  been  but  a  short  time  exposed  to  the  air  shows  the  two  bands 
of  haemoglobin,  but  they  are  weaker  than  is  the  case  with  fresh  blood. 
There  is  also  a  third  band  in  the  red,  near  the  line  C.  {PI.  V.}  No.  4. 
Absorption-bands  of  solution  of  blood-coloring  having  but  a  short  exposure  to 
the  air.) 

With  a  solution  from  blood  which  has  been  long  exposed  to  the  air 
the  band  in  the  red  (C)  is  wider  and  darker,  while  the  others  are  much 
weaker.  {PI.  V.,  Ab.  5.  Absorption-bands  of  blood  solution  after  long  ex- 
posure.) The  addition  of  ammonia  to  such  a  solution  causes  the  band  in 
the  red  to  disappear,  but  it  causes  the  bands  in  the  green  to  become  much 
more  distinct. 

The  effect  of  reducing  agents  added  to  a  solution  of  blood  obtained 
from  a  stain  after  prolonged  exposure  is  shown  in  PI.  V.,  No.  6.  The 
two  bands  are  much  darker,  and  perfectly  well  denned.  They  closely 
resemble  the  bands  of  haemoglobin,  but  are  a  little  farther  to  the  right. 
In  very  dilute  solutions  the  band  at  the  right  may  fail  to  make  its  ap- 
pearance. 

(Sorby,  Monthly  Microscopic  Journal,  London,  vol.  vi.,  p.  9.) 

(Suffolk,  Spectrum  Analysis  Applied  to  Microscopical  Observation,  Lon- 
don, 1873.) 

(Preyer,  Die  Blutkrystalle,  Jena,  1871.) 

(Thudicum,  Chemical  Physiology,  New  York,  1872.) 

(Rosenberg,  The  Use  of  the  Spectroscope,  New  York,  1876.) 

Crystalline  Bodies  obtained  from  Blood=Coloring  Matter. — From 
fresh  blood  crystals  of  haemoglobin  (oxy-haemoglobin)  may  be  obtained 
which  show  some  differences  in  crystalline  form,  according  to  the  source 
whence  they  are  derived.     Blood-crystals  were  first  observed  by  Funke 


148 


A   SYSTEM  OF  LEGAL   MEDICINE. 


in  1851.  {Zeitschrift  fur  rat.  Med.,  vol.  i.,  p.  148.)  They  may  be  pro- 
duced from  blood  by  mixing  it  with  about  one  sixteenth  its  volume  of 
ether  and  shaking  the  mixture  until  the  liquid  becomes  a  clear  lake 
color.  Sometimes  the  crystals  form  in  a  few  minutes,  and  sometimes 
several  days  are  required  to  develop  them.  A  single  drop  of  blood 
should  be  'mixed  with  a  very  little  ether  and  covered  with  a  thin  glass. 
Crystals  are  obtained  less  readily  from  the  blood  of  the  ox,  pig,  pigeon, 
and  frog  than  from  the  blood  of  man,  mouse,  rabbit,  and  sheep ;  they  are 
easily  obtained  from  the  bk>od  of  the  dog,  rat,  squirrel,  and  guinea-pig. 
In  the  majority  of  animals  the  crystals  are  in  the  form  of  prisms  belong- 
ing to  the  rhombic  system ;  in  the  guinea-pig  they  are  rhombic-tetrahedra, 
and  in  the  squirrel  they  are  hexagonal.  They  have  a  light-red  color 
when  observed  with  a  microscope  of  low  power,  and  appear  of  greater 
or  less  intensity  of  color  according  to  their  thickness,  varying  from 
purplish  red  to  a  peach-blossom.  The  tetrahedral  crystals  are  much 
more  soluble  than  those  which  assume  the  prismatic  form,  while  the 
solubility  of  the  hexagonal  plates  is  somewhat  greater  than  that  of  the 
prisms,  but  less  than  is  the  case  with  the  tetrahedra.      The  general 


Crystals  from  Man  and  most  of  the  Carnivora. 


^ 


* 


«       <*>  .  tk      > 

4-*" 


r4 


A 


4 

Crystals  from  the  Squirrel.  Crystals  from  the  Mouse 

Fig.  13.    Haemoglobin  Crystals. 


P 


appearance  of  these  crystals  is  shown  (after  Funke)  in  Fig.  12.  {Atlas  de 
PJiysiolog.  Chemie,  Leipzig,  1853,  Tl.  x.)  Crystals  can  be  obtained  only 
from  fresh  blood,  or  a  moist  clot  not  more  than  a  day  or  two  old.  They 
are  not  characteristic  of  the  blood  of  any  particular  genus,  since  all  of 
the  forms  have  been  found  in^the  blood  of  several  different  animals. 


BLOOD  AND  OTHER  STAINS.  149 

As  already  stated,  haemoglobin  by  exposure  to  air  or  by  the  action  of 
reagents  is  changed  into  haematin.  Haematin,  being  insoluble  in  water, 
yields  crystals  only  from  its  solution  in  acid.  Teichmann  in  1853  found 
by  treating  dried  blood  with  strong  acetic  acid  in  presence  of  common 
salt  that  small  crystals  entirely  different  from  haemoglobin  were  pro- 
duced. They  have  been  found  to  be  haematin  hydrochloride,  and  are 
commonly  called  luemin,  and  sometimes  Teichmann's  crystals.  (Zeitschrift 
fur  rat.  Med.,  Zurich,  vol.  iii.,  p.  375.)  Most  minute  traces  of  blood  will 
yield  these  crystals,  and  all  authorities  agree  that  they  can  be  produced 
from  no  other  substance.  They  assume  the  form  of  slender  prisms  with 
irregular  rhombic  terminations.  They  are  frequently  found  in  stellate 
groups  and  in  the  form  of  an  X.  They  vary  considerably  in  size,  ac- 
cording to  the  strength  of  the  solution,  and  are  identical  in  composition 
and  crystalline  form  in  all  of  the  different  kinds  of  blood  which  have 
been  examined.  Haemin  crystals  are  obtained  by  heating  a  drop  of 
fresh  or  a  small  particle  of  dried  blood  with  a  trace  of  salt  and  glacial 
acetic  acid.  The  materials  are  placed  in  the  center  of  a  microscope-slide 
and  heated  until  by  the  evaporation  of  the  acid  the  liquid  begins  to 
solidify.  In  some  cases  the  microscope  shows  transparent  cubical  crys- 
tals mixed  with  the  crystals  of  haemin.  These  are  due  to  the  use  of  an 
excess  of  salt,  but  the  two  kinds  of  crystals  are  readily  distinguished  by 
their  difference  in  form,  color,  and  solubility. 

(Halliburton,  Text-book  of  Chemical  Physiology,  Londou,  1891.) 

(Gamgee,  Physiological  Chemistry.) 

The  Action  of  Chemical  Agents  upon  Blood. —  Water. — Fresh  blood 
mixes  freely  with  cold  water,  and  forms  a  bright-red  solution.  The 
color,  as  already  stated,  is  due  to  haemoglobin.  By  continued  exposure 
this  body  becomes  less  and  less  soluble,  owing  to  the  production  of 
met-hasinoglobin,  and  finally,  when  converted  into  haematin,  the  blood- 
coloring  matter  is  quite  insoluble  in  water.  The  action  of  water  upon 
blood-stains  is  therefore  variable  according  to  the  age  of  the  stain. 
Comparatively  recent  stains  are  soluble,  older  ones  less  so,  and  very  old 
stains  may  be  wholly  insoluble.  Sometimes  the  latter  may  be  soaked  in 
water  for  weeks  without  the  liquid  becoming  in  the  least  degree  colored. 

Ammonia  and  the  Alkalies. — Ammonia  added  to  a  solution  of  blood, 
if  in  small  amount,  has  no  effect  upon  the  color  except  to  make  it  a  little 
brighter  and  clearer.  If  a  larger  quantity  or  a  very  strong  solution  be 
employed,  the  red  color  becomes  brown.  Solutions  of  caustic  potassa  or 
soda  produce  a  dirty  .green  color  with  stains  on  linen.  Old  stains  upon 
cloth  or  portions  of  dried  blood  are  dissolved  by  dilute  ammonia  water 
on  soaking,  and  especially  hy  the  aid  of  a  gentle  heat.  Solutions  of 
potassa  or  soda  acting  upon  stains  give  them  a  darker  color  before  they 
are  fully  dissolved. 

Effect  of  Heat. — A  solution  of  blood  is  coagulated  by  boiling.  On 
continuing  the  heat,  a  more  or  less  voluminous  precipitate,  according  to 
the  strength  of  the  solution,  makes  its  appearance.  The  precipitate  is 
reddish  brown  in  color,  and  consists  of  albumen  rendered  insoluble  by 
the  heat,  combined  with  the  coloring  matter  of  the  blood.  The  precipi- 
tate is  readily  soluble  in  ammonia  water. 

Bleaching  Agents. — Chlorin  water,  solution  of  sulphurous  acid,  and 
solution  of  sodium  hypochlorite  (the  so-called  chloride  of  soda)  have  but 
little  effect  upon  the  color  of  blood  unless  the  solutions  are  concentrated 


150  A   SYSTEM  OF  LEGAL  MEDICINE. 

or  heated  with  the  blood.  Acids  of  all  kinds  coagulate  the  albumen  of 
blood,  which,  on  precipitation,  carries  down  the  coloring  matter. 

Tincture  of  Galls. — A  tincture  of  galls  or  an  alcoholic  solution  of 
gallic  acid  produces  a  reddish  precipitate,  containing  the  albumen  and 
coloring  matter. 

The  reactions  of  ammonia,  bleaching  agents,  and  of  tincture  of  galls 
are  peculiar  to  blood.  All  other  soluble  red  colors  are  differently 
affected.  They  are  changed  to  a  green,  blue,  purple,  and  in  some  cases 
a  crimson  color  by  dilute  ammonia.  Vegetable  colors  are  readily 
bleached,  and  certain  compounds  of  iron  which  are  reddish  brown  in 
color  are  changed  by  the  tincture  of  galls  to  a  bluish  black  or  a  bluish 
green. 

Alcohol,  Ether ,  Chloroform,  etc. — Dried  blood  is  insoluble  in  strong 
alcohol,  ether,  petroleum  benzin,  or  chloroform.  The  coloring  matter 
of  dried  blood  is  soluble  in  nearly  all  of  the  acids. 

Tincture  of  Guaiacum. — When  a  small  quantity  of  a  freshly  made 
solution  of  guaiacum  resin  in  alcohol  is  added  to  blood  either  in  a  pure 
state  or  mixed  with  a  large  amount  of  water,  there  is  a  precipitation  of 
the  resin  which  renders  the  liquid  milky  white.  If  now  a  few  drops  of 
hydrogen  peroxide  be  added,  there  is  at  once  produced  a  beautiful  sap- 
phire-blue coloration  of  the  liquid.  Particles  of  dried  blood  or  stains 
upon  cloth  give  the  same  reaction. 

The  BIood=Corpuscles. — When  a  very  thin  film  of  fresh  blood  is  ex- 
amined by  the  microscope  under  a  power  of  two  hundred  diameters,  it 
is  seen  to  consist  of  a  clear  and  nearly  colorless  fluid,  in  which  are  sus- 
pended an  innumerable  number  of  isolated  cells  having  a  reddish-yellow 
tint,  called  blood-corpuscles.  Seen  flatwise  they  appear  as  disks,  while 
edgewise  they  show  a  depression  on  each  of  the  sides,  which  gives  them 
somewhat  the  appearance  of  a  thin  rubber  ball  compressed  in  the  central 
portion  hy  pressure  between  the  fingers. 

Corpuscles  were  first  observed  by  Malphigi  in  1661  in  the  blood  of 
the  hedgehog,  but  he  considered  them  merely  globules  of  fat.  Leeuwen- 
hoeck  in  1673  detected  them  in  human  blood.  The  early  observers  of 
these  bodies  thought  them  spherical  in  form,  and  called  them  blood- 
globules  ;  but  Hewson  in  1770  showed  that  they  are  not  spheres,  but 
disks.  Young  in  1813  inferred  that  their  flat  surfaces  are  depressed  in 
the  center,  but  the  fact  that  they  are  bi-concave  disks  was  only  finally 
determined  by  Hodgkin  and  Lister  in  1827.  Further  study  of  the  blood 
showed  that  it  contains  two  other  kinds  of  corpuscles — white  corpuscles 
and  the  so-called  blood-plates  of  Hayem,  discovered  in  1878. 

The  red  corpuscles  are  by  far  the  most  numerous ;  the  white  ones  are 
found  (in  normal  blood)  only  in  the  small  proportion  of  one  to  about 
five  hundred  of  the  red,  and  the  blood-plates  to  the  extent  of  about  one 
to  twenty  of  the  others.  Neither  the  white  corpuscles  nor  the  blood- 
plates  have  any  importance  in  the  examination  of  blood-stains,  and  it  is 
unnecessary  to  consider  them  further. 

A  comparative  study  of  the  red  corpuscles  of  the  vertebrates  shows 
considerable  difference  both  in  size  and  form  of  these  bodies  as  they 
exist  in  the  various  classes.  With  a  few  unimportant  exceptions,  the 
corpuscles  of  the  mammalia  are  circular,  while  those  of  the  ovipara  are 
oval.  In  certain  of  the  ruminantia,  including  the  camel,  dromedary, 
llama,  and  alpaca,  the  corpuscles  are  oval ;  in  the  Mexican  deer  they  have 


BLOOD  AND  OTHER  STAINS. 


151 


a  variety  of  forms — circular,  heart-shaped,  crescent,  etc.,  even  in  a  single 
individual.  (Gulliver.)  The  lamprey  and  a  few  fishes  of  the  cyclostoma 
have  circular  disks,  which,  like  those  of  the  mammalia,  are  slightly  de- 
pressed in  the  center.  In  the  corpuscles  of  all  of  the  ovipara  there  is 
found  an  aggregation  of  granules  called  a  nucleus,  which  gives  them  a 
raised  center.  The  addition  of  acetic  acid  to  such  corpuscles  renders  the 
surrounding  parts  more  transparent  aud  makes  the  nucleus  more  dis- 
tinctly visible.  In  all  of  the  mammalia  there  is  an  absence  of  this  nucleus, 
and  the  corpuscles  have  a  depressed  center.  Under  certain  conditions  of 
light  and  focus  circular  corpuscles  appear  to  have  a  dark  center,  but  this 
is  the  effect  of  refraction  due  to  the  lenticular  form  of  the  disk.  Ficr.  13. 


Fig.  13.    Blood-Corpuscles  from  the  Mammalia  and  the  Ovipara. 


shows  the  appearance  of  the  round  and  of  the  nucleated  oval  corpuscles. 
The  round  corpuscles  at  1  are  represented  as  being  sharply  focused, 
while  at  2  they  are  shown  within  the  focus.  Just  beyond  the  focus  they 
have  the  center  dark  and  the  periphery  bright.  The  effect  of  acetic  acid 
upon  the  nucleus  is  seen  at  the  extreme  right  of  the  figure. 

The  size  of  the  corpuscles  varies  considerably  in  the  different  classes, 
and  is  variable  within  smaller  limits  in  animals  of  the  same  class,  and 
even  in  the  same  animal.  The  diameters  of  the  corpuscles  bear  no  rela- 
tion to  the  size  of  the  animal.  They  are  larger  in  the  mouse  than  in  the 
lion,  while  the  ox  and  the  horse  have  corpuscles  considerably  smaller 
than  those  in  man.  The  largest  corpuscles  are  found  among  the  batra- 
chia ;  the  long  diameter  of  the  corpuscles  of  the  eel-salamander  (amphi- 
uma)  is  1-350  of  an  inch.  The  smallest  corpuscles  are  found  in  the 
musk-deer.  In  this  animal  their  average  diameter  is  1-12,000  of  an 
inch.  The  corpuscles  of  the  reptiles  are  the  largest;  next  in  size  are 
those  of  fishes  and  birds.  Mammalian  corpuscles  are  the  smallest  of  all. 
Among  the  latter  class  a  few  genera  have  corpuscles  somewhat  larger 
than  man,  but  in  the  majority  they  are  smaller.  Gulliver  made  careful 
measurements  of  the  diameters  of  the  corpuscles  in  nearly  six  hundred 
genera.  His  tables  may  be  found  in  the  Proceedings  of  the  Zoological 
Society  of  London  (1875,  p.  474).  All  of  Gulliver's  measurements,  with 
some  additions,  are  given  in  Milne-Edwards'  Treatise  on  Comparative 
Physiology.     (Lecons  sur  Physiologic,  etc.,  Paris,  1857,  vol.  i.,  pp.  83-90.) 

The  number  of  red  corpuscles  found  in  a  single  drop  of  blood  is  very 
large.  Five  million  of  these  bodies,  according  to  Vierordt  and  other 
authorities,  is  the  estimate  of  the  number  contained  in  a  cubic  millimeter 
(one  twenty-fifth  of  an  inch) — a  volume  not  larger  than  the  head  of  a 
small  Dm. 


152  A   SYSTEM  OF  LEGAL  MEDICINE. 

The  structure  of  the  red  corpuscles  is  generally  believed  to  consist  of 
a  network  of  albuminous  fibers  attached,  according  to  some  observers,  to 
the  outer  hardened  layer  of  the  protoplasm  of  the  corpuscle,  and  accord- 
ing to  others  to  a  cell  wall  or  investing  membrane.  The  cell  thus  formed 
holds  a  fluid  which  contains  the  blood-coloring  matter,  or  haemoglobin. 
In  consequence  of  this  structure  the  corpuscles  exhibit  the  phenomena 
of  endosmose  and  exosmose.  If  placed  in  water — a  liquid  of  less  specific 
gravity  than  that  contained  in  the  corpuscles — the  water  penetrates  into 
their  interior,  increases  their  volume,  and  thereby  causes  them  to  become 
spherical.  This  change  is  necessarily  accompanied  by  a  reduction  in 
diameter  amounting  to  about  one  third.  A  human  blood-disk  having  a 
diameter  of  1-3300  of  an  inch  if  placed  in  water  becomes  a  sphere  of 
about  1-4500.  The  oval  corpuscles  of  the  ovipara  act  in  the  same 
manner,  and,  except  for  the  presence  of  the  nucleus,  appear  like  those  of 
mammalian  blood.  On  the  other  hand,  if  corpuscles  are  immersed  in  a 
liquid  of  high  specific  gravity,  as  a  solution  of  sugar  or  of  sodium  sul- 
phate, the  fluid  in  the  interior  passes  into  the  outer  liquid,  and  the  sides 
are  brought  closely  together  and  the  corpuscle  becomes  shriveled  and  the 
edges  crenated.  Weak  solutions  of  the  alkalies  and  dilute  acids  dissolve 
the  substance  of  the  corpuscle  and  speedily  destroy  it.  Concentrated 
solutions  of  the  alkalies  (thirty-three  percent.)  act  much  more  slowly, 
and  form  a  very  good  medium  for  separating  the  corpuscles  from  a  mass 
of  dried  blood  under  microscopic  examination.  A  solution  of  common 
salt,  glycerin,  or  other  substance  not  capable  of  acting  upon  albumen, 
if  of  specific  gravity  substantially  the  same  as  that  of  the  serum  of  the 
blood,  may  be  mixed  with  the  blood  without  producing  any  distortion  or 
dissolving  effect  upon  the  corpuscles. 


THE  PRACTICAL   TESTING  OF   SUSPECTED   STAINS. 

Preliminary  Examination. — Before  proceeding  to  the  actual  tests, 
every  article  of  clothing,  instrument,  or  other  object  upon  which  stains 
are  suspected  should  undergo  a  minute  inspection,  and  memoranda  of 
the  details  put  in  writing,  as  follows  : 

(1)  Date  and  time  of  day  when  the  specimens  were  received. 

(2)  From  whom  the  specimens  were  received,  together  with  all  par- 
ticulars as  to  condition  of  the  packages,  seals  (if  used),  place  where  the 
specimens  were  received,  etc. 

(3)  A  detailed  list  indicating  every  article  submitted  for  examination. 

(4)  The  number,  size,  shape,  and  exact  position  of  the  suspected 
stains. 

(5)  If  the  stains  are  upon  clothing  or  other  fabric,  note  the  side  on 
which  they  occur.  Examine  particularly  all  the  pockets,  linings,  buttons, 
and  seams.  These  portions  often  contain  minute  clots  which  escape 
casual  observation. 

(6)  If  there  appear  to  be  drops,  spatters,  or  smudges  upon  any  of  the 
objects,  note  the  direction  of  the  spatters  and  the  appearance  of  the 
drops.     (See  remarks  below  on  direction  of  spatters,  etc.) 

Observe  also  the  following  precautions : 

(1)  When  not  in  use,  keep  the  specimens  under  lock  and  key. 

(2)  As  the  examination  proceeds,  each  spot  tested  should  be  marked. 


PLATE  VI. 


200    DIAMETERS. 


1,200    DIAMETERS. 

HUMAN  BLOOD  CORPUSCLES, 

DRIED    ON    GLASS    (FROM    ORIGINAL    NEGATIVES). 


BLOOD  AND  OTHER  STAINS. 


155 


Iii  the  case  of  clothing  this  may  be  done  by  securely  pinning  a  small 
piece  of  white  linen  to  the  side  of  each  spot  or  place  from  which  it  is 
taken,  and  marking  it  in  ink  with  a  designating  letter  or  figure.  Chips 
of  wood  cut  from  the  floor  or  furniture,  and  other  small  specimens, 
should  be  kept  in  separate  small  vials  properly  labeled.  Spots  upon 
weapons  may  be  sufficiently  indicated  by  descriptive  notes. 

(3)  If  possible,  use  only  a  portion  of  each  stain  for  the  examination. 
In  the  case  of  minute  spots  the  whole  may  be  required  for  the  necessary 
tests,  but  in  all  other  cases  reserve  a  part  of  the  material.  It  may  be 
required  for  additional  tests  or  further  examination  in  consequence  of 
facts  developed  during  the  trial,  and  possibly  the  defendant's  counsel  may 
desire  a  portion  for  the  inspection  of  his  own  experts.  In  the  latter  case 
deliver  nothing  except  upon  a  written  order  of  the  prosecuting  officers. 

(4)  Keep  accurate  notes  of  every  detail  of  the  examination  as  it  pro- 
ceeds. 

The  Appearance  of  Drops  and  Direction  of  Spatters. — Drops  of 
blood  from  a  height  of  one  or  two  feet  are  larger  than  those  falling  only 
a  few  inches.  In  the  first  case 
the  circumferences  of  the  spots 
are  deeply  indented,  but  in  the 
second  they  show  a  perfectly 
regular  outline.  (Fig.  14,  a  and 
1).)  Spatters  indicate  their  di- 
rection by  the  smaller  extrem- 
ity. This  is  always  farthest  from 
the  point  of  origin  (r).  An  im- 
pression of  the  end  of  the  thumb 
is  represented  at  d.  Drops  of 
blood  when  examined  by  the 
aid  of  a  small  hand  magnifying- 
glass  show  that  their  edges  are 
slightly  raised  above  the  level  of 
the  central  portion. 

The  Appearance  of  Blood= 
Stains  and  of  the  Substances 
which  resemble  them. — The 
appearance  of  recent  blood,  either 
fluid  or  in  a  dried  state,  upon  the 
surface  of  cloth,  wood,  or  metals, 
is  so  characteristic  that  it  is  un- 
likely that  any  other  substance 
will  be  mistaken  for  it.  When, 
however,  the  blood  is  of  greater 

age  and  present  only  in  small  spots  or  stains,  and  especially  upon  a  dark 
fabric  or  surface,"  it  is  much  more  difficult  to  determine  its  character. 

Small  spots  upon  clothing  should  be  marked  by  a  pin  stuck  into  the 
cloth  near  the  stain.  Unless  this  is  done  it  will  sometimes  be  difficult  to 
find  a  given  spot  when  it  is  again  looked  for.  Considerable  time  may 
be  saved  by  attention  to  this  precaution.  An  ordinary  hand  magnifying 
or  reading-glass  will  be  found  useful  for  the  preliminary  inspection. 
The  observer  should  place  the  article  about  to  be  examined  in  a  hori- 
zontal position  between  his  eye  and  the  source  of  light.     The  article 


*• 


a 


Fig.  14.    Blood  Drops  and  Spatters. 


156  ^   SYSTEM  OF  LEGAL  MEDICINE. 

should  be  held  at  different  angles,  so  that  the  light  may  be  reflected 
from  the  spots  somewhat  obliquely.  Under  these  conditions  blood-stains 
present  a  peculiar  dark-crimson  reflection,  which  is  strongly  indicative 
of  blood.  Blood-stains,  if  of  any  considerable  size,  upon  silk,  woolen,  or 
cotton,  give  a  stiffness  to  the  fabric  from  the  drying  of  the  albumen,  like 
that  produced  by  gum ;  they  are  glossy  and  smooth,  and  have  a  reddish- 
brown  color.  Stains  on  dark  surfaces  are  best  observed  by  artificial 
light. 

In  1833  a  murder  was  committed  in  Paris,  but  the  most  careful  ex- 
amination of  the  apartment  occupied  by  the  suspected  parties,  and  which 
was  believed  to  have  been  the  place  where  the  homicide  occurred,  failed 
to  reveal  the  slightest  appearance  of  blood.  The  experts  of  the  govern- 
ment, Ollivier  and  Pillon,  on  making  further  investigation,  about  eight 
o'clock  in  the  evening  discovered  upon  the  wall-paper  a  large  number  of 
small  spatters  of  a  dull  red  color,  which  by  daylight  had  the  appearance 
of  black  points  or  dots,  which  were  very  easily  concealed  by  the  design 
upon  the  paper ;  they  observed,  also,  many  similar  spots  on  the  front  of 
a  chest  of  drawers  the  wood  of  which  had  a  deep-brown  color.  These 
spots  proved  to  be  blood.  Other  experts,  Leseur  and  Barruel,  failed  to 
find  the  spots  on  the  following  day,  and  were  obliged  to  employ  the  light 
of  a  candle  to  detect  them.  (Archives  de  Mfflecine,  1833,  second  series,. 
vol.  i.) 

Drops  or  clots  of  blood  upon  metals  or  any  hard  surface  are  not 
adherent,  and  readily  scale  off  when  dry.  If  the  spot  is  very  thin  or 
merely  a  smudge,  it  will  probably  be  necessary  to  scrape  it  lightly  with 
a  penknife  if  it  is  desired  to  remove  it. 

There  are  many  substances  which  in  small  stains  look  somewhat  like 
blood,  but  they  may,  in  most  cases,  be  easily  distinguished  by  character- 
istics peculiar  to  each. 

Iron-rust,  Corrosions  upon  Metals  by  Lemon  J)<ice,Yi)tegar,  etc. — The  ap- 
pearance of  iron-rust  varies  considerably  in  its  different  forms.  Some 
of  these  closely  resemble  dried  blood.  The  rust  upon  iron  or  steel  in- 
struments due  to  contact  with  lemon  juice,  vinegar,  etc.,  has  been  mis- 
taken for  blood. 

Orfila  mentions  the  case  of  a  man  suspected  of  murder  in  whose 
possession  was  found  a  knife  apparently  covered  with  blood.  A  chem- 
ical examination  of  the  spots  showed  that  they  were  due  to  citric  acid. 
The  knife  had  a  few  days  before  been  used  for  cutting  a  lemon,  and  had 
been  put  away  without  being  wiped. 

In  the  case  of  rust,  its  character  may  be  determined  by  carefully  de- 
taching a  small  portion,  putting  the  same  into  a  porcelain  capsule  in 
contact  with  pure  hydrochloric  acid,  and  applying  a  gentle  heat.  If  the 
spot  be  iron-rust,  the  particles  are  dissolved  and  form  a  yellow  solution. 
A  drop  of  this  may  be  tested  by  a  solution  of  potassium  ferrocyanide, 
which  produces  a  blue  color.  Alkalies  change  the  blue  color  to  a  red- 
dish-brown precipitate.  Another  drop  gives  with  solution  of  potassium 
sulphocyanide  a  deep-red  coloration.  A  report  by  Robin  upon  the  dis- 
tinctive characters  of  blood-stains  found  upon  an  instrument  covered 
with  rust  may  be  found  in  the  Annates  de  Hygiene,  1859,  vol.  xii.,  p.  150. 
Stains  of  iron-rust  upon  linen  may  be  tested  in  a  similar  manner.  A 
small  piece  cut  from  the  fabric  is  boiled  with  pure  hydrochloric  acid  to 
form  a  solution,  as  in  the  previous  case.     A  portion  of  the  unstained 


BLOOD  AND  OTHER  STAINS.  157 

fabric  should  be  similarly  tested,  since  salts  of  iron  are  frequently  em- 
ployed as  mordants  in  dyeing  and  calico-printing. 

Extracts  of  Dye-woods  and  Tanning  Materials. — Various  commercial 
extracts  used  by  dyers  and  tanners  closely  resemble  dried  blood.  Among 
the  most  common  of  these  are  extract  of  hemlock  bark,  extract  of  logwood, 
cutch,  catechu,  madder,  cochineal  and  its  compounds.  All  of  these  are  solu- 
ble in  water,  giving  brown  solutions  in  the  case  of  logwood,  hemlock, 
cutch,  and  similar  extracts,  and  red  solutions  where  madder  and  cochi- 
neal are  present.  Solutions  containing  logwood,  hemlock,  cutch,  or 
other  astringent  drugs  become  black  upon  the  addition  of  a  few  drops 
of  solution  of  ferric  chloride  or  of  tincture  of  perchloride  of  iron.  Ex- 
tract of  logwood  becomes  bright  red  in  presence  of  the  stronger  acids. 
Colors  of  more  or  less  red  shade  are  derived  from  Brazil-wood,  red  sun- 
ders, ami  anatto.  Anatto  yields  an  orange-yellow  color  to  water,  and  is 
slightly  intensified  but  not  changed  by  ammonia ;  acids  change  its  color 
to  a  red  or  pink.  Most  of  the  red  dye  colors  become  crimson  or  deep 
red  on  the  addition  of  ammonia.  Madder  is  changed  to  a  yellow  by 
acids,  and  on  the  addition  of  iron  salts  becomes  brown.  All  of  these 
colors  are  bleached  by  chlorin  water,  which,  unless  very  concentrated, 
has  no  effect  upon  blood.  A  case  in  which  blood-stains  found  upon  the 
clothing  of  a  prisoner  were  claimed  to  be  catechu,  with  a  report  of  tests 
upon  the  same,  is  given  in  Guijs  Hospital  Reports,  second  series,  vol.  vii., 
p.  413. 

Spots  of  Grease  or  Tar. — These  may  be  detected  by  covering  the  stain 
by  a  piece  of  white  filter-paper  and  pressing  with  a  hot  iron,  when  more 
or  less  of  the  material  will  be  absorbed  by  the  paper.  Grease  and  tar 
are  insoluble  in  water,  but  readily  dissolve  in  petroleum  naphtha,  oil  of 
turpentine,  and  ether.  (See  report  of  a  case  of  this  kind  in  Casper's 
Forensic  Medicine,  vol.  i.;  p.  202.) 

Fruit,  Wine,  and  other  Vegetable  Stains. — Such  stains  do  not  cause  any 
stiffening  of  the  fiber  of  the  fabric,  and  they  are  turned  blue  or  green  by 
ammonia.  They  are  readily  distinguished  by  proper  tests,  but  some- 
times have  a  strong  resemblance  to  blood.  Taylor  reports  a  case  of  this 
kind.     (2Iedical  Jurisprudence,  third  American  edition,  p.  217.) 

A  farmer's  boy  was  arrested  on  a  charge  of  murder.  The  blue  blouse 
and  trousers  which  he  had  worn  had  on  them  numerous  brown  and  red 
stains  resembling  blood,  and  appearing  to  have  been  produced  by  the 
wiping  of  bloody  fingers.  The  stained  articles  were  subjected  to  chem- 
ical analysis,  and  it  was  found  that  the  color  was  produced  by  some  sort 
of  vegetable  juice.  The  accused  stated  that  the  day  before  his  arrest  he 
had  collected  a  large  quantity  of  red  poppies  which  had  become  bruised 
by  trampling  on  them,  and  that  he  had  carried  them  home  in  his  blouse. 

Red  Paint. — Dried  paint  consists  of  a  mixture  of  oil  solidified  by 
oxidation,  and  a  pigment,  generally  of  mineral  origin  and  in  red  colors, 
most  commonly  oxide  of  iron  or  red  oxide  of  lead.  It  is  insoluble  in 
water,  but  on  soaking  in  naphtha,  oil  of  turpentine,  or  in  a  strong  solu- 
tion of  alkali  it  is  softened  and  removed.  A  small  portion  may  be  so 
treated  in  a  watch-glass,  in  which,  after  a  time,  there  will  be  found  depos- 
ited the  mineral  pigment,  which  may  be  tested  for  iron  as  already  indi- 
cated. Red  lead  is  so  different  in  color  from  iron  that,  like  vermilion,  its 
appearance  is  sufficiently  indicative  of  the  fact  that  it  is  not  blood. 

In  1840  a  person  was  murdered  at  Islington.     An  individual  was 


-[58  A    SYSTEM   OF  LEGAL  MEDICINE. 

arrested  on  suspicion,  and  in  his  possession  was  found  a  sack  having 
upon  it  many  red  stains,  which  were  supposed  to  be  dried  and  coagulated 
blood.  On  analysis  they  proved  to  be  due  to  red  paint,  containing 
peroxide  of  iron.  The  sack  was  shown  to  have  been  worn  the  day 
before  by  a  youth  who  was  an  apprentice  to  a  paper-stainer.  It  had 
been  sent  to  the  accused  a  short  time  previously  as  a  wrapper  to  a 
parcel.     (Taylor.) 

THE  VARIOUS  METHODS   OP   TESTING  BLOOD-STAINS. 

Of  the  various  tests  for  blood  which  have,  from  time  to  time,  been 
proposed,  there  are  but  four  of  much  value  or  importance.  Two  of  these 
depend  upon  chemical  and  two  upon  optical  principles.     They  are : 

(1)  The  Guaiacum  Test,  which  consists  in  the  production  of  a  blue 
color  from  a  blood-stain  treated  with  tincture  of  guaiacum  and  hydrogen 
peroxide. 

(2)  The  Hmmin  Test — the  formation  of  microscopic  crystals  of  ha?m- 
atin  hydrochloride. 

(3)  The  Spectroscopic  Test — the  identification  of  the  absorption-bands 
peculiar  to  haemoglobin  and  its  derivatives. 

(4)  The  Histological  Test — the  microscopical  observation  and  meas- 
urement of  the  blood-corpuscles. 

Where  the  size  of  the  blood-stains  to  be  tested  is  such  as  to  furnish  a 
sufficient  amount  of  material,  separate  portions  may  be  used  for  the  dif- 
ferent tests ;  but  in  case  only  a  very  small  stain  is  available,  and  it .  is- 
desired  to  make  several  examinations,  we  may  proceed  by  the  following 
process,  suggested  by  Richardson :  The  clot  or  scrapings  from  the  stained 
portion  of  the  article  under  examination  is  placed  in  the  center  of  a  thin 
cover-glass,  and  upon  this  is  deposited  a  minute  drop  from  a  capillary 
pipette  of  a  solution  of  one  part  of  glycerin  in  seven  parts  of  water. 
The  cover  is  inverted  over  the  cavity  of  a  concaved  slide  and  allowed  to 
remain  until  the  coloring  matter  of  the  blood  has  given  a  decided  tinge 
to  the  liquid.  The  drop  may  then  be  examined  by  the  microscope  for 
the  presence  of  corpuscles,  and  afterward,  without  removing  it  from  the 
slide,  in  the  microspectroscope.  A  very  minute  portion  of  the  same 
may  be  tested  by  the  guaiacum  reaction.  (Philadelphia  Medical  Times, 
1875,  p.  78.)  Special  methods  for  making  a  solution  adapted  to  each  of 
the  tests  to  be  described  will  be  given  in  their  appropriate  place. 

The  observer  should  make  as  many  tests  as  possible.  If  only  one 
test  can  be  made,  it  should  be  that  which  will  detect  the  presence  of  cor- 
puscles. Next  in  importance  is  the  hasmin  test.  This  can  be  made  from 
the  specimen  used  for  the  microscopical  examination,  provided  that 
Richardson's  fluid  (three-fourths  percent,  salt  solution)  is  employed  for 
soaking  out  the  corpuscles,  but  not  otherwise.  The  guaiacum  test  may 
be  made  upon  the  haemin  crystals,  or  indeed  under  nearly  all  conditions. 


THE  CHEMICAL  TESTS  FOR  BLOOD. 

Thirty  years  ago  the  chemical  methods  for  the  examination  of  sus- 
pected blood-stains  consisted  only  in  the  identification  of  certain  prop- 
erties and  constituents  which  are,  at  present,  seldom  or  rarely  consid- 


BLOOD  AND  OTHER  STAINS.  159 

ered  in  studying  the  subject.  Albumen  contained  in  a  reddish  stain, 
with  an  ash  from  the  same  giving  reactions  for  iron,  was  considered 
indicative  of  blood.  These  tests  being  successfully  made,  attention  was 
given  to  various  means  by  which  it  was  attempted  to  prove  that  the 
stains  were  not  made  by  a  large  number  of  substances,  which,  under  cer- 
tain conditions,  have  some  resemblance  to  dried  blood.  Tests  of  this 
character  are  now  practically  abandoned,  and  the  only  properties  of 
blood  which  constitute  the  basis  of  chemical  tests  arc  those  possessed 
by  the  coloring  matter  in  producing  a  peculiar  blue  color  with  tincture 
of  guaiacum  under  precise  conditions,  and  in  the  formation  of  minute 
crystals  of  haematin  hydrochloride,  commonly  called  hasmm.  These  re- 
actions are  called  respectively  the  guaiacum  test  and  the  hozmin  test.  Both 
tests  are  very  sensitive,  and  are  capable  of  application  to  the  very  small- 
est visible  particle  of  material.  The  hamiin  test  is  absolutely  conclusive 
as  to  the  presence  of  blood,  but  the  guaiacum  test  is  only  confirmatory. 
A  very  large  number  of  substances  besides  blood  produce  a  blue  color 
with  guaiacum,  so  that  the  test  is,  by  many,  held  to  be  of  but  slight  ac- 
count. The  guaiacum  test,  however,  has  its  value,  because  if  a  suspected 
stain  fails  to  give  a  blue  color  it  is  very  strong  evidence  of  the  absence 
of  blood,  or,  if  originally  blood,  that  it  has  become  so  altered  by  some 
means  (as  by  boiling  water  or  the  action  of  chemicals)  that  it  will  prob- 
ably fail  when  attempts  are  made  to  test  it  in  other  ways. 

The  two  tests  are  the  complements  of  each  other.  The  ha?min  test  is 
conclusive  of  the  presence  of  blood,  and  the  failure  to  obtain  the  guaiacum 
reaction  is,  for  all  practical  purposes,  conclusive  of  its  absence. 

The  Guaiacum  Test. — The  guaiacum  test  for  blood  was  first  sug- 
gested by  Van  Deem,  a  Dutch  chemist,  but  it  attracted  little  attention 
until  1863,  when  it  was  studied  by  Liman  (Casper's  VierteljahrscJiriff, 
1863,  p.  193),  and  later  by  Day  in  1867  (Australian  Medical  Journal, 
1867).  Shortly  after,  the  test  was  made  the  subject  of  a  critical  exam- 
ination by  Taylor,  who  highly  commended  it.  {Guy's  Hospital  Reports, 
third  series,  1867,  vol.  xiii.,  p.  431.)  The  subject  was  still  further  inves- 
tigated by  Lefort  in  1870.  (Annates  de  Hygiene,  second  series,  vol.  xxxiv., 
p.  429.) 

The  test  is  very  simple,  and  requires  but  a  moment  for  its  applica- 
tion. It  is  made  as  follows :  To  an  aqueous  extract  from  a  suspected 
stain  is  added  a  few  drops  of  tincture  of  guaiacum.  The  resin  is  at  once 
precipitated,  and  produces  a  milk-white  opacity  in  the  liquid.  With 
blood  alone  there  is  no  development  of  color,  but  on  the  addition  of  a 
small  quantity  of  hydrogen  peroxide  the  milky  appearance  changes  to  a 
beautiful  blue.  If  the  stain  is  old  and  does  not  yield  any  color  to  water, 
the  test  may  be  applied  directly  to  the  stain  itself.  A  drop  of  water  is 
placed  upon  the  stain,  and  afterward  the  tincture  of  guaiacum,  which  is 
immediately  followed  by  the  addition  of  the  peroxide.  The  stain,  if 
blood,  gives  at  once  the  peculiar  blue  coloration.  If  the  stain  is  upon  a 
dark  surface,  the  developed  color  may  be  readily  observed,  as  suggested 
by  Taylor,  if  a  small  piece  of  white  filter-paper  be  pressed  upon  the  spot- 
while  it  is  still  wet  with  the  reagents.  The  blue  liquid  is  absorbed  and 
colors  the  paper.  Several  impressions  may  thus  be  taken  from  a  single 
stain.  In  the  case  of  very  small  stains  they  may  be  moistened  with 
water  and  some  of  the  coloring  matter  absorbed  by  pressing  upon  the 
stain  with  filter-paper.     The  test  may  then  be  applied  to  the  impression 


1G0  A   SYSTEM  OF  LEGAL  MEDICINE. 

upon  the  paper  instead  of  directly  to  the  stain.  It  is  essential  in  all 
cases  to  add  the  guaiacum  before  the  peroxide.  In  some  cases  a  blue 
color  may  appear  before  the  addition  of  the  latter ;  if  this  occurs,  the 
blood,  if  present,  is  mixed  with  some  foreign  substance.  Blood  alone 
does  not  color  the  guaiacum.  The  test  depends  upon  the  production  of 
a  blue  color  after  the  addition  of  the  peroxide,  and  not  before.  Should 
the  guaiacum  become  blue  when  added  to  the  stain,  the  conditions  are 
such  as  make  the  test  valueless.  If  the  blue  color  be  not  produced  by 
the  guaiacum,  but  appears  on  the  addition  of  the  peroxide,  there  is 
established  a  probability  of  the  presence  of  blood  which  must  be  con- 
firmed by  other  tests.  If  the  reddish  stain  produces  no  blue  color  under 
this  test,  blood  is  absent,  unless  the  stain  has  been  washed  with  hot  water 
or  there  has  been  applied  some  chemical  agent  which  makes  the  test  in- 
operative. The  guaiacum  test  is  so  delicate  that  one  drop  of  blood  in  six 
fluid  ounces  of  water  may  readily  be  detected  in  one  or  two  drachms  of 
the  mixture.     (Taylor.) 

The  writer  has  frequently  made  the  test  with  a  solution  containing 
no  more  than  one  drop  of  blood  in  four  thousand  parts  of  water.  If  the 
experiment  be  made  upon  the  white  surface  of  a  porcelain  capsule,  the 
blue  color  may  be  observed  in  still  greater  dilutions.  Taylor  in  1867 
obtained  the  guaiacum  reaction  from  blood-stains  upon  a  towel  which 
had  been  in  his  possession  for  ten  years.  Twelve  years  afterward  the 
stains  were  again  examined,  and  it  was  found  that  while  the  tincture  of 
guaiacum  alone  produced  no  effect,  the  addition  of  hydrogen  peroxide 
still  developed  the  blue  coloration. 

The  writer  has  never  failed  to  obtain  the  characteristic  color  pro- 
duced by  this  test  from  blood-stains  not  more  than  three  years  old,  but 
from  stains  of  greater  age  he  has  obtained  unsatisfactory  results. 

In  1881  a  murder  was  committed  near  Springfield,  Mass.  The  dead 
body  of  a  man  killed  by  a  pistol-bullet  was  found  seated  in  a  carriage, 
the  horse  being  tied  to  a  tree,  in  a  lonely  place  in  the  woods.  The 
deceased  was  known  to  have  had  a  considerable  sum  of  money  in  his 
possession,  but  when  the  body  was  found  both  the  money  and  a  valuable 
watch  were  missing.  Suspicion  was  immediately  directed  to  one  Loomis, 
who  had  been  in  the  company  of  the  murdered  man  on  the  previous 
afternoon,  but  there  could,  at  first,  be  found  but  little  evidence  to  incrim- 
inate him.  A  little  more  than  a  year  after  the  affair,  a  watch  wrapped 
in  a  handkerchief  and  inclosed  in  a  buckskin  glove  was  found  under 
some  rubbish  near  the  place  where  the  horse  was  tied.  The  watch  was 
identified  as  one  which  had  been  the  property  of  the  victim,  and  the 
glove  and  handkerchief  were  proved  to  belong  to  the  suspected  party. 
The  glove  and  handkerchief  were  placed  in  the  hands  of  the  writer  by 
the  attorney-general,  to  be  examined  in  regard  to  the  nature  of  several 
suspicious  stains.  These  under  the  microscope  showed  blood-corpuscles, 
and  gave  satisfactory  tests,  both  by  guaiacum  and  the  process  for  obtain- 
ing hsemin  crystals.  Upon  this  new  evidence  Loomis  was  convicted  and 
executed.  Twelve  years  later,  during  the  preparation  of  the  present 
article,  the  guaiacum  test  was  again  tried  upon  the  stains  still  showing 
upon  the  glove  and  handkerchief,  but  no  blue  color  could  be  produced 
nor  ha?min  crystals  obtained. 

Wormley  states  that  this  test  will  react  with  very  old  stains,  and 
even  in  cases  where  they  have  been  washed.   No  doubt  the  length  of  time 


BLOOD  AXD  OTHER   STAINS.  161 

during  which  the  guaiacum  test  may  be  successful  varies  according  to 
circumstances  not  fully  understood.  It  is  improbable,  however,  that  the 
examination,  in  any  important  case,  will  be  delayed  until  the  blood  is  so 
old  that  the  test  fails.  The  guaiacum  reaction  is  of  value  only  as  a  cor- 
roborative test,  or  as  an  indication  of  the  probable  absence  of  blood.  It 
is  a  test  which  merely  demonstrates  a  single  property  of  this  fluid,  that 
of  decomposing  hydrogen  peroxide,  and  any  substance  capable  of  pro- 
ducing this  decomposition  will  develop  the  blue  color.  These  substances 
are  not  very  numerous ;  neither  of  them  has  a  red  color,  nor  can  they 
possibly  be  mistaken  for  blood.  The  tincture  of  guaiacum  is,  without  any 
addition  of  peroxide,  turned  blue  by  a  considerable  number  of  substances. 
A  list  of  these  is  here  given.  Some  of  the  bodies  named  produce  the 
blue  color  only  under  certain  conditions,  and  not  in  all  cases. 

Substances  which  produce  a  blue  color  with  tincture  of  guaiacum,  but 
without  the  addition  of  hydrogen  peroxide. 

Inorganic.  Organic. 

All  oxidizing  agents.  Gluten. 

Solution  of  chlorin.  Flour  paste  (if  unboiled). 

Hypochlorites.  The  fresh  juice  of 

Permanganates.  Potato, 

Ferric  chloride.  Carrot, 

Mercuric  chloride.  Onion, 

Gold  chloride.  Horse-radish, 

Nitrous  ether.  Dandelion, 

Iron  peroxide.  Chicory, 

Manganese  dioxide.  Burdock, 

Platinum  black.  Sorrel, 

Cherries, 

Currants,  mushrooms,  and  many 
other  fungi. 

Milk. 

All  of   these   substances   lose 

their  property  of  producing  the 

blue  color  if  dried  or  heated  to 

212°  F. 

Nasal  mucus,  pus,  bile,  saliva,  and  sweat-stains  produce  the  guaiacum 
reaction  under  the  same  conditions  as  blood,  but  they  have  no  red  color 
and  cannot  be  mistaken  for  it. 

In  making  the  guaiacum  test  for  blood  carefully  observe  the  following : 

(1)  Use  only  the  freshly  prepared  tincture.  It  should  be  made  as  re- 
quired by  dissolving  two  or  three  pieces  of  the  resin  of  the  size  of  a  pea 
in  a  fluid  ounce  of  alcohol.  Do  not  use  a  strong  solution.  The  tincture 
should  not  be  deeper  in  color  than  pale  sherry  wine. 

(2)  Apply  the  tincture  of  guaiacum  to  the  material  which  is  being 
tested  before  adding  the  peroxide.  It  is  the  failure  to  produce  a  blue 
color  with  the  guaiacum  singly  and  its  subsequent  development  by  the 
peroxide  which  distinguishes  blood  from  the  substances  named  in  the 
list. 

(3)  The  blue  color  must  appear  immediately,  otherwise  no  reliance 
can  be  placed  upon  the  test.  A  thin  film  of  guaiacum  resin  obtained  by 
the  evaporation  of  the  tincture  upon  the  surface  of  cloth  or  paper  will 
become  blue  by  the  action  of  the  air  alone  after  a  few  hours'  exposure. 


IQ2  A   SYSTEM  OF  LEGAL  MEDICINE. 

(4)  The  test  should  be  applied  to  au  unstained  portion  of  the  ma- 
terial which  is  under  examination  previous  to  its  application  to  the  stain. 
Bibulous  paper,  if  used,  must  be  tested  in  the  same  manner. 

Under  the  conditions  we  have  given  the  guaiacum  test  is  reliable  and 
certain.  Taylor,  as  the  result  of  experiments  made  with  a  large  number 
of  substances,  including  cochineal,  red  wine,  red  ink,  extract  of  rose 
petals,  kino,  catechu,  Brazil-wood,  etc.,  states  that  "  no  red  coloring  mat- 
ter, animal  or  vegetable,  excepting  the  red  of  blood,  produces  the  blue 
coloration  of  guaiacum  in  presence  of  peroxide  of  hydrogen." 

(Taylor,  Guy's  Hospital  Reports,  third  series,  1867,  vol.  xiii.,  p.  431.) 
(Lefort,  Annates  de  Hygiene,  second  series,  vol.  xxxiv.,  p.  429.) 
(Clement,  Conferences  Pratiques  sur  Medecine  Legale,  Paris,  1880.) 
The  Haemin  Test. — To  make  this  test  a  drop  of  blood  solution  is 
taken  up  by  the  end  of  a  glass  rod  and  spread  upon  a  microscope-slide, 
so  as  to  give  it  an  extended  surface.  The  slide  may  be  set  aside  in  a 
place  free  from  dust  and  allowed  to  evaporate  spontaneously,  or  it  may 
be  heated  very  carefully  in  the  flame  of  a  spirit-lamp,  the  slide  being 
moved  to  and  fro,  so  that  the  liquid  will  not  be  raised  to  a  temperature 
of  more  than  twenty  or  thirty  degrees  above  the  natural  heat  of  the 
body.  The  warmth  may  be  ascertained  from  time  to  time  by  applying 
the  slide  to  the  back  of  the  hand.  The  temperature  must  not  be  allowed 
to  reach  140°  F.,  the  point  at  which  albumen  coagulates.  Should  the 
coagulation  take  place,  the  test  is  likely  to  fail.  Some  writers  recom- 
mend the  addition  of  a  particle  of  common  salt  to  the  solution  during 
the  evaporation.  This  is  unnecessary  in  the  case  of  fresh  blood,  because 
it  contains  a  sufficient  amount  of  this  substance  as  a  natural  constituent ; 
but  with  old  or  dried  blood  it  is  absolutely  necessary.  The  amount  re- 
quired is  very  small.  The  best  plan  is  to  prepare  a  solution  by  weighing 
out  two  grains  of  pure  sodium  chloride  and  dissolving  in  eight  fluid 
ounces  of  distilled  water.  A  drop  of  this  solution  is  quite  sufficient  for 
the  test,  and  is  placed  upon  the  center  of  the  film  of  evaporated  blood. 
The  drop  is  spread  over  the  film  so  as  to  cover  all  parts  of  it,  and  dried 
off  with  the  same  precautions  as  at  first.  A  drop  of  glacial  acetic  acid  is 
next  added  to  the  film,  the  latter  covered  with  a  thin  glass  and  the  slide 
heated — this  time  to  a  sufficient  degree  to  produce  a  slight  ebullition. 
There  is  no  longer  any  danger  of  the  coagulation  of  the  albumen.  If 
the  boiling  be  too  rapid,  the  cover  may  be  violently  projected  from  the 
slide  by  the  force  of  the  vapor. 

If  the  blood  to  be  tested  is  in  a  dried  state  so  that  a  small  particle 
may  be  detached,  a  minute  portion  is  placed  in  the  center  of  the  slide 
and  warmed  with  a  drop  of  acetic  acid.  The  acid  is  evaporated  and  .the 
residue  treated  with  the  salt  solution,  and  afterward  with  a  fresh  portion 
of  acid,  as  previously  described.  In  the  case  of  fresh  blood  a  single 
heating  with  the  acetic  acid  is  sufficient,  but  with  very  old  blood  it  is 
frequently  necessary  to  add  the  acetic  acid  a  second  time  and  heat  it 
anew.  When  the  acid  has  wholly  evaporated  the  slide  is  examined  in 
the  microscope  under  a  power  of  three  hundred  or  four  hundred  diam- 
eters. The  operation  is  easy,  but  it  requires  a  certain  degree  of  skill  in 
manipulation.  The  attempt  to  obtain  Teichmann's  crystals  will  often 
fail  in  unskillful  hands.  The  principal  causes  of  failure  are  the  coagu- 
lation of  the  albumen  and  an  excess  of  salt.  Coagulation  retards  the 
solvent  action  of  the  acetic  acid,  and  during  the  prolonged  ebullition 


BLOOD  AND  OTHER  STAINS. 


163 


required  under  such  circumstances  the  salt  may  be  entirely  decomposed, 
and  the  evolved  hydrochloric  acid  necessary  for  the  formation  of  the 
crystals  (hasmatin  hydrochloride)  is  expelled  before  it  can  enter  into 
combination.  The  acid  employed  must  be  in  its  highest  state  of  concentration 
— the  so-called  glacial  acid.  Acid  of  lower  strength  fails  to  decompose 
the  salt.  If  too  much  salt  be  employed  the  experiment  fails,  and  the 
slide  shows  only  a  mass  of  crystals  of  sodium  chloride.  Distilled  water 
must  be  used.  Ordinary  water  leaves  a  residue  of  organic  matter  and 
mineral  salts — in  some  cases  very  considerable  in  amount — which  inter- 
fere with  the  development  of  the  crystals  or  may  produce  a  crystalline 
deposit  by  itself. 

Haemin  crystals  are  minute  flat  rhomboids.  In  many  cases  they  lie 
superimposed  in  the  form  of  an  X  or  cross.  They  vary  in  color,  accord- 
ing to  their  thickness,  from  a  clear  yellow  to  a  reddish  brown.  They 
exhibit  considerable  variation  in  size,  according  to  the  amount  of  haemin 
present  and  the  rapidity  of  the  evaporation.  The  smallest  may  be  no 
more  than  1-6000  of  an  inch  in  length,  and  the  largest  may  reach  1-1200. 
The  crystals  obtained  as  the  result  of  the  test  may  be  covered  with  thin 
glass  and  mounted  in  the  usual  manner  of  microscopic  objects.  Speci- 
mens should  be  preserved  as  evidence.  Teichmann's  crystals  once  seen 
can  scarcely  be  confounded  with  any  others.  Only  two  substances  have 
been  suggested  which  resemble  them — indigotin  and  murexide.  These, 
it  is  claimed,  may  possibly  be  produced  by  a  solution  of  the  coloring 
matter  of  a  fabric  dyed  with  indigo  or  with  ammonium  purpurate. 
Crystals  of  indigotin  are  blue,  and  those  of  murexide  are  purplish  red 
and  appear  green  by  re- 
flected light. 

The  haemin  reaction 
is  very  delicate.  A  quan- 
tity of  dried  blood  so 
small  as  1-500  of  a  grain 
may  easily  be  detected, 
and  with  care  1-1000 
will  give  decisive  results. 
(Wormley.) 

Time  or  atmospheric 
changes,  as  a  general 
rule,  have  no  effect  upon 
the  certainty  of  the  re- 
sults, provided  there  be 
left  in  the  stain  a  trace 
of  blood-coloring  mat- 
ter. 

The  celebrated  po- 
litical writer  Kotzebue 
was  murdered  by  an  en- 
thusiast named  Sand  in 
1819.  He  was  assassin- 
ated in  his  own  house, 

and  the  papers  upon  his  desk  were  stained  with  his  blood.  Sixty  years 
afterward,  in  1879,  some  of  these  stains  were  submitted  to  the  haemin 
test  and  the  crystals  readily  obtained.     (Clement.) 


Fig.  15.    Hsemin  Crystals.     (450  diameters.) 


164  A   SYSTEM  OF  LEGAL  MEDICINE. 

Buclmer  and  Simon  detected  hsemin  in  a  portion  of  cloth  cut  from  a 
"butcher's  slaughtering-trousers  which  had  been  eight  years  in  use,  and 
had  not  been  worn  for  a  year  and  a  half  previously.     (Casper.) 

All  authorities  agree  as  to  the  value  and  reliability  of  the  hsemin  test. 
Clement  asserts  that  "  crystals  of  hsemin  are  a  certain  indication  of  the 
presence  of  blood."  A  report  of  a  commission  appointed  by  the  French 
Medico-Legal  Society  declared  that  "  these  crystals  are  so  perfectly  char- 
acteristic, that,  should  they  be  found,  one  may  positively  assert  the  pres- 
ence of  blood."  (Miahle,  Mayet,  Lefort,  and  Cornil,  Annales  de  Hygiene, 
1873,  vol.  xl.) 

Wormley  says,  "  Their  production  is  characteristic  of  blood,  there 
being  no  other  substance  known  from  which  they  may  be  produced." 
(Microchemistry  of  Poisons,  second  edition.) 

Failures  to  obtain  hsemin  crystals  may  occur  even  under  the  most 
expert  manipulation  in  the  case  of  old  washed  stains,  but  it  is  the  experi- 
ence of  the  writer  that  a  stain  which  under  proper  treatment  fails  to 
yield  crystals  will  fail  also  to  give  absorption-bands  in  the  microspec- 
troscope,  although  fragments  of  corpuscles  may  still  possibly  be  found 
under  microscopical  examination.  In  brief,  crystals  of  hsemin,  if  found, 
furnish  conclusive  evidence  of  the  presence  of  blood.  Failure  to  obtain 
them  is  not  conclusive  as  to  its  absence. 

(Erdmann,  Jour,  tie  Phar.  et  de  Chimie,  vol.  xli.,  p.  33.) 
(Blondlot,  Annales  de  Hygiene,  1868,  vol.  xxix.,  p.  130.) 
(Clement,  Conferences  Pratiques  de  Medecine  Legale,  Paris,  1880.) 
(Otto,  Per  Gi'fte  und  Blutflecken,  Braunsweig,  1875,  p.  162.) 
(Wormley,  Microchemistry  of  Poisons,  second  edition,  Philadelphia, 
1885.) 

THE  PRACTICAL  TESTING   OF   BLOOD-STAINS  IN  THE  MICROSPECTROSCOPE. 

Different  modes  of  procedure  are  required  in  preparing  specimens 
for  spectroscopic  examination,  according  to  the  age  of  the  stain  and  the 
amount  of  material  available  for  the  purpose.  If  the  stain  be  com- 
paratively recent  the  operation  is  simple,  easily  conducted,  and  abso- 
lutely conclusive  in  its  results.  In  older  stains  the  conclusions  reached 
are  reliable  when  obtained,  but  specimens  require  a  more  complicated 
treatment. 

1.  Examination  of  a  Recent  Stain. — If  the  stain  is  upon  cloth,  a  por- 
tion of  the  fabric  with  the  stain  (one-half  inch  to  one  inch  square,  if 
possible)  is  cut  into  small  strips  and  macerated  with  distilled  water. 
This  is  best  done  in  small  tube-vials  holding  from  one  eighth  to  one 
fourth  of  a  fluid  ounce.  Glass  stoppers  are  preferable,  but  good  sound 
corks  may  be  used  for  keeping  the  specimens  free  from  dust.  Each  vial 
should  be  carefully  labeled.  If  a  clot  can  be  obtained  free  from  adher- 
ing tissue,  it  may  be  treated  in  the  same  manner.  The  amount  of  water 
should  be  proportioned  to  the  size  of  the  clot  or  stain,  and  such  as  to 
yield  a  reddish  or  reddish-brown  solution  of  moderate  intensity  of  color. 
When  the  water  has  become  colored,  which  will  be  the  case  in  from  fif- 
teen minutes  to  an  hour,  a  portion  is  removed  by  a  capillary  pipette 
made  by  heating  a  small  glass  tube  and  drawing  it  out  to  a  point.  The 
vial  should  be  allowed  to  stand  a  sufficient  time  to  allow  any  sediment 
to  deposit,  and  this  should  not  be  disturbed  when  the  liquid  is  with- 


BLOOD  AND  OTHER   STAIN*.  1 55 

drawn.  The  fluid  taken  up  by  the  pipette  is  transferred  to  a  glass  cell 
made  as  previously  described  (Fig.  11 ),  and  placed  on  the  stage  of  the 
microscope.  The  cell  should  be  covered  by  a  cap  with  a  small  opening 
in  the  top  to  cut  off  extraneous  light,  or  it  may  be  covered  on  the  outside 
with  black  paper.  The  examination  may  be  made  either  by  sunlight  or 
an  artificial  source  of  illumination.  It  is  advisable  to  try  both  methods. 
The  microscope  with  a  low-power  objective  (one-half  inch  to  two  inches) 
is  focused  upon  the  top  of  the  cell,  and  the  spectrum  is  ready  for  obser- 
vation. The  slit  of  the  spectroscope  must  be  narrowed  so  as  to  allow 
only  a  sufficient  light  to  pass,  the  amount  necessary  depending  upon  the 
strength  of  the  solution,  the  degree  of  illumination,  and  the  depth  of  the 
stratum  of  liquid.  Under  favorable  conditions,  the  two  bands  of  oxy- 
hemoglobin will  make  their  appearance,  while  the  blue  end  of  the  spec- 
trum will  be  more  or  less  obscured.  In  many  cases  the  spectrum  will 
appear  like  that  of  No.  4  or  No.  5  in  PI.  V.  This  shows  that  the 
stain  is  of  greater  age  (met-haemoglobin)  than  if  the  spectrum  is  like 
No.  1.  In  either  case,  drop  into  the  cell  a  minute  crystal  of  ferrous  am- 
monium sulphate  (a  particle  not  larger  than  the  head  of  a  small  pin), 
and  immediately  about  the  same  amount  of  sodio-potassium  tartrate 
(Rochelle  salt).  Stir  the  solution  with  a  platinum  wire  until  both  salts 
are  dissolved;  next  add  a  drop  or  two  of  ammonia  water,  and  stir  once 
more.  The  spectrum,  if  originally  that  of  oxy-ha?moglobm  (PI.  V., 
No.  1),  will  now  change  to  that  of  reduced  haemoglobin  (No.  2).  In  case 
the  spectrum  originally  presented  the  appearance  of  No.  4  or  No.  5,  it 
will  under  the  action  of  the  added  reagents  change  to  that  of  No.  6 
(reduced  haematin). 

If  the  first  spectrum  was  like  No.  1  (oxy-ha?moglobin),  a  fresh  portion 
of  the  solution  may  be  tested  as  follows :  To  the  blood  solution  in  the 
tube  a  little  citric  acid  is  added,  when,  if  the  color  be  sufficiently  intense, 
a  spectrum  more  or  less  resembling  No.  3  will  develop.  In  most  cases 
the  band  at  the  extreme  right  is  not  produced,  and  it  frequently  happens 
in  dilute  solutions  that  neither  of  the  other  bands  makes  its  appear- 
ance ;  but  even  in  this  case  the  addition  of  the  iron  salt,  etc.,  and  am- 
monia water  until  the  acid  is  neutralized  will  give  the  spectrum  No.  6 
(reduced  hasmatin). 

A  blood-stain  no  larger  than  one-eighth  inch  square  will  show  these 
bands  in  a  satisfactory  manner,  provided  that  all  the  conditions  are  care- 
fully observed.  If  the  solution  be  very  strong  in  color,  a  thinner  stratum 
may  be  examined  or  the  intensity  of  the  light  increased.  Sorby  remarks 
that  if  all  the  characteristic  results  here  given  are  obtained,  "  no  one  can 
hesitate  in  giving  evidence  that  the  mark  is  blood." 

2.  Examination  of  Older  Stains. — As  we  have  already  observed,  oxy- 
hemoglobin becomes  gradually  converted  into  haematin,  and  when  this 
change  is  complete  the  coloring  matter  is  wholly  insoluble  in  pure  water. 
For  such  cases,  therefore,  a  different  procedure  is  necessary.  If  the 
particles  or  portions  of  fabric  in  the  macerating  vial  do  not  readily  yield 
their  color  to  water,  a  few  drops  of  acetic  or  a  grain  or  two  of  citric 
acid  may  be  added,  and  the  bottle  with  its  contents  allowed  to  stand  in  a 
moderately  warm  place  for  several  hours,  or  longer,  if  necessary.  The 
solution  is  examined  in  the  same  manner  as  before,  but  the  absorption- 
bands  produced  will  be  those  of  acid  hasmatin  (No.  3).  The  iron  salt, 
etc.,  and  ammonia  may  next  be  added  to  the  liquid  in  the  tube-cell,  as 


166  A  SYSTEM  OF  LEGAL  MEDICINE. 

in  the  former  tests,  with  the  effect  of  developing  the  spectrum  of  reduced 
haematin  (No.  6). 

Sorby  states  that  he  has  been  able  to  discover  haematin  by  the  micro- 
spectroscope  in  a  stain  forty-four  years  old.  Tidy  obtained  excellent 
spectra  from  stains  on  a  garment  preserved  by  the  relatives  of  an  officer 
who  died  in  battle  in  1771,  and  consequently  more  than  a  hundred  years 
old. 

Letheby,  from  a  portion  of  a  fabric  one-fourth  inch  square,  having 
upon  it  a  blood-stain  seventeen  years  old,  and  which  had  been  completely 
changed  to  haematin,  obtained  as  well  marked  spectra  as  from  compara- 
tively recent  blood.  [London  Hospital  Reports,  vol.  iii.,  p.  41.)  Richard- 
son, in  a  stain  five  months  old,  obtained  satisfactory  tests  by  the  micro- 
spectroscope  from  a  portion  one  fiftieth  of  an  inch  in  diameter. 

If  there  is  reason  to  believe  that  stains  have  been  washed  with  hot 
water  or  heated,  whereby  the  albumen  becomes  insoluble,  it  will  be 
necessary  to  use  ammonia  water  to  dissolve  the  coloring  matter,  as  dilute 
acids  under  these  circumstances  have  very  little  action.  If  a  blood- 
stained fabric  has  been  washed,  only  a  slight  discoloration  may  be  ob- 
served, but  it  will  be  spread  over  a  greater  surface.  In  such  a  case  cut 
the  stained  portion  into  small  pieces  and  macerate  with  a  little  ammonia 
water,  the  tube- vials  being  set  aside  for  several  days  in  a  warm  place. 
Should  the  solution  thus  obtained  be  of  too  faint  color,  it  must  be  con- 
centrated by  evaporation  on  the  water-bath,  care  being  taken  that  the 
liquid  is  kept  alkaline  during  the  process  by  the  addition,  from  time  to 
time,  of  small  additional  quantities  of  ammonia. 

The  spectrum  of  alkaline  hsematin  may  possibly  be  obtained  from 
this  solution,  but,  in  any  case,  the  test  should  be  made  for  reduced 
hsematin  as  in  the  previous  trials.  When  the  stain  is  upon  a  dyed  fabric, 
the  addition  of  ammonia  may  cause  the  solution  of  more  or  less  of  the 
dye  color.  In  such  a  case  tests  with  the  spectroscope  are  not  very  satis- 
factory, as  the  dye  color  may  completely  mask  the  absorption-bands  of 
blood.  Sodium  bisulphite  will  generally  bleach  these  colors,  while  the 
coloring  matter  of  the  blood  is  not  affected.  Citric  acid  acts  less  upon 
a  dyed  fabric  than  ammonia,  and  should  be  used  if  possible.  Stains 
upon  oak-wood  or  leather  are  difficult  of  detection  by  the  spectroscope, 
owing  to  the  action  of  the  tannin  upon  the  blood-coloring  matter, 
whereby  it  is  rendered  insoluble  and  not  easily  converted  into  a  form 
capable  of  satisfactory  examination.  A  trial,  however,  should  always  be 
made,  even  upon  this  sort  of  stain. 

Spectroscopic  tests  may  be  obtained  from  the  red  blood  of  all  ani- 
mals. "  Oxy-ha?moglobin  from  any  source  is  universally  the  same  in  its 
spectroscopic  properties,  the  compounds  it  forms,  and  the  products  of 
its  decomposition,  haematin,  haemin,  etc."     (Halliburton.) 


SPECTRA  OF  COLORED   SUBSTANCES   SOMEWHAT  RESEMBLING   BLOOD. 

Under  the  action  of  ammonia,  citric  acid,  and  salts  of  iron,  as  pre- 
viously described,  stains  due  to  blood  may  be  absolutely  distinguished 
from  all  other  red  coloring  matters.  Quite  a  number  of  these  colors 
give  absorption -bands  which  resemble  those  of  oxy-ha?moglobin,  but 
their  appearance  under  the  action  of  reagents  is  wholly  different. 


BLOOD  AND    OTHER   STAINS.  1G7 

Cochineal  and  Ammoniated  Carmine. — These  give  absorption-bands 
somewhat  like  those  of  blood  (PL  V.,  No.  7),  but  on  the  addition  of  boric 
hydrate  (boracic  acid)  the  bands  change  their  position  to  the  blue  end  of 
the  spectrum.  The  position  of  the  bands  produced  by  blood  is,  under 
the  same  treatment,  unchanged. 

Lac-dye,  madder-red,  alkanet  root,  and  the  petals  of  red-leaved  plants, 
as  cineraria,  give  spectra  somewhat  similar  to  those  of  blood,  but  they 
are  seen  to  be  distinctly  different  when  the  two  spectra  are  observed 
side  by  side.  These  colors  are  all  bleached  by  the  action  of  sodium 
bisulphite.  These  substances,  and  all  other  red  colors,  says  Wormley, 
"  differ  from  blood  in  most  instances  in  the  position  and  character  of  the 
spectral  bands,  and  in  all  cases  in  the  effect  of  reagents  upon  them.  At 
the  present  time  there  is  no  substance  known  that  in  all  these  respects  is 
similar  to  the  coloring  matter  of  blood." 

(Wormley,  Microchemistry  of  Poisons,  second  edition,  Philadelphia, 
1885,  p.  721.) 

(Sorby,  Quarterly  Journal  of  Science,  London,  1865,  vol.  vi.,  p.  9  ;  also 
Chemical  News,  London,  1865,  vol.  xi.,  pp.  186,  194,  232,  256.) 

(Woodman  and  Tidy,  Forensic  Medicine,  Philadelphia,  1877,  p.  515.) 

(Tidy,  Legal  Medicine,  Philadelphia,  1882.) 


THE  MICROSCOPICAL  EXAMINATION  OF   BLOOD-STAINS. 

The  microscopical  examination  of  blood  when  fresh  and  still  fluid 
presents  no  difficulties.  The  formation  of  a  very  thin  layer  obtained  by 
spreading  a  drop  upon  a  microscope-slide  by  rapidly  drawing  over  it  the 
edge  of  a  cover-glass  slightly  inclined  is  all  the  preparation  necessary. 
Such  a  specimen  examined  in  the  microscope  under  a  good  one-fourth  or 
one-fifth  objective  will  show  hundreds  of  red  corpuscles,  and  probably 
several  colorless  ones. 

The  suspected  blood-stains  which  are  submitted  to  the  microscopist 
for  examination  in  criminal  trials  are  almost  invariably  in  a  dried  state. 
The  precise  conditions  under  which  they  have  been  produced,  their  age, 
and  the  various  agents  or  influences  (heat,  moisture,  etc.)  to  which  they 
have  been  subjected,  are  generally  unknown.  The  blood  must  neces- 
sarily be  removed  from  the  material  to  which  it  adheres  or  into  which  it 
has  penetrated  before  it  can  be  examined  in  the  microscope,  and  this 
must  be  done  by,  and  the  specimen  prepared  in,  an  artificial  serum 
entirely  different  from  the  fluid  in  which  the  corpuscles  are  found  in 
their  normal  state.  Moreover,  in  most  cases,  the  greater  number  of 
these  bodies  in  drying  become  distorted,  shriveled,  and  greatly  reduced 
in  volume.  Water  or  other  agents  may  have  been  applied  to  the  stains, 
by  which  the  texture  of  the  corpuscles  becomes  so  far  altered  that  they 
are  no  longer  recognizable.  These  are  some  of  the  conditions  under 
which  the  microscopical  examination  must  be  undertaken,  and  it  is  not 
surprising  that  it  sometimes  fails  even  when  other  tests  have  demon- 
strated the  presence  of  blood.  Blood-corpuscles  once  entirely  deformed 
by  decomposition  cannot  be  restored  by  any  known  reagent.  On  the 
other  hand,  when  the  blood  has  rapidly  dried  npon  a  non-absorbent 
surface,  or  where  it  has  formed  a  clot  which  has  not  been  subjected  to 
disturbing  agencies,  the  conditions  are  favorable  for  the  discovery  of 


168  A  SYSTEM  OF  LEGAL  MEDICINE. 

some  of  the  corpuscles,  and  for  determining  whether  they  are  mammalian 
or  oviparous. 

A  blood-clot  consists  of  a  mass  of  corpuscles  imbedded  in  and  held 
together  by  fibrin  and  albumen,  which,  on  drying,  form  a  strong  cement- 
ing material.  In  this  condition  no  corpuscles  can  be  distinguished,  so 
that  to  prepare  a  specimen  for  examination  in  the  microscope  it  is  neces- 
sary to  dissolve  the  albumen  in  order  that  these  bodies  may,  if  possible, 
separate  from  the  clot,  or  that  the  clot  itself  be  made  sufficiently  trans- 
parent for  the  outlines  of  the  corpuscles  to  become  visible.  This  is 
attempted  by  soaking  the  clot  or  stain  in  a  liquid  so  constituted  that  it 
can  dissolve  or  soften  albumen  while  having  little  or  no  action  upon  the 
corpuscles.  A  large  number  of  fluids  for  this  purpose  have  been  pro- 
posed. A  very  complete  list,  with  formulas  for  their  preparation,  is 
given  by  Formad  in  his  article  on  mammalian  blood  contained  in  the 
Journal  of  Comparative  Medicine  and  Surgery,  1888,  vol.  ix.,  p.  289.  An- 
other collection  of  formulas,  by  Masson,  may  be  found  in  the  Annales  de 
Hygiene,  1885,  third  series,  vol.  xiii.,  p.  393. 

The  best  of  these  preparations  are  the  following : 

I.    Virchow's  Solution  of  Potassium  II.     Richardson 's  Salt  Solution. 

Hydrate. 

Potassium  hydrate 33  parts.       Sodium  chloride 3  parts. 

Water 100      "  Water 400      " 

(33-percent,  solution.)  (f -percent,  solution.) 

III.    Welcker's  Glycerin  Solution.  IV.    Yibert's  Fluid. 

Pure  concentrated  glycerin  1  part.  Mercury  bichloride 1  part. 

Water 7  parts.  Sodium  chloride 4  parts. 

(The  solution  to  be  diluted  to  S.  G.  Water 200      " 

1.028.) 

Virchow's  preparation  acts  with  greater  rapidity  than  the  others,  and 
gives,  in  most  cases,  excellent  results.  It  is  not  desirable  to  employ  it, 
however,  in  treating  very  old  stains,  which  require  a  prolonged  soak- 
ing, as  it  gradually  destroys  the  corpuscles.  With  stains  which  require 
longer  treatment  Richardson's  solution  appears  to  be  open  to  the  least 
objection.  Diluted  glycerin  is  highly  praised  by  many  observers,  and 
is  very  satisfactory  in  its  operation.  It  has  the  advantage  of  evaporat- 
ing less  rapidly  than  fluids  containing  only  water  as  a  menstruum.  It 
is  always  advisable  to  make  several  preparations  of  each  specimen  exam- 
ined, using  a  different  fluid  in  each  case.  It  very  often  happens  that 
stains  give  results  with  some  one  of  the  preparations  which  are  not 
obtained  with  the  others.  The  examination  of  a  clot,  however  minute,  is 
much  more  satisfactory  than  that  of  a  stain  upon  a  fabric  or  porous 
surface.  Such  a  specimen  should  be  selected,  if  possible.  To  prepare 
it,  a  small  particle  is  placed  upon  a  thin  cover-glass,  which,  after  the 
addition  of  a  drop  or  two  of  either  of  the  above-mentioned  fluids,  is 
inverted  over  a  concaved  slide.  The  edges  of  the  cover  should  be  sealed 
with  paraffin  or  mounting- varnish  to  prevent  evaporation.  The  slide 
may  be  set  aside  for  a  few  hours,  or  may  be  at  once  examined  as  the 
action  of  the  fluid  progresses.  Scrapings  from  a  stain,  if  no  clot  is  pro- 
curable, may  be  treated  in  the  same  manner ;  or  a  small  portion  of  the 


BLOOD  AND  OTHER   STAINS.  169 

stained  fabric  may  be  moistened  upon  the  slide  and  the  fibers  separated 
by  picking  apart  with  needles. 

If  the  stain  or  clot  be  tolerably  recent  the  corpnscles  may  begin  to 
show  themselves  in  a  few  minutes.  With  older  stains  the  process  may 
require  several  hours,  or  even  days.  Stains  which  are  more  than  a  week 
old  act,  under  the  operation  of  the  solvent,  in  substantially  the  same 
manner  as  stains  which  are  much  older,  and  there  is  practically  no 
difference,  in  most  cases,  between  stains  of  a  month's  age  and  those  of  a 
year's  standing,  provided  the  specimens  have  been  kept  under  conditions 
which  have  not  affected  the  structure  of  the  corpuscles. 

In  specimens  under  examination  the  portions  of  fluid  immediately 
surrounding  each  particle  become  gradually  tinted  of  a  reddish  or 
orange-yellow  color  from  the  solution  of  the  blood-coloring  matter,  and 
when  the  decolorization  is  nearly  complete  the  corpuscles  begin  to  be 
visible.  Very  few  perfect  ones  may  be  found,  because  most  of  them 
have  become  broken  or  distorted  while  drying.  If,  however,  the  drying 
has  taken  place  under  favorable  conditions,  if  the  stain  has  not  been 
washed,  subjected  to  heat  or  prolonged  dampness,  we  may  by  searching 
almost  always  discover  a  few  well-preserved  corpuscles.  If,  under  the 
treatment  we  have  given,  the  characteristic  disks  make  their  appearance, 
there  can  be  no  question  as  to  the  character  of  the  stain,  but  the  observer 
must  be  certain  that  the  cell-like  structures  which  develop  really  are  corpus- 
cles. Serious  mistakes  have  many  times  occurred  where  objects  have 
been  discovered  which,  under  preconceived  notions  of  the  observer,  have 
been  pronounced  corpuscles  of  blood. 

The  following  remarkable  case  is  within  the  personal  knowledge  of 
the  writer : 

In  the  case  of  Commonwealth,  vs.  Piper,  tried  in  Boston  in  1875,  the 
defendant,  a  sexton,  was  charged  with  the  murder  of  a  child  in  the 
belfry  of  his  church.  Certain  articles  having  upon  them  suspicious 
stains  were  placed  in  the  hands  of  several  local  experts  for  examination. 
Among  the  specimens  was  about  a  half-pint  of  water  found  in  a  pitcher 
in  the  basement,  in  which  it  wras  thought  that  the  prisoner  had  washed 
his  bloody  hands.  A  short  time  previous  to  the  trial,  the  experts,  four 
in  number,  made  their  report  of  the  results  of  their  examination  to  the 
prosecuting  officers,  and  every  one  of  the  four  stated  that  the  water  con- 
tained blood-corpuscles  which  measured  on  the  average  about  1-3300  of 
an  inch  in  diameter.  This  evidence  was  not  given  at  the  trial,  because 
the  government  decided  not  to  introduce  any  testimony  in  relation  to 
blood,  but  the  results  stated  in  the  report  would  undoubtedly  have  been 
given  if  it  had  been  called  for.  A  portion  of  the  water  was  critically 
examined  by  Professor  Wormley,  and  the  bodies  which  had  been  con- 
fidently measured  as  corpuscles  were  proved  to  be  merely  the  spores  of  a 
conferroid  alga. 

In  the  case  of  State  of  Connecticut  vs.  Hayden,  tried  at  New  Haven  a 
few  years  since,  a  stone  was  produced  at  the  preliminary  trial  which  had 
been  found  in  a  field  near  the  spot  where  a  young  woman  had  been  mur- 
dered, and  it  was  the  theory  of  the  prosecution  that  it  had  been  used  for 
striking  a  blow  upon  the  head  of  the  victim.  The  stone  was  stained 
with  what  appeared  to  be  blood,  and  it  was  testified  by  a  medical  witness 
of  some  local  celebrity  that  a  microscopical  examination  demonstrated 
its  presence.     Subsequently,  in  preparation  for  the  regular  trial,  the  stone 


170 


A   SYSTEM  OF  LEGAL  MEDICINE. 


was  examined  by  another  expert,  and  it  was  shown,  and  acknowledged 
by  the  first  witness,  that  a  mistake  had  occurred,  and  that  spores  had 
been  taken  for  corpuscles. 

The  following  case  is  given  by  Erdmann.  (Zeitsclirift  fur  Analyt 
Chemie,  vol.  ii.,  1862.)  An  assassination  had  been  committed  in  Leipzig, 
and  there  was  found  near  the  spot  where  the  crime  had  been  perpetrated 
a  brownish  stain,  which,  under  the  influence  of  rain,  assumed  the  appear- 
ance of  coagulated  blood.  An  aqueous  solution  of  this  stain  furnished  a 
reddish  fluid,  which  gave  with  tannin,  potassium  ferrocyanide,  and  other 
reagents  the  same  reactions  as  a  solution  of  dried  blood.  Examined 
under  the  microscope,  the  brown  matter  was  found  to  contain  corpuscles 
similar  to  those  of  blood.  The  stain,  however,  failed  to  give  any  haemin 
crystals  when  this  test  was  applied,  and  this  caused  Erdmann  to  enter- 
tain doubts  as  to  the  value  of  the  other  tests.  He  repeated  the  micro- 
scopical examination  with  greater  care,  and  then  discovered  that  the 
bodies  supposed  to  be  blood-corpuscles  were  the  spores  of  an  alga,  prob- 
ably porphyridium  omentum,  a  vegetation  so  named  on  account  of  its 
resemblance  to  blood. 

The  disks  found  in  pine,  spruce,  cedar,  and  other  coniferous  woods, 
the  excrements  of  the  cimex,  spheroidal  crystals  of  ammonium  urate,  oil- 
globules,  air-bubbles,  etc.,  are  mentioned  by  writers  as  possible  causes  of 
error  in  suspected  stains,  but  no  microscopist  of  experience  can  possibly 
mistake  any  of  them  for  blood-disks.  The  only  dangerous  fallacies  are 
to  be  found  in  bacteria  and  spores.  Bacteria  are  very  much  smaller 
than  blood-corpuscles.  The  micrococcus  known  as  prodigiosus,  which  in 
masses  appears  to  the  naked  eye  like  fresh  blood,  has  not  one  tenth  the 
diameter  of  a  blood-disk.  But  there  are  spores  of  various  fungi  and 
alga?  which  in  many  instances  have  the  same  diameter  as  blood- corpus- 
cles. The  spores  of  porphyridium  mentioned  in  Erdmann's  case  measure 
from  1-2900  to  1-3700  of  an  inch  in  diameter.     (Rabenhorst.)     Some  of 

the  fluids  which  have  been  recommended  by 
certain  writers  for  soaking  out  the  corpuscles 
from  blood-clots,  particularly  sodium  sul- 
phate, sodium  phosphate,  and  glycerin  solu- 
tion, if  too  much  diluted  will,  in  a  few  days, 
if  kept  in  a  warm  place,  develop  spores  some 
of  which  closely  resemble  decolorized  blood- 
corpuscles. 

Richardson,  referring  to  a  preparation 
recommended  by  several  writers,  a  saturated 
solution*of  sodium  sulphate,  says :  "  It  must, 
I  think,  owe  its  popularity  chiefly  to  the  fact 
that  it  contains  large  quantities  of  fungus, 
the  spores  of  which  resemble  blood-corpuscles 
both  in  size  and  general  appearance,  and  have, 
I  have  no  doubt,  frequently  been  mistaken 
for  blood-cells."  (Amer.  Jour.  Med.  Sciences, 
vol.  lxviii.,  p.  109.) 

Under  the  action  of  water,  blood-corpus- 
cles become  globular  and  finally  transparent 
and  invisible,  but  spores  are  not  in  any  way  changed  in  appearance  under 
the  same  circumstances.    Spores  are  never  disk-shaped,  though  they  often 


Fig.  16.     Blood-clot  and  Various 
Spores.    (750  diameters. ) 


BLOOD  AND   OTHER  STAINS. 


171 


appear  so.  They  are  frequently  oval  and  often  circular ;  they  may  have 
buds  upon  them,  and  they  are  generally  found  in  groups  of  two,  three, 
or  more.  Close  examination  will,  in  many  cases,  show  an  interior  struct- 
ure wholly  different  from  a  blood-corpuscle.  That  they  are  a  dangerous 
source  of  fallacy  is  proved  by  the  instances  we  have  given,  and  the  ob- 
server should  make  it 
a  rule  to  first  micro- 
scopically examine 
the  preparation  with 
which  he  intends  to 
;Soak  up  a  suspected 
stain,  and  use  only 
fresh  or  recently  made 
solutions. 

Materials  found 
Associated  with  Blood. 
— Incidentally  to  the 
microscopic  examina- 
tion of  suspected 
stains  in  the  search 
for  blood-corpuscles, 
other  bodies  may  be 
discovered,  of  which 
careful  note  should  be 
made.  These  may  be 
one  or  more  of  the  fol- 
lowing :  fibers  of  silk, 
wool,  cotton,  or  linen; 
fragments  of  mineral 
substances,     as     sand, 

earth,  bits  of  metal,  etc.;  hairs  of  various  hinds,  barbules  of  feathers,  vege- 
table tissues,  grass,  wood,  etc.;  particles  of  bom ,  muscular  fiber,  cerebral  mat- 
ter, epithelium,  etc.  All  such  substances  should  be  carefully  preserved. 
They  may  furnish  important  evidence  as  to  locality  or  circumstances. 
The  limits  of  this  article  do  not  permit  the  discussion  of  the  means  of 
identification  of  these  bodies,  and  the  reader  is  referred  to  any  good 
work  on  the  microscope,  as  the  treatises  of  Carpenter,  Frey,  Beale,  and 
others. 


Fig.  17.     a,  Cotton  Fiber;  h.  Air  Bubbles;  c,  Portions  of  Feather; 
d,  Silk;  e,  Oil  Globules.    (After  Hofmann;  300  diameters.) 


MEASUREMENT  OF  BLOOD-CORPUSCLES. 

If  blood-corpuscles  are  found  by  the  microscopic  examination,  it  will 
be  necessary  to  measure  them.  There  are  several  methods  by  which  this 
may  be  accomplished : 

(1)  By  the  screw  micrometer. 

(2)  By  photography. 

(3)  By  the  eye-piece  micrometer. 

The  last  is  the  most  common  as  well  as  the  most  convenient  method, 
and  is  the  only  one  which  we  shall  describe.  The  eye-piece  micrometer 
in  its  simplest  form  consists  of  a  circular  glass  plate  ruled  with  fine 
lines  (Fig.  17,  B),  which  is  cemented  upon  the  diaphragm  of  the  eye- 
piece between  the  field-glass  and  the  ocular  lens.     The  best  arrangement 


17 


70 


A   SYSTEAI   OF  LEGAL  MEDICINE. 


is  that  of  a  thin  brass  slide  holding  the  ruled  glass,  which  is  inserted 
through  a  slit  in  the  side  of  the  eye-piece  and  has  at  one  end  a  screw  by 
which  the  micrometer  can  be  given  a  slight  lateral  motion.  The  object 
to  be  measured  is  observed  through  the  glass  micrometer ;  one  side  of 
the  object  to  be  measured  is  brought  exactly  up  to  one  of  the  lines,  and 
the  number  of  spaces  which  the  object  covers  is  carefully  counted. 

The  value  of  the  spaces  of  the  eye-piece  micrometer  is  merely  rela- 
tive, and  dependent  upon  different  objectives  and  varying  adjustments 
of  the  instrument  The  value  of  the  spaces  is  determined  by  a  stage 
micrometer.  This  consists  of  a  piece  of  ruled  glass  with  spaces  of 
1-1000  of  an  inch.  These  spaces,  when  magnified  and  seen  through  the 
eye-piece  micrometer,  are  covered  by  a  certain  number  of  lines  in  the 
latter.  With  a  given  objective,  a  1-1000  space,  for  example,  may  be 
magnified  until  it  covers  five  lines  in  the  eye-piece ;  one  of  the  latter 
spaces,  therefore,  measures  1-5000  of  an  inch.  In  most  cases  the  eye- 
piece micrometer  will  not  cover  any  certain  number  of  full  spaces,  but 
there  will  be  so  many  spaces  and  a  fractional  part  of  another  space. 

In  such  cases  the  draw-tube  of  the  instrument  must  be  extended 
until  the  increased  amplification  makes  the  space  of  the  stage  micrometer 

equal  to  a  number  of  full  spaces  in  the  eye-piece. 
For  convenience  of  calculation  the  number  of  these 
should,  if  possible,  be  some  multiple  of  five  or  ten.  If  r 
under  a  high  power  (2500  diameters),  forty  spaces  in 
If  I         the  eye-piece  are  required  to  cover  one  space  (1-1000 

inch)  of  the  stage  micrometer,  one  space  of  the  former 
will  indicate  1-40,000  of  an  inch.  Fig.  18,  A,  repre- 
sents a  portion  of  an  eye-piece  micrometer  under  a 
micrometry  of  40,000,  and  the  concentric  circles  the 
outlines  of  blood-corpuscles  of  man,  the  dog,  rabbit, 
ox,  and  sheep.  The  largest  corpuscle  covers  12^ 
spaces ;  its  measurement  is  therefore  12.33-40,000  of 
an  inch.  Eeducing  this  fraction  to  its  simplest  form, 
we  obtain  1-3244.  In  the  same  manner  we  find  that 
the  corpuscle  of  the  sheep  covers  7^  spaces,  and  there- 
fore measures  7.75-40,000,  which  equals  1-5161. 

We  cannot  enter  further  into  the  minute  details 
of  micrometry,  but  must  not  omit  a  single  most  im- 
portant suggestion.  No  perfect  stage  micrometer  was 
ever  produced,  and  the  observer  must  carefully  com- 
pare and  calculate  the  true  value  of  each  space  which  forms  the  basis  of 
his  measurements.  An  otherwise  valuable  piece  of  testimony  may  be 
completely  shattered  by  a  single  question  on  cross-examination  :  "  If  you 
have  not  verified  your  micrometer,  how  do  you  know  that  your  measure- 
ments are  correct  ? " 


Fig.  18.     Eye-piece 
Micrometer. 


THE  DISTINCTION  BETWEEN  HUMAN  AND   OTHER  BLOOD. 


It  is  only  by  the  microscope  that  any  satisfactory  distinction  can  be 
made  between  human  and  other  blood.  Various  methods  have  been 
suggested  depending  upon  other  principles,  but  they  have  been  found  to 
be  unreliable  or  impracticable  in  their  application  to  dried  stains.  Bar- 
ruel's  process  depends  upon  the  production  of  an  odor  characteristic 


BLOOD  AND  OTHER  STAINS.  173 

of  the  particular  animal  when  fresh  blood  is  mixed  with  sulphuric  acid. 
(Annates  de  Hygiene,  1829.)  Taddei  proposed  to  distinguish  human 
blood  from  that  of  animals  by  the  degree  of  fluidity  produced  in  a  com- 
pound of  blood  and  carbonate  of  copper  when  treated  with  sulphuric 
acid.  (For  an  account  of  Taddei's  process,  called  haematolloscopy,  and 
also  Barruel's  method,  see  Fleming's  article  on  blood-stains  in  Am.  Jour. 
Med.  Sciences,  vol.  xxxv.,  p.  98, 1859.)  Neumann  claims  that  blood  evap- 
orated at  a  temperature  of  60°  F.  gives  a  residue  exhibiting  certain 
appearances  called  "  blood  pictures,"  which  are  characteristic  of  different 
animals.     (Die  Erhenmmg  des  Blutes,  Leipzig,  1869.) 

There  are  two  marked  points  of  difference,  under  microscojric  exam- 
ination, between  mammalian  and  oviparous  blood :  1.  The  circular  out- 
line of  the  corpuscles  of  the  former,  in  contradistinction  to  the  oval 
shape  of  the  latter ;  2.  The  presence  of  a  nucleus  in  oviparous,  and  its 
absence  in  mammalian,  blood.  Whether  the  stain  be  fresh  or  dry,  re- 
cent or  very  old,  these  differences  are  apparent  and  unmistakable.  Many 
instances  have  occurred  in  murder  trials  in  which  the  defendant  has 
claimed  that  stains  on  his  clothing  were  produced  by  the  killing  of  a  fowl 
or  were  due  to  the  blood  of  fishes.  In  all  such  cases,  the  falsehood,  if  it 
be  one,  is  easily  proved. 

The  possibility  of  distinction  between  the  blood  of  man  and  the  other 
mammalia  has  been  claimed  by  several  eminent  authorities,  including 
.Schmidt,  Richardson,  Formad,  Wormley,  and  Reese,  and  strenuously 
denied  by  others,  especially  by  Woodward  and  Ewell.  Nearly  all  writers 
on  medical  jurisprudence  express  grave  doubts  as  to  the  value  of  opin- 
ions based  upon  variable  fractional  differences  obtained  by  comparative 
measurements  of  corpuscles  derived  from  dried  stains. 

The  blood-corpuscles  of  most  of  the  mammalia  are  smaller  than  those 
of  man,  so  that  when  human  blood  is  compared  with  that  of  the  ox,  for 
example,  each  being  in  a  fresh  state,  by  examining  the  specimens  side 
by  side  upon  the  same  slide  (for  an  account  of  Richardson's  method  of 
preparing  such  slides,  see  American  Naturalist,  May,  1876)  a  difference 
in  the  diameters  of  the  two  is,  even  to  the  most  careless  observer,  clear 
and  unmistakable. 

The  diameters  of  the  corpuscles  of  a  large  number  of  animals  have 
been  measured  and  their  averages  recorded.  Suppose  now  that  a  speci- 
men of  mammalian  blood  of  unknown  origin  and  in  a  dried  state  upon 
cloth  is  subjected  to  microscopic  examination :  within  what  limits  is  the 
observer  warranted  in  expressing  his  opinion  as  to  its  origin  ? 

In  answer  to  this  inquiry,  we  remark  that  there  is  no  fixed  or  invari- 
able average  for  the  diameters  of  the  blood-corpuscles  of  any  animal.  It 
is  true  that  the  average  does  not  vary  beyond  certain  limits,  but  these 
limits  have  been  shown  by  the  observations  of  Woodward  and  Ewell 
upon  the  corpuscles  of  man  and  the  dog  to  be  much  greater  than  for- 
merly supposed.  Not  only  is  this  true,  but  the  averages  given  by  differ- 
ent observers,  while  agreeing  closely  in  some  instances,  show  consider- 
able^differences  in  others,  so  that,  assuming  the  principle  involved  in  this 
method  of  comparison  to  be  correct,  "it  entirely  depends,"  as  Formad 
observes,  "  upon  whose  figures  we  accept  whether  we  can  or  cannot  dis- 
criminate between  human  blood  and  the  blood  of  certain  other  animals." 

The  following  tables  give  the  average  measurements  of  the  blood- 
corpuscles  of  man,  dog,  guinea-pig,  rabbit,  rat,  mouse,  opossum,  wolf, 


174 


A   SYSTEM  OF  LEGAL  MEDICINE. 


ass,  pig,  ox,  cat,  horse,  sheep,  and  goat,  according  to  different  observers. 
The  figures  represent  fractions  of  the  inch,  and  the  measurements  are  of 
fresh  blood  dried  upon  glass. 


Man. 


Woodward  (1876). 
Ewell  (1890). 


1- 

1- 

Gulliver  (1875) 1- 

1- 

1- 

1- 

1- 

, 1- 

1- 

1- 

, 1- 

1- 

1- 

1- 

1- 

1- 


Formad  (1888). 
Richardson  (1876) 
Wormley  (1885)  .. 

Massou  (1885) 

C.  Schmidt 

Malinin  (1875). .. . 
Woodward  (1875). 

Kollicker 

H.  Schmid  (1878). 

Harting 

Robin 

Taylor 

Flint 


3092 
3162 
3200 
3200 
3224 
3254 
3257 
3267 
3300 
3379 
3390 
3412 
3436 
3484 
3500 
3500 


BdbUt. 

Gulliver 1-3607 

Masson 1-3636 

Wormley 1-3653 

Formad 1-3662 

Schmidt 1-3968 

Bat. 

Wormley 1-3652 

Gulliver 1-3754 

Schmidt 1-3968 

Schmid 1-5000 

Pig. 

Schmidt 1-4098 

Masson 1-4098 

Gulliver 1-4230 

Formad 1-4250 

Wormley 1-4268 

Ox. 

Formad 1-4200 

Wormley 1-4219 

Masson 1-4237 

Schmidt 1-4254 

Gulliver 1-4267 

Welcker 1-4545 

Schmid 1-4695 

Sheep. 

Wormley 1-4912 

Formad 1-5000 

Welcker 1-5076 

Gulliver 1-5300 

Schmidt 1-5649 

Schmid 1-6060 


Bog. 

Woodward 1-3246 

Gulliver 1-3395 

Welcker 1-3485 

Wormley 1-3561 

Masson 1-3577 

Formad 1-3580 

C.  Schmidt 1-3636' 

H.  Schmid 1-3846 

Guinea-pig. 

Woodward 1-3213 

Masson 1-3300 

Formad 1-3400 

Gulliver 1-3538 

Opossum. 

Wormley 1-3145 

Gulliver 1-3557 

Wolf. 

Wormley 1-3422 

Formad 1-3450 

Gulliver 1-3600 


Wormley. 1-3620 

Gulliver 1-4000 

Mouse. 

Wormley 1-3743 

Gulliver 1-3814 

Schmidt 1-4000 

Cat. 

Welcker 1-3922 

Wormley 1-4372 

Masson 1-4400 

Schmidt 1-4545 

Horse. 

Wormley 1-4243 

Formad 1-4310 

Schmidt 1-4464 

Welcker 1-4545 

Gulliver 1-4600 

Goat. 

Welcker 1-5525 

Formad 1-6100 

Wormley 1-6189 

Gulliver 1-6366 

Schmidt 1-6369 


The  subjoined  diagram  represents  the  apparent  areas  of  the  corpus- 
cles of  these  animals  (except  the  ass  and  wolf)  according  to  the  tables. 
The  outside  columns  represent  respectively  the  highest  and  the  lowest 


BLOOD  AND  OTHER  STAINS. 


175 


Man. 


Opossum. 


Guinea-pig. 


Babbit. 


average  of  any  observer,  while  the  middle  column  represents  the  averages 
of  the  averages.     It  is  obvious  that  the  blood  of  some  of  the  common 
animals  cannot  be  distinguished 
from  that  of  man  even  in  afresh 
state. 

Formad  (Jour,  of  Gomp.  Med., 
1888,  vol.  ix.,  p.  269)  attacks  the 
measurements  of  Woodward,  and 
endeavors  to  prove  that  they  are 
erroneous.  To  this  it  may  be  re- 
plied that  if  it  be  possible  that  so 
distinguished  a  microscopist  as 
Woodward  did  make  an  error,  it 
demonstrates  that  the  conclu- 
sions drawn  from  measurements 
of  a  less  competent  observer 
would  be  of  little  value  as  evi- 
dence in  a  capital  trial. 

There  is  no  doubt,  however, 
that  micrometric  measurements 
are  liable  to  error.  In  order  to 
ascertain  the  relative  accuracy 
of  such  determinations  made  by 
different  competent  observers, 
Ewell  ruled  a  glass  slide  with 
fifteen  lines,  making  spaces  ap- 
proximately of  1-250  to  1-125 
of  an  inch,  and  caused  the  same 
to  be  measured  by  six  well-known 
microscopists,  who  were  instruct- 
ed to  take  the  mean  of  at  least  five 
measurements  of  each  space.  Using 
standard  micrometers  by  the 
same  maker,  the  result  showed 
that  the  measurements  of  the 
same  space  by  different  observers 
varied  from  0  to  1-9090.  This  is 
a  greater  difference  than  that  be- 
tween the  average  diameters  of 
the  blood-corpuscles  of  man  and 
any  of  the  common  domestic  ani- 
mals except  the  sheep  and  goat, 
according  to  all  observers.  On 
the  other  hand,  Wormley  and  two 
others  measured  ten  lines  of  the 
1-1000  divisions  of  a  stage  mi- 
crometer, and  it  was  found  that 
they  agreed  in  the  several  read- 
ings within  1-200,000  of  an 
inch. 

The  uncertainty  of  discrimination  between  human  blood  and  that  of 
other  mammals  does  not  depend  upon  possible  errors  of  measurement. 


Mouse. 


Horse. 


Sheep. 


Goat. 


Fig.  19.  Diagram  representing  the  Compara- 
tive Sizes  of  the  Red  Blood-Corpuscles  of  various 
Animals.     (1450  diameters.) 


176  A   SYSTEM  OF  LEGAL   MEDICINE. 

Gulliver,  referring  to  his  own  extensive  measurements  of  corpuscles, 
says :  "  Special  circumstances,  too,  of  which  we  have  not  yet  sufficient 
knowledge,  may  affect  the  value  of  any  series  of  such  measurements  as 
are  recorded  in  these  tables.  When  the  bird  is  much  excited  and  the 
circulation  quickened  by  attempts  at  its  capture  in  an  aviary,  the  oval 
figure  of  its  red  blood-corpuscles  may  be  more  elongated  than  in  the 
same  bird  when  quietly  at  rest ;  .  .  .  and  my  attention  was  sometimes 
arrested  by  like  diversions  in  other  vertebrates  at  different  times  and 
seasons,  though  not  in  so  many  observations,  and  with  such  notes  as 
would  be  needful  for  satisfactory  conclusions.  But  the  facts  are  suffi- 
cient to  show  that  exact  and  extensive  investigations  are  yet  necessary 
on  the  comparative  magnitude  of  the  red  corpuscles  and  their  aggregate 
proportion  to  the  other  parts  of  the  blood  at  different  seasons  and  under 
different  circumstances.  For  example :  whether  minute  diversities  in 
the  corpuscles  may  not  be  found  in  man  at  the  tropics  and  at  the  frigid 
zone ;  in  animals  at  rest  and  during  violent  exertion ;  in  hibernating 
animals  during  summer  and  winter ;  in  species  subject  to  periodic  changes 
in  temperature."     (Proc.  Zoolog.  8oc,  London,  1875,  p.  477.) 

Woodward  measured  1766  corpuscles  in  groups  of  22  to  140  upon 
twenty-two  photographic  negatives  taken  from  the  blood  of  eight  per- 
sons, and  found  averages  *  as  follows : 


1-2915 

1-3049 

1-3068 

1-3165 

1-3215 

1-2967 

1-3058 

1-3068 

1-3165 

1-3236 

1-2985 

1-3058 

1-3125 

1-3175 

1-2994 

1-3068 

1-3135 

1-3185 

1-3021 

1-3068 

1-3155 

1-3205 

General  average  of  1766  corpuscles,  1-3090. 

(Trans.  Am.  Med.  Asso.,  1876,  vol.  xxvii.,  p.  303.) 

In  another  series  of  measurements  of  651  corpuscles  in  groups  of  50 
each  Woodward  found  the  averages  to  be : 

1-3472 


1-3289 

1-3356 

1-3379 

1-3425 

1-3333 

1-3367 

1-3400 

1-3448 

1-3344 

1-3367 

1-3425 

1-3460 

General  average,  1-3379. 

(Am.  Jour.  Med.  Sciences,  1875,  vol.  lxix.,  p.  151.) 

Ewell  obtained  the  following  averages : 

Boy  (thirty-six  hours  old),  average  of  200  corpuscles 1-2873 

Man  (plumbism),  "  100  "  1-2950 

Man  (tuberculosis),  "  100  "  1-3048 

Man  (gastritis),  "  100  "  1-3067 

Man  (normal),  "  100  "  1-3162 

Man  (amentia),  "  100  "  1-3311 

(North  American  Practitioner,  1890,  pp.  97,  151.) 

In  the  dog  Woodward  reports  the  averages  obtained  from  1571  cor- 
puscles measured  upon  thirteen  negatives : 

f  In  these  and  the  succeeding  values  the  original  decimal  measurements  have 
been  reduced  to  the  form  of  vulgar  fractions,  and  the  order  of  statement  slightly 

transposed. 


BLOOD  AND  OTHEli   STAINS.  177 

1-2941     1-3226     1-3246     1-3356     1-3379 
1-3155     1-3226     1-3279     1-3356 
1-3175     1-3226     1-3322     1-3379 
General  average,  1-3246. 

('Trans.  Am.  Med.  Asso.,  1876,  vol.  xxvii.,  p.  303.) 

Ewell,  in  measuring  several  series  of  100  corpuscles  from  each  of 
three  dogs,  obtained  the  following  results  : 

Puppy  (eight  days  old) 1-2985  1-3039  1-3039  1-3125 

Puppy  (eight  weeks  old) 1-3333  1-3378  1-3412 

Puppy  (seventy-six  days  old)  . .  1-3257  1-3355  1-3610 

(North  American  Practitioner,  pp.  97,  151.) 

We  are  not  aware  that  any  extended  series  of  measurements  has 
been  made  of  the  corpuscles  of  other  animals  covering  different  ages, 
breeds,  etc.,  but  it  is  probable  that  as  wide  variations  exist  in  all  cases 
a,s  have  been  proved  with  man  and  the  dog. 

The  averages  above  given  are  of  fresh  blood  rapidly  dried  upon  glass 
under  the  most  favorable  conditions  for  measurement.  In  dried  blood 
after  attempted  restoration,  the  difficulties  of  exact  measurement  and  of 
possible  variation  are  much  greater.  In  a  moist  atmosphere  corpuscles 
on  drying  sometimes  diminish  in  diameter  to  a  very  marked  degree.  In 
the  Sturtevant  murder  case,  tried  at  Plymouth,  Mass.,  in  1874,  two  medi- 
cal experts  of  excellent  reputation  testified  that  "  in  all  probability  "  cer- 
tain blood-stains  were  human,  because  the  corpuscles  averaged  "  between 
1-5400  and  1-6000  of  an  inch  in  diameter,"  these  figures  having  also 
been  obtained  by  the  witnesses  from  measurements  of  their  own  blood, 
dried  and  treated  in  the  same  manner  as  the  specimens  in  evidence. 

The  question  may  still  be  asked,  Are  there  not  limits  in  the  measure- 
ments of  blood-corpuscles  which,  in  certain  cases,  will  warrant  the  ex- 
pression of  opinion  as  to  their  origin  ?  Doubtless  there  are  limits,  but, 
in  our  opinion,  these  practically  exclude  all  the  common  animals  except 
the  sheep  and  the  goat.  There  may  be  instances,  under  specially  favor- 
able circumstances  (as  spots  upon  glazed  paper,  porcelain,  or  metallic 
buttons,  etc.),  in  which  one  may  make  satisfactory  measurements  of  the 
corpuscles.  Not  less  than  300  corpuscles  should  be  measured  to  ascer- 
tain the  average  (Form ad  says  500).  In  such  cases,  if  the  corpuscles  be 
too  large,  it  can  be  said  with  reasonable  certainty  that  the  blood  is  not 
that  of  some  given  animal. 

Richardson  admits  that  it  is  practically  impossible  to  determine  the 
difference  in  dried  stains  between  human  blood  and  the  blood  of  any 
animal  the  average  measurement  of  whose  corpuscles  is  more  than 
1-4000  of  an  inch.     {Monthly  Micros.  Jour.,  London,  vol.  xiii.,  p.  215.) 

The  following  animals  are  included  under  this  head,  if  we  accept  the 
highest  average  of  any  observer  as  the  one  on  which  we  base  our  conclusion : 

Elephant 1-2745  (Gulliver)  Wolf 1-3422  (Wormley) 

Sloth 1-2865  (Gulliver)  Woodchuek 1-3484  (Gulliver) 

Whale 1-3099  (Gulliver)  Hare 1-3560  (Gulliver) 

Opossum 1-3145  (Wormley)  Rabbit 1-3607  (Gulliver) 

Capybara 1-3164  (Wormley)  Ass 1-3620  (Wormley) 

Guinea-pig 1-3213  (Woodward)  Rat 1-3652  (Wormley) 

Dog 1-3246  (Woodward)  Bear 1-3656  (Wormley) 

Seal 1-3281  (Gulliver)  Mouse 1-3743  (Wormley) 


178  A   SYSTEM  OF  LEGAL  MEDICINE. 

Muskrat 1-3282  (Wormley)  Mule 1-3760  (Wormley) 

Beaver 1-3325  (Gulliver)  Bat 1-3880  (Gulliver) 

Porcupine 1-3369  (Gulliver)  Cat 1-3922  (Welcker) 

Monkey 1-3382  (Wormley)  Raccoon 1-3950  (Wormley) 

Kangaroo 1-3410  (Wormley)  Squirrel 1-4000  (Gulliver) 

The  following  expressions  of  opinion  of  well-known  authorities  are 
of  interest : 

Gulliver  (Proe.  Zoolog.  Soc,  London,  1875,  p.  484)  says :  "  The  magni- 
tude of  the  corpuscles  in  a  single  species,  not  excepting  the  human,  is 
liable  to  variations  within  certain  limits ;  and  there  commonly  appear  in 
one  field  of  vision  of  the  same  corpuscles  differences  amounting  to  at 
least  one  third  larger  and  smaller  than  the  average.  Hence,  as  regards 
the  medico-legal  question,  however  truly  a  careful  observer  (Dr.  Richard- 
son, Monthly  Micros.  Jour.,  1874)  may  have  distinguished,  by  comparative 
measurements  of  the  corpuscles,  stains  of  human  blood  from  those  of  the 
sheep  and  ox,  this  kind  of  diagnosis  would  be  ineffectual  in  some  prob- 
able and  more  possible  cases." 

Woodward  (Am.  Jour.  Med.  Sciences,  1875,  p.  151)  maintains  it  to  be 
the  duty  of  the  microscopist  summoned  as  a  scientific  expert  to  examine 
a  suspected  blood-stain  to  make  it  clearly  understood  by  both  judge  and 
jury  "  that  neither  by  the  microscope  nor  by  other  means  yet  known  to 
science  can  the  expert  determine  that  a  given  stain  is  composed  of 
human  blood  and  could  not  have  been  derived  from  any  other  source. 
This  course  is  imperatively  demanded  of  him  by  common  honesty,  with- 
out which  scientific  experts  may  become  more  dangerous  to  society  than 
the  very  criminals  they  are  called  upon  to  convict." 

Ewell  (Medical  Jurisprudence,  Boston,  1887,  p.  243)  says :  "  It  would 
be  extremely  perilous  to  undertake  by  mere  micrometric  measurements 
alone  to  distinguish  the  blood  of  man  from  that  of  another  mammal." 

Tidy  (Legal  Medicine,  vol.  i.,  Philadelphia,  1882)  says :  "  It  would,  in 
our  judgment,  be  unwise  to  hazard  an  opinion  as  to  the  source  of  a 
given  specimen  of  blood  from  the  microscopic  measurements  of  the 
disks,  especially  considering  that,  as  a  rule,  where  evidence  of  this  kind 
is  needed  the  measurements  have  to  be  made  after  treating  the  dried 
corpuscles  with  some  liquid  reagent." 

Halliburton  (Chemical  Physiology,  London,  1891)  remarks  as  to  cor- 
puscles in  dried  stains:  " Practically  it  is  not  possible  to  distinguish 
between  them." 

Stevenson  (in  Taylor's  Manual  of  Medical  Jurisprudence,  Philadelphia,. 
1892,  eleventh  American  edition,  p.  277)  writes  as  follows :  "  It  is  gen- 
erally admitted  by  scientific  men  that  we  have  at  present  no  certain 
method  of  distinguishing  human  blood  from  other  mammalian  blood 
when  it  has  once  dried  on  an  article  of  clothing  or  a  weapon.  This  is 
practically  the  form  in  which  the  problem  usually  comes  before  the 
medical  jurist.  He  may  be  able  to  state  that  the  shape  and  size  of  the 
corpuscles  as  seen  by  the  microscope  are  consistent  with  the  blood 
being  mammalian  and  probably  human,  but  it  is  impossible  to  say  with 
absolute  certainty  that  it  is  not  the  blood  of  an  animal,  like  the  ox 
or  pig." 

Expert  testimony  in  which  distinctions  are  attempted  between  human 
and  other  mammalian  blood  based  on  differences  of  1-10,000  to  1-15,000 
of  an  inch  are  not  generally  regarded  with  favor  either  by  judge  or  jury. 


BLOOD  AND   OTHER   STAINS.  179 

Suck  niceties  of  distinction  are  looked  upon  with  considerable  skepticism 
by  jurymen  accustomed  only  to  measurements  in  feet  and  inches. 

If  the  witness  is  able  to  say  that  "stains  are  of  mammalian  blood  and 
that  the  diameters  of  the  corpuscles  are  consistent  with  human  blood,"  and  if 
he  expressly  states  that  they  may  be  of  other  blood,  he  is  giving  testimony 
which  will  doubtless  be  accorded,  the  weight  to  which  it  is  entitled,  and  which 
cannot  be  effectively  contradicted  by  the  defense.  On  the  other  hand,  ex- 
treme opinions  given  in  evidence  always  lead  to  contradictions  between 
opposing  experts,  the  result  of  which  is  that  the  jury  are  confused  in- 
stead of  assisted,  and  generally  disregard  all  the  expert  testimony  upon 
that  branch  of  the  case. 

In  the  trial  of  Leavitt  Alley  in  Boston  in  1873  evidence  was  given 
by  a  medical  witness  called  by  the  government  that  certain  blood-stains 
were  not  those  of  a  horse,  and  that  the  difference  in  the  size  of  the  cor- 
puscles of  this  animal  and  man  in  dried  stains  could  be  "  distinguished 
as  easily  as  pease  and  corn."  The  defense,  as  might  be  expected,  brought 
other  witnesses  who  disputed  the  radical  opinions  which  had  been  given, 
making  the  case,  for  the  time  being,  "a  trial  of  blood-stains"  and  not  of 
the  defendant.  The  testimony  as  to  blood,  while  of  no  direct  benefit 
to  the  defendant,  was  a  source  of  weakness  to  the  government.  More 
moderate  opinions  would,  no  doubt,  have  been  received  with  favor  and 
could  not  have  been  disputed.  The  slight  importance  attached  to  the 
opinions  of  the  six  expert  witnesses  who  testified  may  be  inferred  from 
the  charge  of  Judge  Wells.  His  only  allusion  to  the  experts  was  as  fol- 
lows :  "  Perhaps  the  jury  might  not  think  it  worth  while  to  consider  the 
difference  between  the  medical  experts,  but  if  they  could  get  any  help 
out  of  it  they  would  give  it  such  weight  as  it  deserved." 

In  the  case  of  Reg.  vs.  Nation  (quoted  by  Taylor)  it  was  contended  by 
the  prosecution  that  a  certain  knife  had  been  used  for  cutting  the  throat 
of  a  man  who  had  been  murdered.  The  defense  claimed  that  the  knife 
had  been  used  for  cutting  raw  beef.  A  government  expert  testified  that 
the  knife  had  been  stained  by  living  blood,  and  that  it  was  not  the  blood 
of  the  ox.  Chief-Justice  Cockburn,  in  commenting  upon  the  evidence  of 
experts,  said :  "  In  admitting  the  advantages  of  science,  they  are  coming 
to  great  niceties  indeed  when  they  speculate  upon  things  almost  beyond 
perception,"  and  he  added  that  he  would  advise  the  jury  not  to  convict  upon 
this  scientific  speculation  alone. 

Menstrual,  Arterial,  and  Venous  Blood. — The  question  may  arise 
whether  certain  stains  are  of  menstrual  blood.  There  is  no  distinguish- 
ing chemical  or  microscopical  test  by  which  blood  of  this  character  and 
that  flowing  from,  a  wound  may  be  determined.  Certain  well-known 
chemical  differences  exist,  but  they  do  not  furnish  a  basis  for  any  reli- 
able conclusions  in  dried  stains.  Menstrual  blood  under  the  microscope 
may  show  epithelial  scales  from  the  vagina.  Vaginal  epithelium  resem- 
bles that  from  the  mucous  membrane  of  the  respiratory  organs  and  of 
the  whole  alimentary  canal ;  hence,  blood  from  a  hemorrhage,  from  the 
bowels,  or  from  piles  might  be  mistaken  for  menstrual  blood.  For  the 
medico-legal  comparison  of  menstrual  blood  and  that  of  other  stains, 
see  Annates  de  Hygiene,  1858,  vol.  x.,  p.  421.  No  distinction  can  be  made 
between  venous  and  arterial  blood  based  on  chemical  or  microscopical 
examination. 

Age  of  Stains. — The  color  of  blood-stains  (crimson  or  dark  brown) 


180 


A   SYSTEM  OF  LEGAL  MEDICINE. 


and  the  spectroscopic  examination  may,  under  special  circumstances, 
warrant  the  conclusion  that  the  blood  is  comparatively  recent  or  other- 
wise.   Beyond  this  noth- 
ing can  be  determined 
with  certainty. 

Undue  Importance 
Attached  to  Smalt  Stains. 
— An  unwarranted  im- 
portance is  often  at- 
tached to  small  stains 
upon  the  clothing  of  per- 
sons accused  of  crime. 
Taylor  mentions  the  case 
of  a  man  tried  for  mur- 
der upon  whose  shirt 
were  found  minute  spots 
of  blood,  which  were  re- 
garded as  proofs  of  guilt, 
until  it  was  explained 
that  they  were  probably 
derived  from  flea-bites, 
and  that  some  were  on 
one  side  and  some  on  the 
other,  showing  that  the 
shirt  had  been  worn  on 
the  two  sides.  The  stains 
made  by  crushing  the  cimex  and  the  mosquito  show  unchanged  cor- 
puscles of  human  blood.  The  clothing  worn  by  the  laboring  classes 
may  show  blood-stains  derived  from  various  innocent  sources  which  an 
accused  person  might  be  entirely  unable  to  explain.  On  the  other  hand, 
nothing  can  be  more  erroneous  than  the  very  common  idea  that  no  per- 
son can  commit  a  murder  in  which  blood  is  effused  without  having  his 
clothing  more  or  less  stained.  Taylor  gives  many  instances  in  which  he 
had  examined  clothing  worn  by  persons  subsequently  convicted  of  mur- 
der, and  either  no  blood  was  found  on  any  part  of  the  dress,  or  only 
small  spots  wholly  out  of  proportion  to  the  amount  of  blood  which  must 
have  flowed  from  the  wounds  of  the  deceased.  {Principles  and  Practice  of 
Medica  I  Jurisprudence. ) 


Fig.  20.    Epithelium  from  the  Vagina.    (After  Ultzmann; 
300  diameters. ) 


ILLUSTRATIVE   CASES. 

Case  I.    Attempted  Distinction  between  the  Blood  of  Man  and 

the  Cow. 

( Abridged  from  Casper's  "Handbook  of  Forensic  Medicine,"  vol.  i.,  case  Ivi.) 

REPORT  OF  PROFESSORS  CASPER  AND  DUBOIS-REYMOND. 


A  man  was  struck  bleeding  and  senseless  upon  the  highway  and 
afterward  robbed.  A  party  was  arrested  for  the  crime  whose  boots 
exactly  fitted  some  footprints  in  the  snow  at  the  place  of  the  robbery, 
and  upon  whose  trousers  was  a  bloody  stain  the  size  of  the  palm  of  the 


BLOOD  AND  OTHER   STAINS.  181 

hand.  This  he  explained  by  saying  that  during  the  Christmas  just  passed 
he  had  assisted  at  the  slaughtering  of  a  cow.  This  statement  was  found  to 
be  correct,  and  the  trousers  were  sent  to  Professor  Casper  with  the  request 
that  he  would  determine  microscopically  whether  the  blood-stain  arose  from 
human  or  cow's  blood.  The  examination  was  made  jointly  by  Professors 
Casper  and  DuBois-Reymond.     Their  report  in  part  was  as  follows : 

"Investigations  of  this  nature  are  rendered  more  difficult  by  the 
blood  not  being  perfectly  recent,  and  also  by  the  question  lying  between 
the  bloods  of  such  animals  as  have  their  blood-corpuscles  of  similar 
form.  The  latter  is  particularly  the  case  in  respect  to  the  blood-corpus- 
cles of  man  and  those  of  most  of  the  mammalia,  particularly  oxen,  in 
so  far  as  both  are  uniformly  circular,  and  the  human  blood-corpuscles 
merely  somewhat  greater  in  diameter  than  those  of  oxen.  At  our  first 
microscopic  examination,  on  the  8th  of  February,  we  once  more  com- 
pletely satisfied  ourselves  on  these  points,  for  recent  human  and  ox  blood 
having  been  compared  together  the  difference  could  most  distinctly  he  made 
out;  also,  after  mixing  both  kinds  of  blood  together,  the  smaller  corpus- 
cles of  the  ox  could  be  readily  distinguished  from  the  larger  human 
ones.  We  then  proceeded  to  the  corpus  delicti.  Portions  cut  from  the 
blood-stain  on  the  trousers  were  soaked  in  pure  neat's-  foot  oil  and  exam- 
ined, but  instantly  the  utmost  variety  aud  uncertainty  of  opinion  began 
to  prevail  among  the  observers  present  because  the  form  of  the  blood- 
corpuscles  was  indistinctly  seen.  The  blood-stain  in  question,  moreover, 
at  the  time  of  examination  might  have  been  six  and  was  at  least  three 
weeks  old,  and  could  therefore  only  present  to  view  perfectly  shriveled 
blood-corpuscles,  which  always  give  an  uncertain  result.  In  order  to 
test  the  contrary  opinion  advanced  by  a  recent  author  (Schmidt),  .  .  . 
we  experimented  by  dropping  upon  other  parts  of  the  same  trousers 
recent  human  and  recent  ox  blood,  laying  the  pieces  of  cloth  aside  in 
precisely  similar  conditions  for  eight  days  to  dry.  On  the  15th  of  Feb- 
ruary we  proceeded  to  our  second  microscopic  investigation  by  soaking 
both  these  stains  in  bone  oil,  and  bringing  them  under  the  same  micro- 
scope, first  examining  each  stain  separately,  and  afterward  mixing  the 
bloods  together.  The  result  was  that  although  the  dried  human  blood 
seemed  to  have  more  resemblance  to  that  of  the  corpus  delicti  than  the 
dried  ox  blood  had,  yet  the  form  and  diameter  of  both  kinds  of  blood 
were  so  much  altered  by  the  shriveling  they  had  undergone  that  it  was 
perfectly  impossible  to  give  a  decided  opinion  upon  the  subject.  We 
must  therefore  give  it  as  our  opinion  that  it  is  impossible  to  state  with 
certainty  whether  the  blood-stain  on  the  trousers  of  the  accused  is  caused  by 
the  blood  of  man  or  the  cow? 


Case  II.    Human  Blood  or  the  Blood  of  the  Duck. 
( Abridged  from  u Annates  de  Hygiene?  1857,  vol.  viii.,  p.  369. J 

REPORT  OF  PROFESSORS  ROBIN  AND  SALMON. 

The  following  is  an  extract  from  a  report  by  Professors  Robin  and 
Salmon  upon  the  examination  of  stains  upon  a  cotton  blouse  belonging 
to  one  Doiteau,  accused  of  murder.     The  blouse  was  taken  from  the 


182  A   SYSTEM  OF  LEGAL  MEDICINE. 

prisoner  about  eight  hours  after  the  commission  of  the  crime  with  which 
he  was  charged,  and  appeared  to  be  stained  with  blood.  The  defendant 
attempted  to  account  for  the  stains  by  the  story  that  he  had  killed  a 
duck.  One  of  the  qxiestions  submitted  to  the  experts  was  in  substance 
the  following :  "Are  the  blood-stains  those  of  a  duck  or  from  the  body 
of  a  murdered  woman  of  about  seventy  years  of  age  ? "  The  answer  of 
the  experts  was  as  follows  : 

u  The  dark  reddish-brown  stains  upon  the  blouse  have  been  produced 
by  blood.  .  .  .  We  are  warranted  in  this  conclusion  since  blood  is  the 
only  fluid  containing  the  red  globules  which  we  have  separated  from 
these  stains ;  in  blood  alone  are  found  these  bodies,  together  with  fibrin 
and  the  white  globules  which  we  have  recognized  in  the  network  which 
it  forms.  The  microscope  only  can  determine  this  question,  for  these 
stains  are  too  small  to  allow  of  the  detection  of  albumen :  moreover, 
albumen  having  all  the  characteristics  of  the  albumen  of  blood  is  found 
not  only  in  a  great  number  of  animal  fluids,  but  also  in  the  colored  or 
uncolored  juices  of  plants,  while  blood  alone  contains  at  the  same  time 
the  fibrin,  the  flattened  circular  red  globules — destitute  of  a  nucleus — 
and  the  white  spherical  globules,  showing  from  one  to  three  granules 
after  the  action  of  acetic  acid.  .  .  .  But  the  elements  of  blood  which 
compose  these  stains  are  not  those  from  the  blood  of  the  duck;  they 
have,  on  the  contrary,  all  the  constituent  elements  of  human  blood; 
they  have  neither  the  oval  form,  the  dimensions,  nor  the  central  nucleus 
which  are  found  in  the  red  globules  from  either  fresh  or  dried  blood 
derived  from  ducks  or  other  birds. 

"  The  elements  of  the  blood  forming  the  stains  upon  the  blouse  are 
those  of  human  blood,  for  they  contain  fibrin  and  respond  to  the  re- 
actions of  acetic  acid,  etc. ;  the  white  globules  are  found  in  these  stains, 
and  they  have  the  volume,  the  form,  the  granulations,  the  nuclei,  and 
the  chemical  reactions  belonging  to  the  white  globules  of  human  blood. 
The  red  globules  are  found,  also ;  they  have  the  volume,  the  flattened 
circular  biconcave  form,  the  pale  reddish-yellow  color  which  are  seen  in 
the  red  globules  of  human  blood  viewed  by  transmitted  light  in  the 
microscope,  and,  like  these,  dissolve  in  water  and  acetic  acid  without 
leaving  any  traces  behind  them. 

"  But  in  the  present  state  of  science,  it  is  impossible  to  determine,  by 
the  examination  of  this  blood,  either  the  sex  or  the  age  of  the  individual 
from  whom  it  flowed." 


Case  III.    Possible  Human  and  Sheep's  Blood  Present  at  the 
Same  Time  in  Stains  upon  Clothing. 

report  of  a  joint  examination  by  professors  wormley,  chase,  har- 
riman,  and  babcock  made  during  the  progress  of  a  trial 

by  order  of  the  court. 

In  the  month  of  January,  1875,  the  dead  body  of  the  wife  of  a  farmer 
named  Emerson,  residing  in  Piermont,  N.  H.,  was  found  about  nine 
o'clock  in  the  morning  with  the  head  entirely  blown  off.  The  body  was 
still  sitting  in  a  chair  near  the  stove  in  the  kitchen  of  the  house;  the 
right  hand  held  a  needle  with  which  the  deceased  had  been  sewing,  and 


BLOOD  AND  OTHER   STAINS.  183 

scissors  and  thread  were  in  her  lap.  A  recently  discharged  gun,  the 
butt-end  farthest  from  the  body,  was  found  two  feet  behind  it.  There 
were  but  two  persons  about  the  premises  at  the  time — the  husband  and 
a  man  of  about  sixty  years  of  age,  a  visitor  named  Sawyer.  The  latter 
was  arrested  for  the  supposed  murder.  There  had  been  no  trouble  of 
any  kind  between  the  members  of  the  family,  and  no  motive  could  be 
assigned  for  the  commission  of  the  deed.  The  gun,  which  belonged  in 
the  house,  had  been  loaded  by  the  husband  with  a  heavy  charge  of  shot 
on  the  night  before  the  tragedy,  for  the  purpose  of  shooting  a  strange 
cat  which  had  been  prowling  about  the  premises.  Blood  in  several 
small  stains  was,  some  days  after  the  homicide,  found  upon  the  clothing 
both  of  Sawyer  and  of  the  husband,  but  the  expert  for  the  government 
declared  that  the  blood  upon  the  clothing  of  the  prisoner  was  "  probably 
human  blood,  as  the  corpuscles  measured  1-3400  of  an  inch  in  average 
diameter,"  while  that  upon  the  husband's  clothing  was  "  probably  sheep's 
blood,  the  corpuscles  having  an  average  diameter  of  1-5840."  Emerson 
stated  that  about  a  week  before  the  affair  he  had  killed  a  sheep,  and  this 
was  proved  by  several  witnesses.  Circumstances  developed  which  pointed 
strongly  to  the  theory  of  accident :  that  the  husband  with  mittens  on  his 
hands  and  icy  boots  had  hurriedly  gone  into  the  house  to  get  the  gun 
for  the  possible  chance  of  shooting  a  fox  which  was  being  pursued  by 
dogs  a  short  distance  down  the  road ;  that  with  his  snow-covered  boots 
he  probably  slipped  upon  the  wooden  floor,  and  that  the  gun  was  acci- 
dentally discharged ;  and  that  the  husband,  fearing  the  consequences, 
denied  all  knowledge  of  the  occurrence. 

Under  these  circumstances  the  counsel  for  the  prisoner  demanded  a 
reexamination  of  the  clothing  of  Emerson.  The  court  granted  the 
request,  and  appointed  four  experts,  representing  both  the  government 
and  the  defendant,  to  conduct  a  joint  investigation  to  be  made  during 
the  progress  of  the  trial.  Professors  Wormley,  Chase,  Harriman,  and 
Babcock  were  selected  for  this  service.  The  writer  acted  as  secretary  of 
this  board  of  experts,  and  in  giving  the  results  of  the  inquiry  testified 
substantially  as  follows : 

"  Our  examination,  in  which  all  agree,  shows : 

"  1.  In  numerous  places,  both  upon  the  jacket  and  overalls  of  Emer- 
son, there  are  blood-stains. 

"  2.  The  stains  are  of  mammalian  blood. 

"  3.  The  very  marked  difference  in  the  size  of  the  corpuscles  in  the 
different  stains  indicates  two  kinds  of  blood.  One  kind  is  like  that 
which  belongs  to  such  animals  as  man,  the  dog,  monkey,  rabbit,  guinea- 
pig,  etc.,  and  the  other  kind  is  like  that  found  in  animals  having  much 
smaller  corpuscles,  as  the  sheep. 

"  The  measurements  of  the  corpuscles  of  the  larger  kind  were  from 
1-3300  to  1-4200,  and  averaged  about  1-3500.  The  corpuscles  of  the 
smaller  kind  averaged  1-6000  of  an  inch,  and  varied  from  1-5000  to 
1-7000." 

(Figures  showing  the  details  of  a  large  number  of  measurements 
were  here  given.) 

"  The  micrometer  used  for  the  measurements  was  one  which  had 
been  verified  by  Professor  Wormley.  The  larger  corpuscles  were 
within  the  range  of  the  average  of  human  blood,  and  could  not  have 
been  from  the  blood  of  the  sheep,  as  they  were  much  too  large.     The 


134  A   SYSTEM   OF  LEGAL  MEDICINE. 

smaller    corpuscles    were    consistent    with    the    presence    of    sheep's 
blood." 

The  jury  disagreed  as  to  their  verdict,  but  the  majority  were  in  favor 
of  the  defendant.  Under  the  circumstances,  the  government  being  sat- 
isfied that  there  Avas  no  more  evidence  against  Sawyer  than  against 
Emerson,  and  it  being  doubtful,  even,  if  there  had  been  a  murder,  con- 
sented to  the  release  of  the  prisoner,  upon  nominal  bail. 


SEMINAL   STAINS. 

The  seminal  fluid  is  a  viscous  and  opaline  fluid  of  peculiar  odor  and 
slight  alkaline  reaction.  It  contains  about  eighty-five  per  cent,  of  water 
and  fifteen  per  cent,  of  solid  constituents.  But  little  is  known  in  regard 
to  the  nature  of  these  solids  beyond  the  fact  that  they  contain  albumin- 
ous principles,  extractive  matters,  a  small  amount  of  fat,  and  salts.  The 
latter  are  principally  calcium  phosphate  and  sodium  in  combination  as 
albuminates.  There  are  no  characteristic  chemical  tests  by  which  this 
secretion  may  be  identified  in  a  dried  stain. 

Examined  by  the  microscope  under  a  power  of  three  hundred  or  four 
hundred  diameters,  the  fluid  is  seen  to  contain  more  or  less  numerous  so- 
called  animalcules,  or  spermatozoa.  These  structures  consist  of  a  flattened 
pear-shaped  portion  called  the  head,  and  a  long  filament  or  tail.  The 
latter  is  thickest  at  the  end  nearest  the  head,  and  has  a  terminal  portion 
of  extreme  fineness.  The  tail  is  ten  or  twelve  times  the  length  of  the 
head,  and  on  account  of  its  extreme  transparency  may  be  invisible  except 
in  its  thicker  portion,  thus  appearing  much  shorter  than  its  actual  length. 
The  addition  of  a  drop  of  solution  of  eosin  or  of  iodine  in  potassium 
iodide  brings  out  the  entire  length  of  the  tail  with  distinctness.  The 
head  at  its  broadest  part  is  a  little  more  than  one  third  the  diameter  of 
the  human  blood-corpuscle.  According  to  Lehmann,  the  head  measures 
from  1-5300  to  1-4500  of  an  inch  in  length,  and  from  1-16,000  to  1-9000 
of  an  inch  in  breadth ;  the  tail  has  a  length  of  from  1-600  to  1-450  of 
an  inch,  but  may  be,  in  some  specimens,  no  more  than  1-1000.  The 
seminal  fluid  contains  also  epithelial  scales,  mucus-corpuscles,  and  spher- 
ical bodies  called  seminal  granules. 

Seminal  stains  on  cotton  or  linen  when  held  near  the  fire  become  pale 
yellow.  According  to  Orfila,  this  effect  of  heat  is  characteristic,  and  is 
different  from  its  action  upon  all  other  discharges.  If  moistened  with 
water  and  warmed,  there  is  developed  the  peculiar  odor  of  the  seminal 
fluid.  These  tests  must  be  regarded  only  as  indications,  and  in  no  case 
should  a  stain  be  pronounced  as  of  seminal  origin  unless  the  microscope 
shows  the  presence  of  spermatozoa.  It  is  true  that  under  certain  condi- 
tions these  bodies  may  be  absent  from  the  secretion,  but  in  such  a  case 
there  can  be  no  absolute  proof  that  the  suspected  stain  is  of  spermatic 
origin. 

The  following  method,  proposed  by  Koblanck  in  1853,  may  be  adopted 
for  the  preparation  of  specimens  for  microscopical  examination  :  A  portion 
of  the  stained  linen  about  one-half  inch  square  is  moistened  with  a  few 
drops  of  pure  water  contained  in  a  watch-glass.  The  glass  is  covered  to 
protect  it  from  dust,  and  the  linen  allowed  to  absorb  the  water  for  an 
hour  or  more.     The  stain  should  be  moistened  only,  not  immersed  in 


BLOOD  AND    OTHER   STAINS. 


185 


the  water,  and  the  latter  should  be  in  no  greater  quantity  than  is  suffi- 
cient for  the  purpose.  When  the  stain  has  been  softened  it  is  scraped 
lightly  with  a  scalpel,  a  portion  transferred  to  a  microscope-slide,  a  drop 
of  eosin  solution  added,  and  covered  with  a  thin  glass. 

Hamlin  (Proc.  Amer.  *SV.  Micros.,  1883,  p.  83)  has  described  a  process 
for  the  investigation  of  seminal  stains  which  the  writer  has  found  to  be 
much  more  satisfactory  in  its  results  than  the  usual  method.  If  the  stain 
is  upon  a  fabric  of  cotton,  linen,  silk,  or  wool,  a  small  piece  about  one- 
eighth  inch  square  is  cut  out  and  laid  upon  a  slide  previously  moistened 
with  water,  and  allowed  to  soak  for  a  half -hour  or  more,  renewing  the 
water  as  it  evaporates.  The  cloth  is  then  carefully  frayed  out  into 
threads  by  needles,  and  covered  with  a  thin  glass  for  examination. 
Specimens  prepared  in  this  manner  show  the  spermatozoa  clinging  to  the 
fibers  or  lying  in  masses  in  the  meshes  of  the  fabric.  By  the  usual  pro- 
cess of  soaking  and  scraping  the  greater  portion  of  the  spermatozoa  are 
destroyed,  and  in  stains  of  known  origin  evidence  of  their  presence  is 
only  obtainable  after  long  and  persistent  search,  and  even  then  but  few 
specimens  are  to  be  found.  Hamlin's  method  shows  them  at  once  and 
without  difficulty. 

The  appearance  of  the  spermatozoa  under  the  microscope  is  highly 
characteristic,  and  there  can  hardly  be  a  mistake  in  regard  to  their  pres- 
ence. 


Fig.  21. — a,  trichomonas  vaginae  (Donne1);   h,  spermatozoa. 

No  separated  parts  should  be  regarded.  Spermatic  granules  may  be 
mistaken  for  detached  heads,  and  minute  filaments  from  the  stained 
fabric  may  appear  bike  portions  of  the  tail.  Nothing  less  than  the  pres- 
ence of  complete  spermatozoa  should  be  deemed  conclusive  evidence  that 
a  stain  is  of  seminal  origin.  In  the  examination  of  stains  upon  the  linen 
of  females  careless  of  personal  cleanliness  and  containing  vaginal  mucus, 
there  may  possibly  be  observed  an  animalcule  described  by  Donne  {Re- 
cherche* Microscopiques,  Paris,  1837)  as  trichomonas  vaginae.     This  organ- 


186  4.  SYSTEM  OF  LEGAL   MEDICINE. 

isin  has  four  or  six  short  cilia  attached  to  the  head ;  the  head  is  granular, 
and  three  or  four  times  larger  than  that  of  the  spermatozoon.  The  latter 
has  no  cilia,  and  both  in  its  head  and  tail  is  transparent  and  structure- 
less. Spermatozoa  present  in  dried  stains  resist  decomposition  by  atmos- 
pheric influences,  and,  if  not  subjected  to  abrasion  by  rough  handling, 
may  be  detected  even  after  the  lapse  of  several  years. 


BIBLIOGRAPHY. 

A  List  of  some  of  the  Most  Important  Publications  on  the  Medical  Jurisprudence  of 

Blood-stains. 

1848.     Schmidt,  Carl,  "  Diagnostik  verdacktiger  Flecke  in  Criminalf alien."     Milan  und 

Dorpat,  1848. 
1852.     Freidberg,  "Forensiscke  Diagnostik  ties  Blutes."     Berlin,  1852. 
1857.     Robin,  "Memoire  concemant  l'examen  a  l'aide  du  microscope  de  taches  de 

sang,"  etc.     "Annales  de  Hygiene,"  1857,  vol.  viii.,  p.  368. 
1859.     Fleming,  C,  "Blood-stains."    "Amer.  Jour.  Med.  Sciences,"  1859,  vol.  xxxv. 
1865.     Sorby,  " Quarterly  Journal  of  Science."     Loudon,  1865,  vol.  vi.,  p.  9. 
1869.     Richardson,  J.  C,  "Amer.  Jour.  Med.  Sciences,"  1869,  vol.  lviii.,  p.  50. 
1869.     Sonnenschein,  "Handbiick  der  gericktlicken  Ckemie."     Berlin,  1869. 
1869.     Briand,  J.,  et  Chaude,  E.,  "Manuel  Complet  de  Medecine  Legale   avec  une 

Trait6  de  Ckimie  Legale  par  J.  Bonis."     Paris,  1869. 

1873.  Mialhe  (avec  Mayet,  Lefort,  et  Cor  nil),  "Instruction  pour  servir  a  determiner 

les  elements  constituants  du  sang  dans  les  tackes."    "Annales  de  Hygiene," 
1873,  vol.  xk,  p.  190. 

1874.  Richardson,  J.  C,  "Amer.  Jour.  Med.  Sciences,"  1874,  vol.  lxviii.,  p.  102. 

1875.  Richardson,  J.  C,  "Montkly  Microscopic  Journal."     London,  vol.  xiii.,  p.  213. 
1875.     Gulliver,  G.,  "Observations  on  the  Sizes  and  Skapes  of  Eed  Blood-Corpuscles 

of  tke  Blood  of  Vertebrates."     "Proc.  Zoological  Society,"  London,  1875, 
p.  474. 
1875.     Otto,  "Anleitung  zur  Ausmittelung  der  Gifte  und  zur  Erkennung  de  Blut- 
flecken."     Braunsckweig,  1875,  p.  162. 

1875.  Woodward,  J.  J.,  "  Blood-Corpuscles  of  Man  and  tke  Dog."    "Amer.  Jour.  Med. 

Sciences,"  1875,  vol.  lxix.,  p.  151. 

1876.  Woodward,  J.  J.,  "Medical  Jurisprudence  of  Blood-stains."     "Trans.  Amer. 

Medical  Association,"  1876,  p.  302. 

1877.  Woodman,    IV.   B.,    and   Tidy,  J.  M.,   "Forensic    Medicine   and   Toxicology." 

Pkiladelpkia,  1877. 
1880.     Clement,  "  Conferences  pratiques  de  Medecine  Legale."     Paris,  1880. 

1880.  Piper,  R.  U.,  "Expert  Testimony  and  tke  Microscopic  Examination  of  Blood." 

"American  Law  Register,"  1880,  vol.  xxviii.  (old  style),  pp.  529,  593. 

1881.  Dragendorf,  "Der  Blutflecken."    Masckka's  "  Handbuck  der  Gericktlicken  Me- 

decin."     Tubingen,  1881,  Bd.  I.,  p.  482. 

1881.  Hoffman,  "Nouveaux  Elements  de  Medecine  Legale."     Paris,  1881. 

1882.  Tidy,  J.  M.,  "Legal  Medicine."     Philadelpkia,  1882. 

1885.     Masson,  M.,  "L'Origin  du  Sang  en  MMeeine  Legale."     "Annales  de  Hygiene," 

Paris,  1885,  series  iii.,  vol.  xiii.,  p.  393. 
1885.      Wormley,  T.,  "  Microckemistry  of  Poisons."   Second  edition,  Pkiladelpkia,  1885. 
1888.     Formad,  H.  F.,  "  Comparative  Studies  of  Mammalian  Blood."    "  Jour,  of  Comp. 

Med.  and  Surgery,"  1888,  vol.  ix.,  p.  254. 
1890.     Eivell,  M.  D.,  "  Nort'k  American  Practitioner,"  1890,  pp.  97  and  173. 
1892.     Bell,  C,  "Blood-stains  in  Medical  Jurisprudence."     "Medico-Legal  Journal," 

New  York,  vol.  x.,  p.  129. 
1892.     Taylor,  A.  S.,  "Manual  of  Medical  Jurisprudence."    Pkiladelpkia,  1892. 


HAIRS  AND  FIBERS. 

BY 

JAMES  F.  BABCOCK. 


The  presence  upon  weapons  or  the  clothing  of  a  defendant  of  hairs 
from  animals  or  of  various  fibers  used  in  the  manufacture  of  textile 
fabrics  has  in  numerous  cases  proved  to  be  of  great  importance  in  trials 
for  homicide.  In  the  trial  of  Rubenstein  for  the  murder  of  Sarah  Alex- 
ander a  fragment  of  corn-husk  and  a  fiber  of  wool  from  the  shawl  worn 
by  the  girl,  found  attached  to  a  blood-spot  upon  the  boot  of  the  defend- 
ant, proved  to  be  very  important  evidence.  Taylor  gives  the  case  of  a 
woman  accused  of  murdering  her  child,  upon  whose  clothing  were  found 
spots  of  blood  with  hairs  from  a  victorine  worn  by  the  victim.  In  the 
Piper  case,  in  which  the  sexton  of  a  church  was  tried  and  convicted  of 
the  murder  of  a  child  in  the  belfry,  a  single  hair  found  upon  the  person 
of  the  defendant  was  claimed  by  the  government  to  be  identical  with 
that  cut  from  the  head  of  the  deceased. 

Hairs  found  upon  weapons  or  clothing  may  be  from  the  head  or  other 
parts  of  the  human  body,  or  from  some  domestic  animal.  As  in  the  case 
above  cited,  the}'  may  be  from  the  fur  of  a  very  large  number  of  animals, 
of  which  many  varieties  are  used  in  different  forms  as  articles  of  apparel. 
Fibers  may  be  of  silk,  wool,  cotton,  linen,  or  a  mixture  of  these  in  the 
various  kinds  of  textile  fabrics  employed  for  clothing.  The  identification 
of  hairs  and  fibers  is,  in  most  cases,  conclusive  and  satisfactory — i.e.,  it 
can  be  asserted  with  certainty  that  a  given  hair  is  human  or  from  some 
animal,  and  in  most  cases  the  animal,  or  at  least,  the  class  to  which  it 
belongs,  can  be  determined. 

The  diameters,  length,  and  peculiar  markings  of  hairs  when  observed 
in  the  microscope  furnish  the  means  for  distinguishing  them.  Indeed, 
these  are  practically  the  only  data  by  which  reliable  conclusions  can  be 
drawn. 

Hairs  from  the  human  body  may  be  classed  in  three  different  varie- 
ties :  1.  Long,  soft  hairs  from  the  head,  from  one  to  three  or  more  inches 
in  length ;  2.  Short,  thicker,  and  more  rigid  hairs  from  one  fourth  to  one 
half  inch  in  length,  as  in  the  eyelashes ;  3.  Short  and  very  fine  hairs  from 
one  twelfth  to  one  sixth  of  an  inch  in  length,  as  the  down  or  woolly 
hairs  from  the  face,  back,  or  extremities.  In  the  microscopic  examina- 
tion of  hairs  two  structures  are  visible :  a  median,  more  or  less  dark,  and 
somewhat  irregularly  granular  portion,  the  medulla  or  pith;  and  an  outer 
fibrous-looking  portion,  colored  according  to  the  color  of  the  hair,  the 
cortex  or  cortical  portion.  Under  certain  conditions  of  focussing,  hairs 
from  the  head  show  a  very  light  portion  in  the  center,  giving  the  appear- 

187 


188 


32  a3  34  35 

Microscopical  Appearance  of  Hairs  from  Various  Sources,  and  Vegetable  and  other  Fibers. 

Figs.  22  to  35.-22,  horse  (back) ;  23,  mouse;  24.  cat;  25,  chinchilla;  26,  large  hair  from  seal; 

27,  hair  from  head  of  female,  age,  eighteen ;  28,  hair  from  head  of  man  after  treatment  with 

caustic  soda;  29,  fine  hair  from  back  of  hand ;  30,  from  head  of  child ;  31,  cross-sections  of  hairs 

from  the  head  ;  32,  silk ;  33,  cotton ;  34,  flax ;  35,  wool.  [J.  F.  Babcock-DeLJ 


HAIRS  AND  FIBERS.  189 

ance  of  a  tube ;  but  this  is  merely  the  effect  of  refraction,  and  disappears 
when  the  hair  is  examined  after  a  preliminary  soaking  in  a  weak  solution 
of  caustic  soda. 

The  diameters  and  lengths  of  hairs  vary  greatly,  according  to  their 
position  or  the  age  or  sex  of  the  individual.  Hairs  from  the  head  are 
usually  longer,  softer,  and  finer  in  females  than  they  are  in  males.  Hairs 
from  children  are  softer  and  finer  than  those  from  adults.  The  long- 
hairs  from  the  head  average  about  1-350  of  an  inch  in  diameter  in  man 
and  1-450  in  woman.  The  downy  hairs  from  the  body  (lanugo)  vary 
from  1-1000  to  1-3000  of  an  inch  in  diameter.  Hairs  from  the  eye- 
brows, the  pubes,  and  the  mustache  are  about  1-200  of  an  inch ;  on  the 
back  of  the  hand  in  man  they  vary  from  1-250  to  1-500  of  an  inch. 
These  figures  are  subject  to  considerable  variations  in  different  indi- 
viduals, but  may  be  taken  as  showing  the  comparative  diameters  of  the 
hairs  from  different  positions.  Variations  to  a  somewhat  similar  extent 
•occur  among  animals.  Most  mammals  have  two  or  more  varieties  of 
hairs,  one  long,  stout,  and  straight,  and  overlying  others  which  are  much 
finer  and  shorter.  The  peculiar  markings  and  other  appearances  of 
these  hairs  may  vary  greatly  even  in  the  same  animal,  according  to  its 
situation,  or  whether  they  are  of  one  or  another  of  the  varieties  above 
mentioned.  Figures  showing  the  appearance  of  various  animal  hairs 
under  the  microscope  may  be  found  in  the  Micrograpliic  Dictionary  of 
Griffith  and  Henfrey  (plate  29),  and  other  drawings  in  the  Proceedings  of 
the  American  Society  of  Microscopists,  1884,  p.  59,  and  in  Woodman  and 
Tidy's  Forensic  Medicine,  p.  498. 

Hairs  for  microscopic  examination  should  be  soaked  in  oil  of  turpen- 
tine and  mounted  in  Canada  balsam.  The  accompanying  plate,  together 
with  the  drawings  to  which  we  have  referred,  may  be  useful  in  determin- 
ing the  character  of  any  particular  specimen ;  but  in  all  cases  the  latter 
should  be  compared  with  hairs  of  known  origin  before  arriving  at  a 
definite  opinion. 

Silk  fibers  are  cylindrical  in  form,  and  exhibit  a  strong  refraction  of 
the  light  passing  through  them ;  they  are  almost  entirely  devoid  of  mark- 
ings of  any  kind  or  other  peculiar  structural  appearances.  Wool  has  ir- 
regular fibers,  and  the  transverse  markings  are  very  large  and  noticeable. 
Cotton  has  a  spiral  and  twisted  structure.  Flax  has  fibers  which  are 
tapering  toward  the  point,  and  they  show  joints  at  unequal  distances. 
A  solution  of  eosin  or  of  any  of  the  aniline  colors  produces  a  strong  dye 
upon  silk  or  wool,  but  upon  cotton  only  a  feeble  and  easily  washed  out 
stain. 

No  reliance  can  be  placed  upon  conclusions  drawn  from  the  appear- 
ances presented  by  a  single  hair  as  to  the  identity  of  the  individual  to 
whom  it  belonged.  This  has  been  attempted  in  many  criminal  trials, 
with  results  almost  invariably  damaging  to  the  side  winch  has  attempted 
it.  All  that  can  be  fairly  stated  in  such  cases  is  that  hairs  from  some 
particular  head  have  a  resemblance. 

The  reader  may  consult  with  profit  a  paper  by  William  J.  Lewis,  en- 
titled "  Hair  Microscopically  Examined  and  Medico-Legally  Considered," 
in  Proceedings  of  the  American  Society  of  Microscopists,  1884,  p.  59.  Also 
articles  by  Lassaigne,  Robin,  and  Orfila  in  Annates  de  Hygiene,  1857, 
2d  series,  vol.  viii.,  p.  22G ;  1858,  2d  series,  vol.  x.,  p.  434 ;  1835, 1st  series, 
vol.  xiii.,  p.  466. 


IDENTITY   OF   THE   LIVING. 

BY 

ALLAN  McLANE  HAMILTON,  M.D. 


Trials  where  instances  of  mistaken  identity  have  been  the  issue  are 
so  numerous  and  curious  as  to  form  many  of  the  causes  celebres  of  all 
times,  and  have  reflected  perhaps  more  upon  the  value  of  human  testi- 
mony than  any  other  influence.  Plentiful  cases  upon  record  prove  either 
how  poor  is  the  observation  of  the  ordinary  individual,  or  how  common 
are  certain  appearances  which  have  been  looked  upon  as  more  or  less 
striking  peculiarities.  Many  interesting  questions  have  arisen  in  con- 
nection with  identification,  not  a  few  of  which  have  formed  the  basis  of 
legal  proceedings,  and  the  literature  of  medicine  is  full  of  dramatic  in- 
stances of  mistaken  personality.  While  under  some  circumstances  per- 
sons who  have  had  ample  opportunity  for  observation  make  the  gravest 
errors  in  identification,  on  the  other  hand  it  is  sometimes  the  case  that  a 
momentary  glance  in  the  shortest  possible  association  has  sufficed  for  a 
perfect  identification.*  It  often  happens  "with  our  own  authorities  that 
persons  who  have  been  robbed  will  readily  pick  out  the  guilty  person 
from  a  score  of  others  in  whose  company  he  may  be  placed ;  but  possibly 
this  facility  is  owing  to  the  manner  and  anxiety  of  the  culprit  to  escape 
detection  as  much  as  anything  else. 

The  matter  of  systematic  identification  is  largely  a  question  of  prac- 
tice and  skill,  but  in  some  measure  depends  upon  the  faculty  of  intuition, 
which,  however,  does  not  belong  to  many.  It  is  certain  that  the  power 
of  unconscious  observation  is  possessed  by  some  individuals  to  a  marked 
degree ;  and  while  these  persons  never  forget  a  face,  they  are  quite  un- 
able to  explain  their  quickness  or  the  means  which  enables  them  to  reach 
a  conclusion.  An  expert  detective  sergeant  with  twenty  years'  experi- 
ence, who  is  known  as  having  one  of  the  best  memories  and  the  sharpest 
wits  of  the  New  York  police  force,  tells  me  that  he  rarely  looks  at  other 

*  Considerable  space  is  devoted  in  some  works  of  this  kind  to  the  momentary  rec- 
ognition that  often  takes  place  where  the  only  illumination  is  the  flash  of  a  pistol  or 
the  gleam  of  lightning.  In  many  instances  these  examples  are  grossly  exasperated. 
Cauvet  conducted  a  series  of  experiments,  the  conclusions  of  which  are  the  following : 
(1)  That  the  person  firing  a  pistol  may  be  recognized  if  the  observer  is  placed  very 
near  him — say  five  paces — and  at  the  side  of  the  line  of  fire ;  (2)  that  he  may  be  rec- 
ognized when  the  discharge  has  been  in  a  close  place  of  small  dimensions,  and  the 
observer  is  in  a  stooping  posture  or  squatting ;  (3)  that  the  chance  of  distinguishing 
the  person  firing  is  affected  by  the  quality  of  the  powder  employed,  the  best  English 
powder  enabling  the  observer,  when  near  or  by  the  side  of  the  person  firing,  both  to 
see  and  identify  him. 

191 


192  A   SYSTEM  OF  LEGAL   MEDICINE. 

features  than  the  eyes,  and  usually  by  their  expression  and  color  he 
remembers  his  man.  It  is  a  well-known  fact,  however,  that  those  whose 
occupations  should  make  them  familiar  with  particular  persons  are  sin- 
gularly untrained  in  the  matter  of  identification,  such  being  the  case 
with  portrait-painters,  a  great  many  of  whom  are  unable  to  retain  an 
impression  of  a  sitter  five  minutes  after  his  departure,  or  to  be  able  to 
paint  the  portrait  in  his  absence. 


UNRELIABILITY  OF   EVIDENCE. 

The  most  astonishing  examples  of  confident  identification  are  found 
in  books  and  the  daily  press,  which  often  relate  instances  of  individuals 
who  were  perfectly  sure  of  the  identity  of  another,  but  whose  positive 
declarations  were  afterward  proved  to  be  valueless  by  the  appearance  of 
the  real  person.  Such  a  condition  of  affairs  occurred  in  the  Tichborne 
case  (see  Identity  and  Survivorship),  where  Arthur  Orton  was  recognized 
and  whose  cause  was  championed  not  only  by  the  mother  of  the  real  heir, 
but  by  the  old  friends  and  servants  of  Sir  Roger  Tichborne. 

It  seems  almost  incredible,  but  women  have  lived  upon  the  closest 
intimacy  with  men  who  have  turned  up  long  after  the  disappearance  of 
their  lawful  spouses,  firmly  believing  them  to  be  their  long-lost  husbands. 

"  In  one  of  the  early  criminal  records  of  New  York  City  we  find  the 
history  of  one  Joseph  Parker  who  was  tried  for  bigamy  in  the  year  1804 
in  the  court  of  Oyer  and  Terminer,  the  indictment  charging  that  on  the 
8th  of  May,  though  he  was  lawfully  married  to  one  Susan  Fearon,  who 
was  still  living,  he  had  unlawfully,  on  the  25th  of  December,  under  the 
name  of  Thomas  Hoag,  contracted  a  second  marriage  with  one  Catherine 
Secor.  The  first  marriage  and  the  present  existence  of  the  first  wife  being 
admitted,  three  witnesses  then  testified  that  the  defendant  then  in  court 
before  them  was  the  Thomas  Hoag  who  had  come  to  Rockland  County, 
thirty  miles  distant  from  New  York  City,  in  September,  1800,  had  lived 
there  working  as  a  laborer,  had  married  Catherine  Secor  on  Christmas 
Day,  1800,  and  in  the  following  March  had  disappeared.  One  of  these 
witnesses  was  the  woman  who  claimed  to  be  his  wife  ;  another,  the  judge 
who  married  them ;  and  another  was  a  man  who  had  worked  with  him 
constantly  for  five  months.  They  were  positive  the  defendant  was 
Thomas  Hoag,  and  recognized  him  not  only  by  his  features,  but  by  vari- 
ous marks  and  scars  on  his  person,  and  by  a  certain  impediment  in  his 
speech.  On  the  strength  of  this  testimony,  which  must  have  seemed 
conclusive,  the  prosecution  rested,  and  the  defense  called  six  witnesses 
who  swore  just  as  positively  as  the  others  that  the  defendant  was  Joseph 
Parker,  that  he  was  by  occupation  a  rigger,  and  that  he  also  served  on 
the  city  watch.  And  they  swore  with  equal  positiveness  that  on  Christ- 
mas Day,  1800,  and  before  and  after  that  date,  he  was  in  New  York  City 
following  his  usual  occupation,  and  by  no  possibility  could  he  have  been 
at  that  time  in  Rockland  County.  With  this  testimony  the  defense 
rested,  but  the  prosecution  seems  to  have  had  other  evidence  in  reserve. 
Seven  additional  witnesses  were  now  called  for  the  prosecution,  each  of 
whom  in  the  most  positive  manner  identified  the  defendant  as  Thomas 
Hoag,  who  had  married  Catherine  Secor  on  Christmas  Day,  1800.  They 
swore  to  various  marks  on  his  face  and  neck,  which  the  defendant  plainly 


IDENTITY   OF   THE   LIVING.  103 

had,  but  particularly  a  deep  scar  on  the  ball  of  his  foot,  occasioned  by 
treading  on  a  drawing-knife. 

"  The  prosecution  closing  their  case,  the  defense  called  two  more  wit- 
nesses, one  of  whom  was  the  mother  of  his  wife,  who  had  known  him 
for  sixteen  years,  and  swore  positively  that  he  had  not  been  ont  of  New 
York  more  than  a  week  during  that  time ;  and  the  other  swore  to  work- 
ing with  him  on  the  particular  Christinas  Day  in  question.  It  was  then 
agreed  by  the  counsel  that  the  defendant  should  show  the  soles  of  his 
feet  to  the  jury,  that  they  might  ascertain  whether  the  peculiar  scar  upon 
one  of  them,  which  had  been  sworn  to  by  several  of  the  witnesses  for 
the  prosecution,  was  visible.  Upon  exhibiting  his  feet  no  mark  or  scar 
could  be  seen  upon  either  of  them. 

"  The  captain  of  the  watch  was  then  called,  and  after  swearing  posi- 
tively that  the  defendant  was  Joseph  Parker,  whom  he  had  known  for 
many  years,  he  produced  his  books,  in  which  he  kept  a  register  of  the 
watchmen  and  their  times  of  service,  and  showed  that  from  October, 
1800,  till  March,  1801 ,  defendant  was  on  duty  as  a  watchman  in  the  city. 
The  jury,  without  retiring,  found  a  verdict  of  not  guilty." 

When  it  is  borne  in  mind  that  the  witnesses  on  both  sides  of  this 
most  astonishing  case  were  persons  of  responsibility,  and  of  such  stand- 
ing as  to  preclude  all  thought  of  perjury,  it  must  be  admitted  that  it 
presents  one  of  the  strangest  examples  of  disputed  identity  ever  known. 

The  similarity  of  two  individuals  some  time  ago  induced  a  lawyer  in 
the  city  of  New  York  to  resort  to  a  ruse  for  the  purpose  of  clearing  his 
client,  who  had  been  accused  of  a  serious  crime.  While  the  latter  was 
seated  out  of  range  of  vision  of  the  witness  in  the  box,  who  was  very 
decided  in  his  opinion  of  his  own  powers  of  observation  and  his  certainty 
of  the  aj>pearance  of  the  assailant,  the  double  of  the  man  under  trial  was 
told  to  arise,  when  he  was  positively  identified  by  the  confident  witness. 
His  mistake,  of  course,  led  to  the  discharge  of  the  prisoner. 


ACCIDENTAL   OR   VOLUNTARY   ALTERATIONS   IN   APPEARANCE. 

In  investigating  the  history  and  condition  of  the  person  whose  iden- 
tity is  suspected,  it  is  of  the  utmost  importance  that  the  examiner  should 
give  weight  to  two  kinds  of  influences  that  may  effect  an  alteration,  viz. : 

1.  Those  in  which  the  changes  are  due  to  age,  disease,  and  natural  or 
accidental  alteration ; 

2.  Those  in  which  the  alterations  are  willfully  produced. 

To  the  former  belong  the  organic  and  facial  expression  changes  due 
to  insanity,  to  trophic  changes  in  which  pigment  bleaching  or  deposit 
takes  place,  to  the  loss  of  teeth  or  hair,  or  through  cutaneous  disease 
with  pitting  or  other  lesions.  To  this  class  belong  the  existence  of  acci- 
dentally produced  cicatrices,  the  loss  of  limbs,  deformities,  etc.,  and  the 
appearances  due  to  manual  or  other  labor. 

In  the  second  class  we  find  changes  voluntarily  wrought  which  are 
sometimes  willfully  brought  about  for  a  purpose,  or  occasionally  exist  as 
evidences  of  former  vanity.  In  this  group  we  are  presented  with  cases 
where  we  are  required  to  determine  whether  the  hair  has  been  dyed.  whel  her 
abrasions,  wounds,  or  burns  have  been  made  for  a  purpose,  and  whether 
tattoo  or  other  marks  have  been  removed,  or,  on  the  other  hand,  executed 


194 


A   SYSTEM  OF  LEGAL  MEDICLNE. 


with  the  intention  of  counterfeiting  the  marks  upon  the  body  of  some  per- 
son who  has  disappeared  or  died,  for  the  purpose  of  perpetrating-  a  fraud. 

The  determination  of  the  indications  of  age  is  sometimes  an  issue, 
especially  where  a  claimant  presents  himself ;  and  we  may  divide  the  im- 
portant periods  of  life  into  adolescence,  which  begins  at  the  age  of  puberty 
and  lasts  until  twenty-five,  adult  life,  which  is  prolonged  until  the  sixtieth 
year,  and  old  age,  which  may  be  said  to  begin  at  sixty  and  last  until  eighty- 
five,  when  decrepitude  commences. 

It  is  only  exceptionally  that  we  are  called  upon  to  determine  the  age 
of  children,  but  such  may  be  necessary  in  cases  of  rape,  the  question  of 
consent,  or  possibly  where  the  applicability  of  the  laws  of  the  Society  for 
the  Prevention  of  Cruelty  to  Children  is  questioned ;  but  there  is  usually 
little  difficulty  in  closely  approximating  the  period  of  infantile  life. 

The  exact  determination  of  the  age  of  the  adult  is  extremely  difficult 
where  it  is  necessary  to  be  precise,  and  the  same  may  be  said  to  be  the 
case  with  old  age.  Of  course,  in  the  latter  the  association  of  evidences 
of  bodily  decay  must  be  more  or  less  consistent  and  harmonious,  for  in 
men  in  their  prime,  so  far  as  time  is  concerned,  we  often  find  indications 
of  premature  decay.  We  must  take  into  account  the  nature  and  form 
of  the  inferior  maxilla,  the  condition  of  the  teeth,  rigidity  of  articulation, 
possible  existence  of  friable  bones,  coldness  of  the  extremities,  weakness 
of  the  genital  apparatus,  troubles  of  excretion  and  circulation,  as  well  as 
that  mental  weakness  which  is  manifested  by  loss  of  memory,  and  ulti- 
mately by  childishness.  In  addition  to  these,  the  presence  of  the  arcus 
senilis,  weakness  of  vision,  and  alteration  in  gait  and  carriage  may  be 
recognized. 

Change  through  the  Effect  of  Disease. — As  every  one  is  aware,  a 
notable  facial  change  takes  place  as  the  result  of  many  general  diseases, 
so  that  sometimes  what  amounts  to  an  almost  complete  loss  of  identity 


^S*»!**V 


Fig.  36. 


Fig. 


occurs.     Those  especially  who  are  in  the  habit  of  examining  the  insane 
cannot  fail  to  be  impressed  with  what  I  mean.     As  an  illustration,  two 


IDENTITY  OF  THE  LIVING.  195, 

pictures  may  be  presented  of  a  young  married  woman  who  was  indicted 
for  infanticide  in  a  town  in  the  northern  part  of  New  York  (Figs.  36 
and  37).  But  one  year  elapsed  from  the  time  the  first  picture  was  taken 
until  commission  of  the  crime,  and  it  was  during  her  incarceration  in 
prison  before  the  trial  that  the  second  photograph  was  made.  Her  insanity 
had  not  been  recognized  by  her  townspeople,  and  in  fact,  it  was  of  a  low 
order.  So  rapid  a  change  in  appearance  can  hardly  be  conceived,  and  I 
am  sure  under  certain  circumstances  would  lead  to  a  mistake  in  identity. 
Certain  atrophic  affections  of  the  nervous  system,  which  are  attended  by 
loss  of  hair,  discoloration  of  the  skin,  and  various  other  metamorphoses, 
can  produce  a  startling  transformation. 

The  Teeth. — The  coloration  of  the  teeth  may  have  something  to  do 
with  the  determination  of  personal  identity,  and  Tardieu  has  referred  to 
the  existence  of  erosion,  separation,  and  other  changes  due  to  the  habitual 
use  of  the  pipe  in  smokers.  It  is  the  custom  with  most  dentists  to  keep 
accurate  records  of  the  nature  of  the  work  done  by  them,  and,  when  pos- 
sible, such  data  should  be  consulted  to  ascertain  the  history  of  the  person 
whose  place  has  been  usurped  by  the  impostor. 

Changes  in  the  Hair. — It  is  often  a  difficult  matter  to  determine  the 
identity  by  the  color  and  condition  of  the  hair.  Criminals  and  others,  for 
the  purpose  of  disguise,  have  by  means  of  dyes  wrought  a  change  in 
appearance  which  has  been  more  or  less  effectual.  Perhaps,  after  all,  a 
knowledge  of  the  configuration  of  the  head  and  the  natural  growth  of 
hair  among  people  of  different  temperaments  may  guide  the  examiner 
as  much  as  anything  else  ;  and,  of  course,  the  relation  of  head  coloration 
to  that  of  other  regions  will  enable  him  to  expose  a  fraud,  for  it  is  rare 
that  any  systematic  and  harmonious  dyeing  is  resorted  to.  It  is  often 
necessary  to  bring  the  microscope  to  our  aid,  when  it  will  be  found  that 
the  imbibition  of  the  dye  does  not  extend  throughout  the  hair-trunk,  but 
there  is  a  spot  which  presents  normal  and  uniform  color.  This  aid  will 
also  disclose  the  adherence  of  fatty  particles  which  have  followed  the  use 
of  various  pigments.  Vibert  has  pointed  out  the  fact  that  hah-  dyed  with 
black  presents  under  the  microscope  a  coloration  apparently  everywhere 
uniform,  which  is  never  the  case  with  that  which  has  preserved  its  natural 
color.  If  the  dyeing  is  imperfect  there  will  be  brusque  changes  in  color 
and  none  of  the  gradations  that  belong  to  a  normal  condition.  Blond 
tints,  which  are  nearly  always  obtained  by  the  use  of  peroxide  of  hydro- 
gen, result  in  a  discoloration  of  the  pigment  without  destruction.  In 
nearly  every  case  where  several  days  have  elapsed  between  the  last  appli- 
cation of  the  dye  and  the  time  of  examination  there  will  be  ordinarily  no 
difficulty  in  detecting  the  change  in  growth. 

Briand  and  Chaude  have  written  extensively  upon  this  subject,  and 
have  given  certain  instructions  for  the  examination  of  the  hair  of  sus- 
pected persons.  When  lampblack  combined  with  some  fatty  substance 
has  been  applied,  it  will  be  necessary  to  wash  the  hair  in  ether,  which 
will  rapidly  remove  the  fatty  substance,  leaving  the  carbon  in  suspen- 
sion in  the  liquid.  Sometimes  a  mixture  of  litharge,  chalk,  and  lime 
water  is  used,  and  the  effect  is  produced  after  two  or  three  hours.  When 
the  head  is  well  washed  with  warm  water  and  a  small  quantity  of  acid  is 
added,  the  presence  of  these  substances  may  be  determined  by  the  effer- 
vescence, and  the  subsequent  addition  of  sulpho-hydric  acid  and  oxide  of 
ammonia  indicates  the  existence  of  lead.     Slow  dyeing  produces  a  much 


19G 


A   SYSTEM  OF  LEGAL  MEDICINE. 


more  obstinate  and  less  easily  removable  tint,  and  in  such  cases  it  is  well 
to  get  some  of  the  hair  and  treat  it  thoroughly  with  the  above  reagents. 
The  salts  of  bismuth  and  sulphur  are  often  used  when  it  is  desired  to 
obtain  a  more  rapid  coloration,  and  ordinarily  with  the  latter  agent  the 
hair  is  washed  in  ammoniated  water,  and  afterward,  while  damp,  satu- 
rated with  metallic  salt,  and  then  put  in  contact  with  water  containing 
hydrosulphuric  acid  or  sulphur.  Decoloration  after  dyeing  with  nitrate 
of  silver  can  usually  be  effected  with  cyanide  of  potash  and  pyrogallic 
acid,  and  sometimes  a  weak  solution  of  hydrochloric  acid  will  change  the 
color  of  hair  thus  dyed  from  black  to  a  more  or  less  violet  hue.  Briand 
and  Chaude  believe  that  the  best  means  for  recognizing  the  nature  of 
a  salt  which  has  been  used  to  color  the  hair  is  to  burn  a  part  of  the  hair 
and  to  treat  the  ashes  by  nitric  acid  evaporated  to  extreme  concentration, 
and  then  afterward  to  apply  the  ordinary  tests  for  silver  or  lead. 

Orfila  [Traite  de  Med.  Leg.,  T.  i.,  p.  122  et.  seq.)  has  stated  that  locks  of 
black  hair  when  plunged  into  chlorine  water  pass  from  a  light  chestnut 
color  to  deep  blond,  clear  blond,  and  finally  become  entirely  bleached. 
After  a  long  immersion  in  chlorine  water  the  hair  preserves  for  a  long 
time  the  odor  of  chlorine,  and  becomes  brittle.  Red  and  brown  tints  are 
obtained  by  means  of  saffron  and  the  permanganate  of  potash. 

We  should  not  lose  sight  of  the  fact  that  at  times  it  is  necessary  to 
determine  the  individual  type  so  far  as  hair,  features,  etc.,  are  concerned, 
and  while,  of  course,  such  identification  is  not  in  itself  a  matter  of  cer- 
tainty, anthropological  aid  may  be  unexpectedly  suggestive.  The  abun- 
dance of  hair  in  relation  to  race  type  is,  according  to  many  observers,  very 
variable.  The  plate  from  Testut  ( Traite  d'Anatovn ie  Rumaine,  T.  iii,  Fas.  1 , 
Paris,  1892)  (Fig.  38),  taken  in  consideration  with  the  researches  of  Hil- 
gendorf ,  Withof,  and  others,  may  prove  of  service  in  determining  the  race 
characteristics  in  appropriate  cases.  The  former  counted  in  a  square 
centimeter  272  hairs  in  a  German,  252-286  in  a  Japanese,  214  being  the 
average  among  the  Ainos  (the  hairy  tribe  of  northern  Japan).  Withof 
has  found  that  the  hairs  are  more  numerous  in  blond  subjects  than 
among  those  of  darker  skin  and  coloring.  He  has  counted  147  black 
hairs,  162  brown,  and  182  blond  in  a  quarter-inch. 

The  classification  of  hair,  as  agreed  upon  by  Isidore  Geoffrey,  Saint- 
Hilaire,  Huxley,  and  Haeckel,  is  as  follows : 


Woolly  hair. 


In  tufts. 


(  ED 


Hottentots. 
Papuans. 


Primitive  man.  * 


Straight  hair. 


(  African  Blacks. 
I  Fleec>'       j  Kaffirs. 

Australians. 
Hypoboreans. 
'  Stiff.  \  Americans. 

Malays. 
__  Mongolians. 

(  Dravidians. 
__  Curly.        \  Nubians. 

(  Mediterraneans. 


The  finger-nails  may  be  the  seat  of  changes  due  to  the  particular 
work  of  the  person,  or  to  previous  disease.     Esbach  (Modifications  de  la 


IDENTITY  OF  THE  LIVING. 


197 


Phalangette  dans  Ja  su&ur,  etc.,  Paris,  1876)  has  carefully  examined  a  great 
many  finger-nails,  and  announces  it  as  a  fact  that  it  is  possible  by  the 
breadth,  thickness,  and  shape  of  the  nail  not  only  to  distinguish  tuber- 


ry:-  "s*iNv>, 


Fig.  38.  —1  (Straight),  American  Indian;  2  (wavy),  French  child ;  3  (frizzly),  Australian; 
4  (fleecy),  Tasmanian;  5  (bushy),  New  Caledonian;  6  (kinky),  Zambesi.    (Testut.) 

culosis,  but  he  finds  that  typhoid  fever,  chloro-ana?mia,  and  gestation 
effect  and  leave  a  marked  variation  in  the  thickness  of  the  nail.  He 
gives  several  tables  which  show  the  influence  of  the  different  callings 
upon  the  thickness  of  the  nail,  and  finds  that  those  occupations  in  which 
the  hands  are  used  to  a  very  great  extent,  and  where  there  is  habitual 
sweating,  the  nail  substance  is  increased. 


GENERAL   STIGMATA  OF   OCCUPATION. 


It  is  possible  sometimes  to  fix  with  certainty  the  occupation  followed 
by  the  suspected  person  by  various  marks,  such  as  softening  or  destruc- 
tion of  skin,  deep  fissures,  destruction  of  nails,  and  the  formation  of 
cysts,  tumors,  or  callosities;   changes  in  the  trunk;   coloration  of  the 


198  A  SYSTEM  OF  LEGAL  MEDICINE. 

skin,  or  corrosive  action  exerted  upon  the  same  by  substances  used  in 
manufacture.  It  is  requisite  to  bring  to  our  aid  the  help  of  chemistry, 
and  to  carefully  examine  the  traces  of  organic  or  inorganic  discoloration, 
the  parings  of  the  nails,  or  the  dirt  that  may  accumulate  beneath  them, 
the  stains  upon  clothing,  and  to  carefully  note  the  deformity  of  the  fin- 
gers or  body,  the  expansion  of  the  finger-tips,  the  retraction  of  the  flexor 
tendons,  to  recognize  the  duration  or  age  of  such  appearances ;  and  we 
should  naturally  examine  the  hands  first. 

The  Hands. — Le  Grand  du  Saulle  (Traite  de  Medecine  Legale,  second 
edition,  p.  1015  et  seq.)  says  that  in  four  fifths  of  the  workmen  he  ex- 
amined the  hands  showed  the  only  trace  of  the  kind  of  work  done. 

Tardieu  has  by  the  condition  of  the  hands  recognized  the  following : 
laundresses,  bleachers,  copper-workers,  coal-miners,  coachmen,  hair- 
dressers, tanners,  cutters,  hair-workers,  nail-makers,  porters,  gilders, 
cabinet-makers,  clerks,  florists,  engravers  upon  metals,  watchmakers, 
locksmiths,  milliners,  mother-of-pearl  workers,  shoemakers,  glass-pol- 
ishers, button-makers,  rag-pickers,  tortoise-shell  polishers,  bookbinders, 
grinders,  saddle-makers,  stone-masons,  drummers,  dyers,  wood-turners, 
metal-spinners,  vermicelli-makers,  and  glass-blowers.  He  divides  the 
alterations  of  the  hand  into  those  occupying  the  palmar  portion,  the 
fingers  separately  or  together,  the  two  hands  or  one  only.  The  right 
hand  is  that  in  which  the  appearance  is  most  often  marked,  and  when 
both  are  changed,  that  of  the  right  is  different  from  the  left;  and  it 
is  nearly  always  found  that  the  fold  of  the  flexion  in  the  palm  has 
the  greatest  degree  of  epidermis  thickening.  When  the  entire  hand 
is  the  seat  of  alteration,  according  to  Du  Saulle,  we  find  that  this  is  the 
result  of  the  contact  with  some  substance  which  produces  a  general  altera- 
tion, as  is  the  case  with  washerwomen,  tanners,  dyers,  locksmiths,  and 
saddle-makers.  Changes  in  the  feet  are  much  more  rare  than  elsewhere, 
but  such  changes  are  found  among  porters,  tailors,  and  turners. 

Shoemakers,  lace-makers,  clock-makers,  and  shell-polishers  all  present 
a  change  in  the  form,  length,  thickness,  and  wear  of  the  nails,  which 
signs  are  very  characteristic. 


RECOGNITION   OF   CHANGES  INCIDENT  TO   SPECIAL  OCCUPATIONS. 

These  professional  stigmata  are  by  no  means  absolute  evidences  of 
the  occupation  followed  by  the  suspected  individual,  for  there  is  a  decided 
difference  not  only  in  the  shape  of  tools  used,  but  in  the  method  of  work 
of  different  mechanics ;  deductions,  however,  may  be  drawn  which  are 
more  or  less  helpful,  and,  with  other  confirmatory  data,  will  be  of  great 
service  to  the  person  making  the  inquiry. 

Jewelers  are  apt  to  present  a  retraction  of  the  last  phalanx  of  the  left 
thumb,  and  it  has  been  held  that  cataract  is  more  frequent  as  a  result 
of  the  fine  work  which  so  many  of  them  are  in  the  habit  of  doing ;  nev- 
ertheless Desmarres,  pere,  out  of  nine  hundred  and  fifty-two  patients 
affected  with  cataract  found  but  two  jewelers.  Sometimes  cramp  is 
found  of  the  flexors  which  is  analogous  to  that  of  writers  and  others. 

Washerwomen  do  not  always  work  in  the  same  position,  but  when 
following  a  habit  they  present  different  deformities  of  the  upper  extrem- 
ities, callosities  due  to  the  exercise  of  pressure,  and  sometimes  a  con- 


IDENTITY  OF  THE  LIVING.  199 

<lition  of  the  skin  of  the  hand  with  swollen  fingers,  which  is  highly 
characteristic. 

Metal-workers  and  burnishers  present  sometimes  in  the  right  hand  a 
general  callosity  and  blackness,  the  creases  of  flexion  remaining  un- 
affected and  unstained.  The  last  phalanx  of  the  little  finger  is  often 
held  in  extreme  flexion,  the  skin  of  the  left  hand  which  covers  the  back 
and  the  radial  side  of  the  index  finger  and  is  found  over  the  head  of  the 
second  metacarpal  bone  is  very  hard  and  callous,  showing  the  same  ap- 
pearance at  the  extremity  of  the  palmar  face  of  the  thumb. 

Coachmen  and  drivers  nearly  always  present  a  distinct  spot  of  callous 
between  the  thumb  and  the  index  finger,  and  between  the  second  and 
third  and  third  and  fourth  fingers  of  the  two  hands.  The  first  site, 
however,  is  most  common. 

Shoemakers.  On  their  left  hands  where  the  thumb  and  index  finger 
hold  the  thread  the  soft  parts  are  broadened,  and  the  fold  which  separates 
the  second  from  the  third  phalanx  of  the  index  finger  is  cut  by  the  thread, 
presenting  a  deep  crevasse,  the  borders  of  which  are  hard  and  callous. 
On  the  thumb  of  the  right  hand  the  fleshy  substance  is  expanded  in  spat- 
ulous  form,  which  is  quite  broad  and  characteristic,  and  is  like  the  analo- 
gous deformation  met  with  among  glass-workers. 

A  still  more  characteristic  sign,  and  one  which  is  more  striking,  con- 
sists in  the  depression  of  the  nail  of  the  left  thumb,  which  is  considerably 
thickened,  hard,  and  at  its  free  border  is  dentated,  brittle,  crenated,  and 
sometimes  deeply  indented  by  sharp  cuts  from  the  awl.  This  aspect 
of  the  left  thumb  among  working  shoemakers  is  consistent,  and  really 
characteristic.  There  is  a  certain  depression  of  chest,  so  that  the  sternum 
presents  a  distinct  concavity  which  is  very  sharply  circumscribed,  and 
not  accompanied  by  any  general  deformity  of  the  thorax  as  a  whole. 
The  hair-bulbs  of  the  skin  of  the  thighs  are  obliterated,  the  skin  is  often 
rough,  and  in  other  ways  shows  evidences  of  pressure  made  by  the  lap- 
board. 

Carriers  and  tanners  present  in  both  hands  a  great  breadth  of  fingers, 
particularly  at  their  base,  and  very  hard  and  prominent  folds,  which 
correspond  exactly  with  the  line  of  flexion  of  the  metacarpophalangeal 
articulations. 

The  hands  of  carriers  sometimes  present  a  deep  brown  discoloration, 
the  result  of  a  species  of  tanning  which  is  distinct ;  if  the  spots  are  touched 
with  a  solution  of  prussiate  of  potash  and  iron,  they  instantly  turn  a 
darker  color,  and  eventually  become  black. 

Dressmakers  and  seamstresses  present  a  familiar  appearance  which  is 
unmistakable,  consisting  of  a  hardening  of  the  index  finger  of  the  left 
hand,  which  is  pierced  by  numerous  needle-points ;  the  skin  is  rough, 
thick,  and  blackened.  It  is  true  that  these  traces  appear  in  many  pro- 
fessions. 

Workers  in  copper.  The  calloused  skin  of  these  workmen  may  be 
easily  removed  with  the  aid  of  a  bistoury.  The  sections  of  epidermis  of 
these  people  are  thickened,  and  the  nails  of  copper- workers  are  consider- 
ably thickened  at  the  edges.  If  the  detached  skin  and  clippings  of  nails 
be  put  into  boiling  nitric  acid  and  the  solution  subsequently  treated  by 
ammonia,  it  takes  a  beautiful  blue  color.  The  result  is  not  always  con- 
vincing. It  is  then  best  to  burn  the  debris  of  the  skin  in  a  platinum 
crucible  and  treat  the  residue  with  nitric  acid  and  ammonia.     This  result 


200  ^  SYSTEM  OF  LEGAL  MEDICINE. 

was  obtained  even  in  a  workman  who  for  forty  days  had  not  worked^ 
having  been  confined  in  a  hospital.  There  are  exceptions,  however,  but 
the  process  is  generally  a  reliable  one. 

Boatmen  and  seafaring  men,  and  others  whose  occupation  causes  them 
to  come  in  contact  with  water  a  great  part  of  the  time,  present  a  certain 
softening  of  the  skin  which  varies  in  extent.  In  this  connection  Parent 
du  Chatelet  (Annates  iV Hygiene  et  Med.  Legale,  T.  hi.,  p.  245)  has  described 
an  affection  which  is  designated  under  the  name  of  "  grenouille,"  and 
consists  of  an  extreme  softening  of  the  skin,  with  actual  disintegration 
of  parts  which  are  in  constant  contact  with  water.  He  has  found  both 
the  superior  and  inferior  extremities,  but  more  often  the  latter,  to  be  the 
seat  of  softening,  so  that  there  are  vast  tracks  and  crevasses  of  the  depth 
of  several  lines  between  the  great  toes  and  the  others.  It  is  not  rare  to 
observe  the  same  fissures  in  the  palms  of  the  hands,  sometimes  associated 
with  redness  and  extreme  sensibility. 

Gilders.  Signs  which  indicate  the  effects  of  work  are  detected  in 
young  workmen  at  the  end  of  five  or  six  months,  at  the  anterior  and 
internal  part  of  the  left  forearm,  where  a  considerable  callous  commences 
at  the  lower  edge  of  the  flexure  which  marks  the  separation  of  the  fore- 
arm and  the  hypothenar  eminence,  with  an  elevation  on  the  anterior 
part  of  the  forearm  to  the  height  of  fiVe  centimeters,  and  of  considerable 
breadth.  There  are  other  marks  which  have  been  very  positively  con- 
nected with  this  trade  by  Du  Saulle,  and  consist  of  various  callosities 
which  are  produced  by  burnishing-tools. 

Clerics  and  those  who  write  extensively  present  a  dermal  hardening  at 
the  cubital  edge  of  the  little  finger  of  the  right  hand,  corresponding  to  the 
last  phalangeal  articulation,  which  is  in  the  form  of  a  corn,  and  is  pro- 
duced by  the  constant  rubbing  and  pressure  of  the  finger  upon  the  paper. 
Sometimes  there  exists,  besides,  a  hardened  fold  at  the  extremity  of  the 
middle  finger  at  its  radial  side  at  the  point  where  it  comes  in  contact 
with  the  pen. 

Workers  in  artificial  flowers  present  a  characteristic  stigmata  between 
the  thumb  and  index  finger  of  the  left  hand. 

The  formation  of  bursas  in  various  situations  may  throw  some  light 
upon  the  occupation  or  mode  of  life  of  the  person  whose  identity  it  is 
desirable  to  establish.  Housemaids  and  others  who  kneel  a  great  deal 
present  local  prominences  which,  in  the  case  of  the  former,  have  been 
recognized  as  a  distinct  surgical  condition.  These  same  appearances  are 
not  uncommon  among  nuns,  priests,  and  religious  devotees  of  all  kinds. 


SKIN  LESIONS  AND   THEIR  RESULTS. 

Evidences  of  Cutaneous  or  Venereal  Disease. — The  skin  presents 
appearances  which,  when  taken  alone,  do  not  always  afford  a  certain  means 
of  identification,  but  are  occasionally  extremely  suggestive  and  important. 
No  weight,  except  that  which  belongs  to  a  fact  that  may  be  used  in  con- 
firmation, can  be  attached  to  the  existence  of  pitting  or  skin  lesions  which 
are  permanent.  It  can  be  well  understood  how  the  mark  of  a  venereal 
sore  will  influence  the  features  of  a  case.  Many  of  the  lesions  of  tertiary 
syphilis  last  for  a  long  time,  if  they  are  not  permanent,  and  especially  is 


IDENTITY  OF  THE  LIVING.  201 

this  the  case  where  bony  changes  have  occurred.  The  induration  of  the 
primary  sore  is  not  always  of  long  standing,  and  the  excavation  or  cica- 
trix left  by  a  "  soft  chancre  "  may  become  obliterated  in  a  comparatively 
short  space  of  time.  Ogston  refers  to  a  cicatrix  left  by  a  chancroid 
which  disappeared  in  an  unusually  short  period.  In  the  case  of  rape  re- 
ferred to  by  this  writer,  evidence  was  brought  forward  by  the  defense  to 
show  that,  in  the  female,  soft  chancres  could  not  have  existed  after  the 
period  of  intercourse,  as  no  mark  of  their  previous  presence  was  visible 
about  the  genitals  of  the  prisoner  six  weeks  afterward.  His  testimony 
at  the  prosecution  was  that  he  and  another  physician  had  seen  them  at 
the  time  alleged.  He  was  later  the  more  confirmed  in  this  opinion,  from 
the  fact  that  in  a  subsequent  case  in  private  practice,  where  several  such 
chancres  were  met  with  and  treated  by  him,  all  trace  of  them  was  found 
to  have  disappeared  six  weeks  subsequently. 

Cicatrices. — The  duration  of  scars  has  been  questioned  upon  many 
occasions,  and  the  theory  naturally  suggests  itself  whether  a  scar  ever 
entirely  disappears.  Ogston  is  of  the  opinion  that  as  a  rule  "all  scars 
resulting  from  wounds  and  cutaneous  diseases  which  involve  any  loss  of 
substance  are  indelible,  the  only  exception  that  can  be  made  being  in 
regard  to  trifling  punctured  wounds  where  but  little  violence  has  beeu 
done  to  the  skin  and  where  there  has  been  no  loss  of  substance." 

Before  going  further,  it  is  well  to  say  that  the  determination  of 
identification  by  means  of  a  scar  is  very  often  quite  unreliable,  unless 
the  cicatrix  be  of  a  pronounced  and  prominent  character.  In  a  large 
number  of  collected  cases  I  have  been  impressed  with  the  positiveness  of 
testimony  as  to  certain  body -marks,  and  in  many  instances  it  has  been 
found  that  innocent  persons  have  presented  the  scars  that  have  served 
to  fix  the  identification  in  the  minds  of  obstinate  witnesses.  The  follow- 
ing is  a  case  in  point : 

John  M.  Poyn,  a  Cincinnati  detective,  had  sworn  out  a  warrant  for 
the  arrest  of  W.  A.  Hedclen,  of  Tacoma,  charging  him  with  having  de- 
frauded life  insurance  companies  out  of  over  $14,000.  He  was  arrested 
and  bailed,  and  his  examination  was  deferred  two  weeks,  in  order  that 
additional  evidence  might  be  secured  in  Buffalo,  where  the  alleged  frauds 
had  been  committed.  As  he  could  not  give  bonds  he  was  kept  in  jail 
for  over  a  month,  when  he  was  released.  He  had  been  taken  for  B.  A. 
Crandall,  who  in  1886  lived  in  Buffalo  and  had  an  insurance  on  his  life 
for  $14,000.  He  went  West,  and  in  that  year  it  was  reported  that  he 
had  committed  suicide.  The  evidence  of  such  suicide  was  so  strong  that 
the  companies  paid  the  dead  man's  relatives  in  full.  In  1887  Crandall 
had  been  seen  at  Los  Angeles,  and  the  fact  reported  to  the  insurance 
companies.  They  immediately  offered  a  combined  reward  of  $2000  for 
the  arrest  of  Crandall,  and  detectives  were  placed  on  his  track.  Detective 
Poyn  heard  that  Crandall  was  at  Tacoma,  wrent  there  and  saw  Hedden, 
whose  resemblance  to  Crandall  was  great.  He  got  acquainted  with  him, 
they  went  into  partnership,  and  established  a  land-locating  agency. 
Hedden's  height,  color  of  his  eyes,  beard,  his  size  and  weight  exactly 
coincided  with  Crandall's.  On  the  latter's  right  foot  was  a  scar  over 
four  inches  in  length,  the  result  of  a  wound  accidentally  inflicted  upon 
himself  with  an  ax  when  a  young  man.  In  order  to  find  out  whether 
Hedden  had  this  scar,  Poyn  proposed  that  they  should  rent  a  room  to- 
gether, to  which  Hedden  agreed.     The  first  night  when  the  latter  un- 


202  A   SYSTEM  OF  LEGAL  MEDICINE. 

dressed  the  detective  watched  his  room-mate,  and  discovered  the  scar ; 
the  following  day  a  warrant  was  secured  by  Poyn,  and  Hedden  was 
arrested ;  and  now  more  positive  evidence  was  needed  from  Buffalo,  and 
the  telegraph  wires  were  kept  busy.  Hedden's  photograph  was  taken 
and  sent  to  Buffalo,  and  word  came  back  that  it  was  the  picture  of 
Crandall.  Hedden  asserted  his  innocence  vehemently  and  repeatedly, 
and  said  that  he  owned  a  farm  at  Lake  View,  near  Rochester,  upon  which 
his  family  were  liviug ;  and  two  or  three  Tacoma  people  of  prominence 
became  interested  and  did  all  they  could  to  help  him.  It  subsequently 
transpired  that  persons  who  knew  Crandall  saw  the  prisoner,  and  while 
admitting  that  the  resemblance  was  striking,  said  that  the  prisoner  was 
not  Crandall.  After  a  long  and  bitter  fight  Hedden  finally  got  his 
liberty. 

It  is  a  fact  that  must  be  patent  to  all  that  careful  examination  of  a 
large  number  of  scalps  will  reveal  the  presence  of  traces  of  long-forgot- 
ten injuries  which  have  escaped  ordinary  observation,  and  these  may  be 
discovered  for  the  first  time  by  persons  anxious  to  find  something. 

The  Age  of  Cicatrices. — French  writers  have  tried  to  fix  with  more  or 
less  certainty  the  date  of  formation  of  a  cicatrix,  but  there  is  no  absolute 
way  of  determining  the  exact  time  of  the  wound  itself.  Much,  however, 
depends  upon  its  situation,  and  character  of  the  instrument  used,  and, 
after  all,  we  can  only  be  governed  by  the  general  rule  of  Casper,  that 
"  a  white  cicatrix  indicates  that  the  wound  is  not  recent."  Occasionally 
it  is  possible  to  determine  the  existence  of  the  marks  of  a  former  solu- 
tion of  continuity  by  vigorous  rubbing,  which  brings  the  blood  to  the 
surface. 

A  cicatrix  is  not  always  the  consequence  of  a  wound,  for  those  left 
by  a  very  sharp  instrument  may  heal  quickly  without  any  trace,  espe- 
cially if  antiseptic  precautions  have  been  taken ;  on  the  other  hand,  if  no 
cicatrix  remains  to  mark  the  alleged  locality  of  a  burn  or  stab  of  any 
magnitude,  it  is  most  probable  that  none  has  been  made. 

Tattooing. — Very  often  the  identity  of  a  suspected  person  may  be 
determined  by  initials  or  inscriptions  which  have  reference  to  some  other 
person,  or  to  his  calling  or  previous  life. 

According  to  Lombroso,  the  greater  number  of  tattooed  criminals  are 
among  the  recedivists  and  instinctive  criminals,  "  especially  those  who 
have  committed  crimes  against  the  person."  Ellis  (The  Criminal,  Lon- 
don, 1892,  p.  104)  says  that  "  the  fewest  are  found  among  swindlers  and 
forgers,  the  most  intelligent  class  of  criminals." 

In  making  an  examination  it  will  be  found  that  among  women  of  easy 
virtue,  paedrasts,  and  tribades  the  designs  are  nearly  always  obscene,  but 
it  cannot  be  denied  that  tattooing  among  women  is  as  a  rule  very  rare. 
Alborghetti  found  that  40  of  100  children  at  the  reformatory  at  Turin 
were  tattooed,  which  was  not  the  case  with  the  children  among  the  ordi- 
nary population.  Greaves  (referred  to  by  Ellis)  examined  555  tattooed 
persons  in  Derby  Prison ;  41  were  tattooed,  the  subjects  being  chiefly 
soldiers,  sailors,  and  miners. 

The  Question  of  Indelibility. — Considerable  controversy  has  taken 
place  regarding  the  indelibility  of  tattoo  marks.  Tardieu,  whose  in- 
vestigations were  very  thorough  and  far-reaching,  believed  that  it  was 
possible  to  entirely  get  rid  of  extensive  tattoo  marks,  and  found  that  it 


IDENTITY   OF  THE  LIVING.  203 

was  the  custom  for  criminals  in  French  prisons  to  resort  to  blisters, 
acids,  and  other  escharotics,  with  more  or  less  success.  It  would  appear 
from  his  investigations  that  deposits  of  India  ink  are  much  more  in- 
delible than  vermilion,  or  other  pigments,  but  even  they  would  occa- 
sionally disappear  without  any  systematic  attempt  at  removal.  A  French 
criminal  referred  to  by  Tardieu  effectually  removed  within  six  days  very 
extensive  marks  from  his  body  b}^  means  of  an  application  of  a  paste  of 
acetic  acid  and  lard,  and  afterward  they  were  rubbed  with  potash  and 
finally  with  dilute  hydrochloric  acid.  Tardieu,  who  experimented,  found 
that  if  the  paste  were  left  on  for  a  day  there  would  be  some  detachment 
of  the  cuticle,  and  that  if  the  potash  were  used  the  second  day,  and  the 
parts  rubbed  five  or  six  times,  such  application  would  be  followed  on  the 
third  day  by  the  formation  of  a  crust  which  finally  fell  off,  leaving  a 
partial  obliteration.  Successive  crusts,  which  were  undoubtedly  due  to 
a  more  or  less  deep  destruction,  were  removed,  and  at  last  it  was  found 
that  the  parts  beneath  were  without  any  remaining  pigment. 

Taylor,  on  the  other  hand,  is  of  the  opinion  that  deep  tattoo  marks 
-cannot  be  effaced,  in  which  conclusion  he  is  opposed  by  the  writer  to 
whom  reference  has  just  been  made,  as  well  as  by  Casper  and  Hutin. 

Casper  found  that  out  of  37  persons  examined  the  marks  had  become 
effaced  in  6  ;  Hutin,  of  509  examined,  disappeared  in  47 ;  Tardieu,  of  76 
examined,  effaced  in  3 — over  nine  percent,  of  the  whole.  In  the  famous 
Tichborne  trial,  evidence  was  given  that  both  Roger  Charles  Tichborne, 
the  heir,  and  the  man  called  Arthur  Orton  had  been  tattooed.  Now 
Tichborne's  tattoo  was  R.  C.  T.,  and  Arthur  Orton's  was  A.  0.  On  the 
arm  of  the  claimant  there  were  no  tattoo  marks  at  all,  but  there  were 
two  round  depressed  scars  on  the  left  wrist  about  the  size  of  a  shilling, 
and  suggestive  of  the  tattoo  marks  as  A.  O.  These  scars  had  evidently 
been  produced  by  escharotics.  Of  course  excision  of  tattooed  wounds  is 
an  easy  possibility. 


HANDWRITING. 

Identification  by  means  of  handwriting  is  largely  a  matter  of  com- 
parison and  natural  proof,  and  I  will  only  refer  to  it  briefly.  Attention, 
however,  must  be  called  to  the  peculiarities  of  style,  the  formation  of 
habits,  and  the  variation  of  chirography  under  different  circumstances. 
When  once  the  automatic  habit  of  writing  is  acquired,  there  is  usually 
very  little  difficulty  in  determining  by  comparison  the  correspondence  of 
one  given  example  with  another ;  but  when  through  disease  the  volitional 
impulse  is  interrupted,  a  very  decided  change  occurs,  which  may  to  a 
certain  extent  confuse  the  examiner.  Mere  trend  >lings  need  not  be  con- 
sidered, but  through  mental  disease  or  certain  organic  nervous  affections 
a  very  material  change  in  style  and  letter  formation  is  a  familiar  feature ; 
among  the  sane,  sustained  efforts  at  deception  are  almost  impossible,  and 
different  parts  of  the  same  letter,  as  well  as  an  inspection  of  letters  writ- 
ten at  different  times,  will  reveal  peculiarities  which  are  the  result  of 
acquired  habit.  It  will  be  necessary  to  determine  sometimes  whether  a 
person  has  written  with  his  right  or  left  hand,  and  it  must  not  be  for- 
gotten that  it  is  possible,  as  we  know  in  the  cases  of  writer's  cramp,  for 


204  A    SYSTEM   OF  LEGAL    MEDICINE. 

persons  to  educate  themselves  to  write  with  the  unaffected  extremity, 
the  result  being  often  a  legible  and  clear  production  with  more  or  less 
change  of  style. 


FINGER  AND   FOOT   IMPRESSIONS. 

For  the  establishment  of  the  identity  of  a  criminal  a  careful  exami- 
nation should  always  be  made  of  the  papers  handled,  window-panes,  and 
china  and  glass  ornaments,  or,  in  fact,  any  other  object  which  may  re- 
ceive an  impress  from  his  more  or  less  greasy  fingers,  at  the  place  of 
commission  of  the  crime.  By  oblique  fight  there  will  sometimes  be  no 
difficulty  in  finding  upon  the  polished  window-pane  a  faint  though  per- 
fect imprint,  which  can  afterward  be  strengthened  and  made  the  subject 
of  a  permanent  record.  For  this  purpose  the  method  contrived  by  For- 
geot  (publications  of  the  Laboratoire  d  Anthropologie  CrimineUe,  of  Lyons), 
which  consists  in  the  application  of  common  ink  or  some  aqueous  pig- 
ment which  will  adhere  to  the  parts  that  are  not  greasy,  may  be  tried ; 
or  the  glass  may  be  subjected  to  the  vapor  of  hydrofluoric  acid.  Forgeot 
has  shown  that  even  pieces  of  paper  which  have  been  touched  by  slightly 
greasy  hands  will  bear  the  imprint  of  the  fingers,  and  the  most  delicate 
markings  may  be  brought  out  after  treatment  with  ordinary  ink,  and 
these  used  as  a  negative  with  good  results.  In  exceptional  cases  the 
finger-marks  may  be  made  to  give  lithographic  impressions. 

Galton  {Finger  Prints,  London,  1892)  refers  to  the  comparison  of  these 
markings  with  those  which  are  obtained  by  making  the  suspected  person 
press  his  thumb  and  fingers  upon  transfer-paper,  the  impression  being 
subsequently  transferred  to  stone,  thus  correcting  the  impression,  which 
should  be  reversed  if  direct  contact  were  made. 

The  value  of  finger  impressions  as  a  proof  of  identity  is  certainly  one 
that  has  not  been  over-exaggerated.  Galton  says :  "  So  far  as  the  propor- 
tions of  the  patterns  go,  they  are  not  absolutely  fixed,  even  in  the  adult, 
inasmuch  as  they  change  with  the  shape  of  the  finger.  If  the  finger  is 
plumped  out  or  emaciated,  or  variously  deformed  by  usage,  gout,  or  age, 
the  proportions  of  the  pattern  will  vary  also.  Two  prints  of  the  same 
finger,  one  taken  before  and  the  other  after  an  interval  of  many  years, 
cannot  be  expected  to  be  as  closely  alike  as  two  prints  similarly  made 
from  the  same  woodcut.  They  are  far  from  satisfying  the  shrewd  test 
of  the  stereoscope,  which  shows  if  there  has  been  an  alteration  even  of  a 
letter  in  two  otherwise  duplicate  pages  of  print.  The  measurements  vary 
at  different  periods,  even  in  the  adult,  just  as  much  if  not  more  than  his 
height,  span,  and  the  length  of  his  several  limbs.  On  the  other  hand, 
the  numerous  bifurcations,  origins,  islands,  and  inclosures  in  the  ridges 
that  compose  the  pattern  are  proved  to  be  almost  beyond  change.  A  com- 
parison is  made  between  the  pattern  on  a  finger  and  one  on  a  piece  of 
lace ;  the  latter  may  be  stretched  or  shrunk  as  a  whole,  but  the  threads 
of  which  it  is  made  retain  their  respective  peculiarities.  The  evidence 
on  which  these  conclusions  are  founded  is  considerable,  and  almost  wholly 
derived  from  the  collections  made  by  Sir  W.  Herschel,  who  most  kindly 
placed  them  at  my  disposal.  They  refer  to  one  or  more  fingers,  and  in 
a  few  instances  to  the  whole  hand,  of  fifteen  persons.     The  intervals  be- 


IDENTITY  OF  THE  LIVING. 


205 


fore  and  after  which  the  prints  were  taken  amount  in  some  cases  to 
thirty  years.     Some  of  them  reach  from  babyhood  to  boyhood,  some 


Fig.  39. — Schematic  figure  showing  the  different  thumb-tip  types  of  Galton  and  the  dispo- 
sition of  the  papillary  lines.  The  capitals,  C  and  T,  respectively  indicate  the  curved  lines  (C) 
and  the  transverse  lines  (T) ;  the  small  letters,  e  and  i,  correspond  to  the  external  and  internal 
sides  of  the  last  phalanx.  1,  First  type  (primary  type);  2,  second  type  (Cei,  Tei);  3,  third  type 
(Ce,  Ti) ;  4,  fourth  type  (Ci,  Te) ;  5,  fifth  type  (Ci,  Ti) ;  6,  sixth  type  (Cei,  Ti) ;  7.  seventh  type  (Ci, 
Tei) ;  8,  eighth  type  (Ce,  Te) ;  9,  ninth  type  (Ce,  Tei) ;  10,  tenth  type  (Cei,  Te).     (Testut.) 


from  childhood  to  youth,  some  from  youth  to  advanced  middle  age,  one 
from  middle  life  to  incipient  old  age.  These  four  stages  nearly  include 
the  whole  of  the  ordinary  life  of  man.  I  have  compared  altogether  some 
700  points  of  reference  in  these  couplets  of  impressions,  and  only  found 
a  single  instance  of  discordance,  in  which  a  ridge 
that  was  cleft  in  a  child  became  united  in  later 
years.  Photographic  enlargements  are  given  in 
illustration,  which  include  between  them  a  total 
of  157  pairs  of  points  of  reference,  all  bearing  dis- 
tinctive numerals  to  facilitate  comparison  and  to 
prove  their  unchangeableness.  Reference  is  made 
to  another  illustrated  publication  of  mine,  which 
raises  the  total  number  of  points  compared  to  389, 
all  of  which  were  successful,  with  the  single  excep- 
tion above  mentioned.  The  fact  of  an  almost  com- 
plete persistence  in  the  peculiarities  of  the  ridges 
from  birth  to  death  may  now  be  considered  as  de- 
termined. They  existed  before  birth,  and  they  per- 
sist after  death,  until  effaced  by  decomposition." 

A  definite  and  constant  series  of  patterns  is 
found.  (See  Fig.  39.)  These  consist  of  ridges  and 
depressions,  and  the  last  phalanx  of  the  thumb  con- 
tains in  its  space  between  the  parallel  ridges  "  a 
compact  little  system  of  its  own,  variously  curved 
and  whorled,  being  a  fictitious  resemblance  to  an 
eddy  between  two  currents."     (See  Fig.  40.) 

Galton  gives  examples  to  show  how  the  outlining  is  performed,  and 
some  of  the  patterns  which  are  characteristic.     He  says :  "  Outlines  fall 


Fig.  40. — Impression  of 
the  right  thumb — schem- 
atic. (Testut.)  1,  Curved 
lines ;  12,  transverse  lines :  3, 
intermediate  lines;  C.  the 
highest  of  the  curved  lines ; 
V.  the  lowest  of  the  curved 
lines;  e  I,  external  and  in- 
ternal sides  of  the  thumb. 


20G 


A   SYSTEM  OF  LEGAL  MEDICINE. 


for  the  most  part  into  nine  distinct  genera,  confined  by  the  relative  direc- 
tion of  the  divergent  ridges  that  inclose  them."  He  divides  his  classifi- 
cation with  reference  to  the  existence  of  arches,  loops,  and  whorls.  "  In 
the  arches  there  is  no  pattern,  strictly  speaking,  for  there  is  no  inter- 
space ;  the  need  of  it  being  avoided  by  a  successive  and  regular  broad- 
ening out  of  the  ridges  as  they  cross  the  bulb  of  the  finger.  In  loops  the 
interspace  is  filled  with  a  system  of  ridges  that  bends  back  upon  itself,  in 
which  no  ridge  turns  through  a  complete  circle.  Whorls  contain  all  cases 
in  which  at  least  one  ridge  turns  through  a  complete  circle,  and  they  in- 
clude certain  double  patterns  which  have  a  whorled  appearance." 

I  append  one  of  his  plates,  which  has  been  reproduced  by  Testut, 
which  may  serve  as  a  guide  for  examination. 

THE   SIGNIFICANCE   OF   FOOTPRINTS. 

Sometimes  footprints  are  the  only  traces  left  by  a  murderer,  and  will 
alone  lead  to  the  identity  of  the  assassin.  Much  attention  has  been  paid, 
especially  by  Ogston,  to  the  impressions  that  are  often  found  in  the  soil 
near  the  place  where  the  deed  has  been  committed.  Putting  out  of  the 
question  certain  scars  and  other  peculiarities  that  may  be  subsequently 
compared  with  the  foot  of  the  suspected  person,  and  devoting  more  atten- 
tion to  the  footmark  itself,  we  may  assume  that,  according  to  Mascar  and 


Fig.  41. 


taost  others,  the  print  in  the  ground  is  smaller  than  the  foot  which  made 
it.  This  is  in  variance  with  the  popular  idea  that  the  impression  in  the 
ground  is  equal  if  not  larger  than  the  foot  that  made  it,  and  Causse 
holds  to  this  view  that  the  impression  is  usually  larger.  It  has  been 
shown  that  the  action  of  the  individual  can  be  somewhat  determined — 
that  is  to  say,  whether  he  was  standing,  walking,  or  running — from  the- 
depth  and  extent  of  the  marks. 


IDENTITY  OF  THE  LIVING.  207 

Fig.  41  represents  the  method  adopted  by  Causse  (Annales  cV Hygiene 
Publique  et  de  Medeeine  Legale,  2d  series,  vol.  i.,  1854)  for  the  purpose  of 
identifying  the  footprints  of  incriminated  persons.  The  line  A  B  is  drawn 
between  the  internal  part  of  the  curve  of  the  heel  and  the  prominent 
point  at  the  metatarso-phalangeal  articulation.  This  line  is  divided  by 
others  equidistant  at  right  angles  from  the  first,  leaving  a  number  of  divi- 
sions which  serve  as  guides  for  measurement  and  for  tracing  the  internal 
border  of  the  footprints.  It  will  be  seen  by  Fig.  41  the  variations  that 
may  take  place  under  different  circumstances,  and  this  may  be  con- 
sidered in  every  way  to  be  a  safe  and  certain  guide,  unless  the  bottom 
of  the  foot  is  so  smeared  with  blood  as  to  prevent  the  recognition  of  its 
contour. 

It  is  often  of  the  utmost  importance  that  a  mold  should  be  taken  of 
the  footprints,  and  when  one  is  found  that  is  the  most  satisfactory,  the 
method  of  Hougilon  may  be  resorted  to.  This  consists  in  heating  the 
impressed  ground  to  220°  F.,  or  more,  which  may  be  done  by  holding 
over  it  a  shallow  pan  containing  burning  charcoal,  or  more  quickly  and 
simply  by  the  use  of  a  painter's  benzine  lamp,  and  then  dusting  the 
heated  impression  with  ground  paraffine.  When  the  soil  is  cool  the 
paraffine  may  be  removed  for  a  mold  of  plaster  of  Paris,  or  electro-metal- 
lurgical reproduction. 

RIGHT-   AND   LEFT-HANDEDXESS. 

A  consideration  to  be  regarded  is  the  question  of  right-  or  left-hand- 
edness ;  the  movements  of  the  suspected  individual  should  therefore  be 
closely  watched.  The  degree  and  situation  of  a  possible  asymmetry 
shoidd  be  determined,  and  his  boot-heels  inspected — in  fact,  it  is  always 
wise  to  closely  examine  the  clothing  of  a  prisoner  with  reference  to  its 
condition,  fit,  and  newness.  A  trap  into  which  the  prisoner  unwarily 
falls  may  be  arranged  by  asking  him  suddenly  to  hold  up  his  right  or  left 
hand,  and  he  will  usually  not  consider  the  result.  A  case  is  referred  to 
in  which  Sir  Astley  Cooper  was  called  as  a  witness  where  the  prisoner 
was  pressed  to  admit  that  he  was  left-handed,  but  denied  the  accusation. 
"When  called  upon,  however,  to  plead  to  the  indictment,  he  uncon- 
sciously held  up  his  left  hand." 


GENERAL  SUGGESTIONS  AS  TO  EXAMINATIONS. 

The  conduct  of  the  examination  of  a  suspected  person  should  be 
thorough  and  painstaking.  The  memory  of  past  occurrences  shoidd  be 
investigated  and  the  consistency  of  answers  noted.  His  body  shoidd  be 
carefully  gone  over,  and,  if  possible,  an  outline  figure  shoidd  be  provided 
upon  which  the  location  of  body-marks  are  noted,  with  measurements 
and  explanatory  text.  Not  only  is  every  external  part  to  be  inspected, 
but  evidences  of  mutilation  or  disease  alteration  should  be  looked  for, 
and  the  presence  of  artificial  pigments,  powder  grains,  tattooing,  the 
scars  of  venereal  and  other  sores  recognized.  The  teeth  must  be  sep- 
arately looked  at,  and  their  appearance,  condition,  and  the  fact  recorded 
whether  and  how  they  are  filled. 


208  A   SYSTEM  OF  LEGAL   MEDICINE. 

If  possible,  a  photograph  is  to  be  secured,  and  it  is  best  to  have 
two,  one  of  the  full  face  and  the  other  of  the  profile.  The  photographer 
should  carefully  avoid  any  sources  of  distortion ;  lighting  the  face  uni- 
formly, and  avoiding  the  forward  projection  of  the  upper  or  lower  half. 
If  there  be  any  bodily  peculiarities,  or  extensive  tattooing,  a  photographic 
representation  should  be  made.  As  a  rule,  old  photographs,  carelessly 
taken,  are  not  of  much  use,  and  are  often  unreliable  for  positive  identifi- 
cation. I  have  seen  three  pictures  of  one  New  York  criminal  taken  at 
different  times,  but  all  during  a  criminal  career  of  adult  life,  which  are 
utterly  dissimilar.  At  the  Prefecture  in  Paris,  although  photographs 
accompany  the  identification  cards,  very  little  value  is  placed  upon  their 
help  except  as  an  auxiliary  aid. 

In  these  days  of  progress,  criminal  registry  is  becoming  so  general 
that  some  notice  should  be  made  of  the  admirable  work  of  Bertillon. 

M.  Alphonse  Bertillon  has  invented  an  admirable  system,  which  has 
been  adopted  by  the  French  Government  and  has  found  its  way  to  this 
country,  being  in  vogue  in  Boston  and  Chicago,  and  may  serve  to  fix  the 
identity  of  criminals  coming  from  these  places,  although  it  is  not  prac- 
ticed as  systematically  as  in  France.  In  ten  years  he  has  made  measure- 
ments of  no  less  than  100,000  criminals,  preserving  the  results  and  classi- 
fying them  so  that  it  is  possible  to  accurately  hit  upon  the  required 
description  of  any  suspected  person,  and  I  have  myself  seen  habitual 
criminals  or  recedivists  positively  identified  at  the  Prefecture  after  a  few 
minutes'  search. 

It  is  Bertillon's  method  to  tabulate  the  measurements,  together  with 
a  description  of  certain  physical  appearances,  and  a  front  and  profile 
photograph,  which  are  recorded  upon  a  card  which  is  filed  away  with 
others  within  easy  reach. 

There  are  four  chief  measurements :  (1)  the  head  length  ;  (2)  the  head 
breadth  ;  (3)  the  middle-finger  length  ;  and  (4)  the  foot  length — the  meas- 
urements of  these  parts  being  found  to  be  more  constant  than  others. 

These  four  are  still  further  subdivided  into  "small,"  "medium,"  and 
"  large/'  so  that  there  are  in  all  eighty-one  principal  headings  which  may 
include  the  case  of  the  particular  prisoner.  There  are  still  further  sub- 
divisions of  these  primary  headings,  the  same  triplex  classification  being 
carried  out.  The  height  of  the  trunk  is  made  the  basis  of  one  division, 
while  the  ear  measurements  are  recorded  so  that  its  length  and  breadth 
are  taken,  the  height,  the  span,  and  cubit  forming  others.  The  color  of 
the  eye  is  determined,  and  is  classified  under  seven  headings,  and  finally 
the  records  are  grouped  and  subdivided,  and  upon  each  body-marks  and 
special  appearances  are  detailed. 

Bertillon's  classification  of  appearances  presented  by  the  ear  includes 
the  variations  presented  in  Fig.  60.  He  also  refers  to  the  configuration  of 
the  nose  and  the  characteristics  of  the  forehead,  and  these  are  portrayed 
in  Figs.  42-59.  According  to  this  investigator  the  ear  undergoes  very 
little  change.  Contorted  and  swollen  ears  often  indicate  the  existence  of 
previous  insanity. 

It  can  be  seen  that  numerous  classifications  are  possible,  and  it  is 
comparatively  easy  to  nearly  approximate  the  exact  description  of  any 
particular  person. 

The  possibilities  of  this  admirable  system  are  unlimited,  and  doubtless 
when  insurance  companies  subject  their  applicants  to  some  general  form 


IDENTITY  OF  THE  LIVING. 


209 


Fig.  42.    Concave-elevated.  Fig.  43.    Concave-horizontal.  Fig.  44.    Concave-descending. 


Fig.  45.    Rectilinear-elevated.         Fig.  46.    Rectilinear-horizontal.      Fig.  47.    Rectilinear-descending. 


r    >'  • 

\ 

»*<* 

ifE& 

fr. 

"ST' 

i^PC 

jp^k.-^i 

1 

t'r    WBM& 

Fig.  48.    Convex-elevated.  Fig.  49.    Convex-horizontal.  Fig.  50.    Convex-descending. 

Noses  Classified  according  to  Bridge  and  Base.    (Bertillon.)    By  permission  of  S.  S.  McClure  Co. 


210 


A    SYSTEM  OF  LEGAL  MEDICINE. 


Fig.  51.    Receding  forehead.         Fig.  52.    Intermediary  inclination.        Fig.  53.    Vertical  inclination. 


Fig.  54.     Height  of  forehead : 
Small. 


Fig.  55.    Medium. 


Fig.  56.    Great. 


Fig.  57.    Breadth  of  forehead: 
Small. 


C~ — 


Fig.  58.    Medium.  Fig.  59.     Large. 

Classification  of  Foreheads.    (Bertillon.)    By  permission  of  S.  S.  McClure  Co. 


IDENTITY  OF  THE  LIVING. 


211 


of  measurement  at  the  time  of  taking  policies,  there  will  be  no  likelihood 
of  conspiracies  for  the  purpose  of  illegally  obtaining  premiums. 

Drs.  Smart  and  Greenleaf,  of  the  Medical  Department  of  the  United 
States  Army,  have  adopted  a  system  which  has  its  advantages,  although 
it  is  less  reliable  than  the  Bertillon  system. 


'<S        '"■■■■ s      "\»J 

Open.  Medium.        Adherent. 

Outer  Border  of  the  Ear. 


,\ 


•;   .';  to 

■•  'J  J 


'•••- 


v>H 


V 


Rectilinear.   Medium.    Indented. 
Profile  of  Antitragus. 


i  | 

«     • 


> 


f   : 


Square.  Medium.         Gulf-like. 

Exterior  Contour  of  Lobe. 


tf$\   frrh  /£fi\ 


v-.. 


^Jl 


Complete.       Medium.        Separate. 
Adherence  of  Lobe  to  Cheek. 


Fig.  60.— Some  Classifications  of  the  Form  of  the  Ear.    (Bertillon.) 


According  to  Smart  and  Greenleaf,  desertions  from  the  United  States 
army  are  believed  to  greatly  exceed  deserters  who  are  apt  to  repeat  their 
offense.  It  is  believed  to  be  possible  to  detect  such  "  repeaters  "  if  the 
body-marks  of  all  recruits  are  recorded,  if  all  deserters  are  recorded,  and 
if  all  recruits  are  compared  with  previous  deserters.  In  like  manner  men 
discharged  for  cause  should  be  excluded  from  reentry.  The  originators 
of  this  plan  do  not  believe  in  the  value  of  Bertillon's  method  before 
courts-martial,  because  of  possible  inaccuracies  and  allowable  errors,  but 
only  as  a  confirmatory  proof  when  following  coincident  indelible  marks, 
when  height,  age,  and  hair  fairly  correspond.  In  other  words,  Bertillon's 
collateral  evidence  is  practically  primary  evidence.  Smart  and  Greenleaf 
use  for  each  man  an  outline-figure  card,  giving  anterior  and  posterior 
surfaces,  divided  by  dotted  lines  into  regions,  which  are  filed  alphabet- 
ically at  the  Surgeon-General's  office  at  Washington.  As  a  man  goes  out 
for  cause,  or  deserts,  his  card  is  filed  separately,  and  the  cards  of  recruits 
are  compared  Math  the  last  file. 

"  To  make  this  comparison,  a  register  in  two  volumes  is  opened,  one 
for  light-eyed  and  one  for  dark-eyed  men.  Each  is  subdivided  into  a 
fair  number  of  pages,  according  to  height  of  entrance,  and  each  page  is 
ruled  in  columns  for  body  regions.  Tattooed  and  non-tattooed  men  of 
similar  height  and  eyes  are  entered  on  opposite  pages.  Recruits  without 
tattoos  are  not  compared  with  deserters  with  tattoos ;  but  recruits  with 
tattoos  are  compared  with  both  classes.  On  the  register,  S.,  T.,  B.,  M., 
etc.,  are  used  as  abbreviations  for  scar,  tattoo,  birth-mark,  mole,  etc.  One 
inch  each  side  of  recorded  height  allowed  for  variation  or  defective  meas- 
urement. When  probability  of  identity  appears,  the  original  card  is  used 
for  comparison." 


IDENTITY  AND   SURVIVORSHIP. 

BY 

BENJAMIN  N.  CARDOZO. 


It  would  seem,  to  the  world  of  to-day,  a  strange,  if  not  incredible, 
notion  that  there  was  a  stage  in  the  growth  of  law  when  personal  iden- 
tity was  a  problem  of  very  limited  concern.  Yet  it  was  so.  That  prob- 
lem has  not  always  existed  to  tax  the  energies  of  litigants  and  to  per- 
plex the  minds  of  courts.  Only  with  the  gradual  development  of  law 
has  it  emerged  as  a  legal  concept  of  permanent  and  paramount  impor- 
tance. It  is  a  concept  that  had  but  little  place  in  the  most  primitive  stages 
of  legal  growth,  for  the  identity  of  the  individual  was  absorbed  in  the 
identity  of  the  tribe.  Vengeance,  to  be  sure,  was  not  unknown  ;  vengeance, 
prompt  and  sharp  and  merciless,  was  exercised  then  as  now ;  yet  it  was  ven- 
geance not  merely  on  the  perpetrator  of  the  deed,  but  on  his  kinsmen, 
his  family,  his  clan.  There  was  no  thought  of  this  as  a  punishment 
vicarious  in  its  nature.  It  did  not  present  itself  to  those  ages  in  such  a 
light.  The  individual  had  no  life  apart  from  his  clan ;  he  had  no  legal 
status  except  beneath  its  sheltering  care ;  and  a  sense  of  solidarity,  un- 
known to  future  times,  made  each  the  agent  of  the  other  and  each  the 
guardian  of  all* 

It  is  a  slow  and  in  many  ways  a  curious  history  that  marks  the  rise 
of  this  concept  of  personal  identity  from  its  crude  beginnings  to  the 
commanding  position  which  it  holds  to-day.  There  seems,  indeed,  to 
have  been  a  sort  of  intermediate  stage  where  the  identity  of  the  offend- 
ing person  was  confused  with  the  identity  of  the  instrument  through 
which  the  offense  was  perpetrated.  It  must  be  borne  in  mind  through- 
out that  the  unit  of  society  in  primitive  times  is  not  the  individual,  but 
the  family  or  clan.t  Community  of  property,  or  rather  perhaps  the 
absence  of  any  definite  notion  of  property  at  all,  tended  still  further  to 
subtract  from  the  individual's  importance  as  the  bearer  of  rights  or  the 
subject  of  duties.  And  so  it  is  that  private  wrongs  were  wont  to  en- 
gender as  their  consequences,  not  merely  private  vengeance  upon  the 
offender,  but  vengeance  upon  his  clan.  The  personality  of  the  individual 
was  merged  in  the  personality  of  his  tribe.  The  search  after  the  identity 
of  the  offender  was  forgotten  in  the  pursuit  of  the  clan  from  which  his 
station  in  the  community  was  derived.  And  so  we  find  that  the  first 
dim  awakening  of  a  sense  that  the  individual  offender  should  bear  the 

*  H.  S.  Maine,  Ancient  Law,  p.  122. 
t  Ibid.,  pp.  121,  178. 

213 


214  A   SYSTEM  OF  LEGAL  MEDICINE. 

burden  of  his  own  guilt  was  due  to  the  desire  of  the  clan  to  avert  from 
itself,  and  to  cast  upon  its  guilty  member,  the  consequences  of  his  crime* 
By  yielding  up  the  offender  to  the  vengeance  of  his  accuser,  or  perhaps 
by  sacrificing  him  to  the  anger  of  the  gods,  the  family  purged  itself  of 
blame.  It  was  felt  that  the  wrong  of  the  offender  was  the  wrong  of  the 
clan.  It  was  felt  that  the  accuser  might  fairly  exact  reparation  of 
the  clan.  It  was  felt  that  the  divine  indignation  would  justly  be  visited 
on  the  clan ;  and  the  first  trace  of  a  weakened  sense  of  tribal  solidarity, 
the  first  trace  of  a  growing  notion  of  individual  responsibility,  the  first 
trace  of  a  distinct  recognition  of  personal  identity  as  a  permanent  legal 
concept,  may  be  found  in  the  effort  to  absolve  the  tribe,  to  cleanse  the 
community,  from  the  crime  and  the  taint  of  its  guilty  member. 

And  yet  even  here  the  effort  was  not  so  much  to  insure  the  punishment 
of  the  real  offender  as  to  insure  the  punishment  of  somebody.  It  was 
not  so  much  an  effort  to  fasten  the  crime  upon  the  guilty  wrong-doer  as 
to  save  and  purify  the  clan  from  the  threatened  vengeance  of  men  or  of 
the  gods.  It  was  an  effort  to  preserve  intact  that  corporate  personality 
in  which  the  identity  of  the  individual  was  deemed  to  have  been  merged. 
The  controlling  necessity  was  that  the  tribe  should  be  purified ;  and  the 
divine  power  might  well  be  trusted  to  single  out  for  destruction  no  other 
but  the  true  offender.  The  traces  of  this  notion  may  be  seen  in  the 
ordeal,  which  once  formed  a  part  of  the  judicial  system  of  every  people, 
whether  of  the  East  or  West,  and  which  in  its  essence  "  was  a  passive 
appeal  to  the  power  of  nature  as  the  voice  of  God."  t  In  England,  even 
in  the  twelfth  century,  an  accusation  by  the  body  of  the  country,  preferred 
on  common  fame  or  general  suspicion,  was  "  practically  equivalent  to  a 
conviction,  subject  to  the  chance  of  the  favorable  termination  of  the 
ordeal  by  water."  If  the  ordeal  failed,  the  accused  person  lost  his  foot 
and  his  hand.  If  it  chanced  to  succeed,  he  was  nevertheless  banished. 
Accusation  was  thus  equivalent  to  banishment  at  least,  and  the  survival 
of  the  ordeal  only  mitigated  the  punishment  of  the  suspected  criminal.! 

That  old  notion  of  the  potency  of  certain  tests  to  indicate  the  divine 
judgment  as  to  the  identity  of  an  offender  lived  on,  indeed,  for  genera- 
tions to  come,  and  under  the  most  divergent  forms  of  law.  Some  of  us 
may  recall  the  account  that  is  given  by  Mr.  Lowell  of  the  trials  for 
witchcraft  among  our  ancestors  of  two  centuries  ago.§  It  was  suggested 
that  no  witch  could  repeat  the  Lord's  Prayer,  and  the  court  directed  that 
the  test  be  made,  but  informed  the  jury  that  they  were  not  in  the  least 
measure  to  regard  it,  "because  it  was  not  legal  evidence."  The  days 
of  the  old  ordeal  had  not  been  yet  forgotten.  The  assumption  that  the 
minds  of  the  jurors,  abstracting  from  the  case  every  item  of  irrelevant 
proof,  would  be  swayed  solely  by  the  directions  of  the  court,  strikes  us 
to-day  as  grimly  grotesque  in  its  hypocrisy ;  yet  perhaps  it  is  not  neces- 
sary that  we  should  turn  to  the  records  of  a  bygone  age  to  meet  with 
parallel  instances  of  the  blindness  of  the  law. 

It  was  a  step  in  advance  of  the  old  trial  by  combat  when  the  law  re- 
quired proof,  though  of  an  arbitrary  and  illogical  kind,  as  to  the  identity 

*  Lightwood,  TJie  Nature  of  Positive  Laic,  p.  163. 
t  George  Neilson,  Trial  by  Combat,  p.  1. 

t  1  Stephen,  Hist.  Grim.  Law  of  England,  252;  Assize  of  Northampton,  A.D.  1176, 
Stubbs'  Charters,  145-150;  Hurtado  vs.  California,  110  U.  S.  516,  530. 
§  J.  E.  Lowell,  Among  My  Books,  vol.  L,  p.  104. 


IDENTITY  AND   SURVIVORSHIP.  215 

of  the  person  accused  of  crime.  For  a  long  time  it  indulged  in  certain 
presumptions  of  guilt  which  it  treated  as  conclusive,  and  which  no  evi- 
dence would  be  permitted  to  rebut.  A  man,  for  example,  who  was  found 
standing  over  a  dead  body  with  a  bloody  knife  in  his  hand  was  deemed 
estopped  from  denying  the  charge  of  murder.  The  inmates  of  a  house 
in  which  a  man  had  been  found  murdered  in  the  night,  if  they  had  raised 
no  hue  and  cry,  and  could  show  no  wounds  or  other  marks  of  violence 
sustained  in  defending  the  dead  man  from  Ms  assassin,  were  conclusively 
presumed  to  have  caused  his  death.*  But  even  these  presumptions, 
crude  as  they  are,  marked  a  certain  advance  in  the  growth  of  legal 
thought.  The  circumstances  from  which  guilt  was  inferred  had  a  certain 
probative  force — not  that  conclusive  force  which  was  ascribed  to  them, 
but  still  a  certain  force  as  tending  toward  the  conclusion  of  a  defendant's 
guilt.  They  were  steps  in  the  direction  of  requiring  proof  of  the  identity 
of  the  offender,  even  though  the  proof  was  weak,  and  the  inference  of 
guilt  that  was  drawn  from  it  unauthorized.  The  necessity  that  punish- 
ment should  be  visited  on  the  real  offender — the  necessity,  too,  that  some- 
thing more  than  chance  should  determine  who  the  offender  was — that  ne- 
cessity had  at  last  made  itself  manifest  to  the  consciousness  of  the  race. 

It  should  be  noted,  indeed,  that  when  the  clan  had  been,  as  it  were, 
resolved  into  its  elements,  and  individual  identity  had  become  a  familiar 
concept  of  the  law,  the  concept  was  applied  with  a  simplicity,  a  rigor,  and 
a  literalness  which  are  unknown  to  later  days.  Back  of  the  mere  instru- 
ment by  which  a  wrong  is  done,  developed,  systems  of  law  look  to  the 
intelligent  agent  by  whom  the  instrument  is  directed.  Primitive  law, 
however,  knows  no  such  distinction,  f  It  recognizes  a  guilt  in  slaves,  in 
animals,  even  in  lifeless  things.  It  yields  up  to  the  accuser  the  tree 
which  has  fallen  on  him,  the  sword  which  has  wounded  him,  the  beast 
which  has  trampled  on  him.  They  are  his,  to  satisfy  his  vengeance  upon 
them ;  they  are  given  up  to  destruction  ;  it  is  the  noxm  deditio.  | 

And  so  we  may  say,  I  think,  that  the  problem  of  identity  in  early  law 
is  a  problem  of  physical  rather  than  personal  identity.  It  is  a,  search 
after  the  hand  that  did  the  wrong ;  it  is  not  a  search  for  the  mind  that 
willed  it,  In  all  this,  early  law  is  but  true  to  its  vindictive  origin.  "  All 
the  law  in  the  world  has,"  in  the  words  of  Ihering,§  "been  obtained  by 
strife  ;"  and  the  passion  of  revenge,  satisfying  itself  even  upon  inanimate 
things,  has  been  the  final  source  and  sanction  of  the  peace  and  the  order 
of  the  world.  But  the  truth  which  I  desire  to  enforce  is  that  the  problem 
of  personal  identity  as  it  presents  itself  to-day  is  a  problem  which  has  an 
historic  past  and  which  has  met  with  different  answers  at  different  stages 
in  the  growth  of  law.  The  gradual  recognition  of  the  truth  that  the  law 
must  regard  the  intelligent  agent  rather  than  the  passive  instrument  and 
the  gradual  demolition  of  arbitrary  presumptions  have  been  the  work  of 
centuries  of  legal  progress.  If  it  be  possible  to-day  to  treat  questions 
of  identity  by  the  methods,  for  the  most  part,  of  a  rational  logic,  it  must 
not  be  forgotten  that  the  problem  was  once  a  very  different  problem,  and 
the  mode  of  its  solution  a  very  different  mode. 

*  Forsyth,  Trial  by  Jury,  p.  167.     Bracton,  lib.  iii.,  e.  18. 
t  O.  W.  Holmes,  Jr.,  The  Common  Law,  p.  10. 
X  Ibid.,  p.  19. 

§  Diering,  The  Struggle  for  Laic,  p.  1 ;  and  see  O.  W.  Holmes,  Jr.,  The  Common 
Law,  p.  2. 


-21  fi  ^   SYSTEM  OF  LEGAL   MEDICINE. 

Adequately  to  present  the  possible  phases  in  which  the  question  of 
identity  may  arise  before  a  court,  and  the  possible  means  by  which  that 
question  can  be  solved,  would  be  to  catalogue  all  the  conceivable  instances 
in  which  the  presence  or  absence  of  a  given  fact  may  be  deemed  to  con- 
firm or  to  weaken  the  hypothesis  of  the  identity  of  two  given  individuals. 
Far  as  we  have  gone  of  recent  years  in  basing  our  law  of  evidence  upon 
the  canons  of  inductive  logic,  a  survey  of  the  decisions  on  this  topic 
must  leave  one  impressed  with  the  belief  that  problems  of  evidence  may, 
indeed,  be  problems  of  logic,  but  they  must  always  be  something  more 
as  well.  "  The  life  of  the  law,"  *  it  has  been  truly  said,  "  has  not  been 
logic ;  it  has  been  experience  j"  and  experience  in  last  analysis  is  the  final 
test  of  the  validity  of  proof.  We  cannot  divorce  the  rales  of  law  from 
the  life,  the  emotions,  and  the  history  of  men.  We  cannot  explain  the 
causal  relation  which  we  feel  to  exist  between  two  phenomena  except  by 
reference  to  the  experience  of  the  race  that  the  two  have  in  practice  been 
found  combined.  We  cannot  give  an  intelligible  explanation  of  the  com- 
pelling force  exercised  b}^  a  given  circumstance  upon  our  minds  except 
by  our  knowledge  that  in  the  ordinary  course  of  events,  in  the  ordinary 
life  of  the  race,  in  the  ordinary  experience  of  mankind,  a  given  circum- 
stance is  wont  to  accompany  another,  and  so  in  the  language  of  the  law 
is  deemed  to  prove  it.  The  content  of  all  rules  of  evidence  is  given  by 
experience ;  and  logic  can  never  do  more  than  to  classify,  and  perhaps 
to  limit  or  restrain  them. 

We  shall  feel  this,  I  think,  if  we  attempt  to  give  any  strictly  logical 
explanation  of  the  decisions  which  illustrate  this  problem  of  personal 
identity.  We  shall  feel  that  the  content  of  the  rule  of  evidence  is  so 
dependent  on  experience  that  it  resists  our  efforts  to  formulate  it  as  a 
rule  of  orderly,  coherent  thought.  And  the  question  is  further  compli- 
cated by  the  fact  that  personal  identity  is  itself  a  symbolic  term ;  that 
identity  is  known  to  us  only  by  its  external  manifestations,  and  yet  is 
felt  to  be  something  separate  and  distinct  from  those  manifestations  by 
which  it  is  revealed. 

To  any  one  but  to  a  man's  own  self,  his  identity  may  be  said  to  be  a 
complex  notion  in  which  his  physical  and  mental  traits,  and  his  past  his- 
tory and  experiences  in  so  far  as  they  are  known,  may  be  deemed  to  be 
the  predominant  elements.  It  is  manifest,  therefore,  that  as  identity 
can  be  known  to  us  only  as  a  man's  qualities  or  experiences  are  known 
to  us,  proof  of  any  element  that  goes  to  make  up  our  notion  of  identity 
will,  in  tliis  connection,  be  material  and  relevant.  If  the  identity  of  a 
person,  either  with  some  one  known  to  us  in  time  past  or  with  the  per- 
petrator of  a  given  deed,  be  a  fact  in  issue,  it  will  accordingly  be  per- 
missible to  prove : 

(a)  Any  fact  that  shows  the  coincidence  (or  the  contrary)  of  the  gen- 
eral appearance  of  the  one  with  that  of  the  other. 

(b)  Any  fact  that  shows  the  coincidence  (or  the  contrary)  of  the  physi- 
cal peculiarities  of  the  one  with  those  of  the  other. 

(c)  Any  fact  that  shows  the  coincidence  (or  the  contrary)  of  the  mental 
peculiarities  of  the  one  with  those  of  the  other. 

(d)  Any  fact  that  shows  the  coincidence  (or  the  contrary)  of  the  his- 
tory or  experiences  of  the  one  with  those  of  the  other. 

*  O.  W.  Holmes,  Jr.,  The  Common  Laic,  p.  1. 


IDENTITY  AND  SURVIVORSHIP.  217 

(e)  Any  fact  that  in  the  ordinary  course  of  events  renders  it  probable 
that  the  person  before  the  court  is  the  person  by  whom  an  act  in  issue 
has  been  perpetrated ;  and  all  facts  that  would  in  common  experience 
precede  or  that  would  in  common  experience  follow  the  act  in  issue,  such 
as  motive,  preparation,  or  the  possession  of  the  fruits  of  crime,  are,  within 
the  meaning  of  this  principle,  to  be  deemed  to  be  relevant. 

The  foregoing  analysis  will  suffice  in  itself  to  show  the  complexity  of 
the  problem ;  but  the  question  is  further  complicated  by  the  fact  that 
those  external  qualities  by  which  identity  is  known  are  not  really  of  the 
essence  of  identity ;  that  the  qualities  may  change  in  their  entirety,  and 
the  identity  may  still  subsist.  If,  for  example,  we  know  the  present 
traits  and  the  past  history  of  A,  and  the  present  traits  and  the  past  his- 
tory of  B,  and  if  complete  agreement  exists,  the  process  is  mainly  one  of 
comparison,  though  the  warrant  for  the  conclusion  of  identity  results 
from  the  general  experience  of  the  race  that  complete  coincidence  of 
traits  and  of  history  is  never  found,  as  between  different  persons,  to 
exist.  On  the  other  hand,  if  we  simply  know  the  present  traits  of  A 
and  the  past  traits  of  B,  and  if  disagreement,  partial  or  complete,  exists, 
the  main  question  will  be  the  likelihood  that  such  changes  should  have 
occurred  were  the  persons  in  reality  the  same ;  and  any  fact  that  in  the 
ordinary  course  of  events  would  tend  to  cause  or  to  prevent  such  changes 
will  thus  become  relevant.  A  case  which  excellently  serves  to  illustrate 
the  difficulties  of  such  inquiries  and  the  application  to  them  of  the  teach- 
ings of  medical  science  is  quoted  by  Dr.  Beck  *  from  the  commentaries 
of  Zacchias :  "A  noble  Bolognese,  name  Casali,  left  his  country  at  an 
early  day  and  engaged  in  military  pursuits.  He  was  supposed  to  have 
lost  his  life  in  battle,  but  after  an  absence  of  thirty  years  returned  and 
claimed  his  property,  which  his  heirs  had  already  appropriated  to  them- 
selves. Although  there  were  some  marks  which  appeared  to  identify 
him,  yet  the  change  in  appearance  was  so  great  that  none  who  remem- 
bered him  were  willing  to  allow  that  this  was  the  individual.  He  was 
arrested  and  imprisoned.  The  judges  were  in  great  doubt,  and  consulted 
Zacchias  whether  the  human  countenance  could  be  so  changed  as  to 
render  it  impossible  to  recognize  the  person.  This  distinguished  physi- 
cian, in  his  consultation,  assigns  several  causes  which  might  produce  such 
an  alteration :  as  age,  change  of  air,  ailments,  manner  of  life,  and  the 
diseases  to  which  we  are  liable.  Casali  had  departed  in  the  bloom  of 
youth ;  he  had  entered  on  the  hardships  of  a  military  life,  and  if  the 
narrative  of  the  individual  in  question  is  to  be  credited,  he  had  languished 
in  prison."  All  these  causes,  it  was  conceived,  might  produce  a  great 
change  in  the  countenance,  and  render  recognition  difficult,  if  not  im- 
possible. 

It  is  because  traits  of  body  or  of  mind  are  those  with  which  in  the 
main  we  associate  a  man's  identity,  and  because  medical  science  can  bear 
the  most  important  witness  to  the  possibility  of  the  effacement  of  traits, 
whether  bodily  or  mental,  that  questions  of  identity  have  found  a  place 
in  treatises  on  medical  jurisprudence.  It  is  very  manifest,  however,  that 
their  connection  with  medicine  is  rather  the  result  of  the  accidents  of 
given  cases  than  of  any  inherent  union  between  the  two,  or  of  any  neces- 
sary dependence  of  the  one  upon  the  other. 

*  Beck's  Medical  Jurisprudence,  vol.  i.,  p.  659. 


218  A   SYSTEM  OF  LEGAL  MEDICINE. 

The  eases  in  which  questions  of  personal  identity  have  been  debated 
or  illustrated  may  be  ranged  in  accordance  with  the  classification  that 
has  been  already  suggested.  We  shall  have,  therefore,  to  consider  in  the 
first  place  the  cases  where  a  man's  identity  has  been  proved  by  the  testi- 
mony of  persons  acquainted  with  his  general  appearance. 

(a)  General  Appearance — We  have  seen  that  in  early  times  identity 
was  proved  by  certain  irrefutable  presumptions,  and  that  the  develop- 
ment of  law  has  been  marked  by  the  gradual  disappearance  of  artificial 
rules  of  evidence  and  the  demand  for  rational  proof.  It  was  one  of  the 
presumptions  of  the  scholastic  jurists  that  a  mother's  recognition  of  her 
child  proved  the  child's  identity  beyond  the  possibility  of  debate.*  How 
unreal  was  the  assumption  on  which  even  this  rule  was  based,  how  falli- 
ble is  even  that  evidence  of  identity  which  to  many  minds  might  well 
appear  the  most  cogent  and  direct,  the  history  of  reported  decisions 
must  serve  conclusively  to  show.  There  are  certain  cases  of  disputed 
identity  which  are  the  common  stock  of  all  the  writers  on  medical  juris- 
prudence, but  which  are  at  once  so  striking  and  so  typical  that,  in  any 
discussion  of  the  topic,  they  cannot  well  be  omitted  from  review. 

One  of  the  earliest  and  most  notable  of  these  cases  is  a  case  which 
came  before  the  parliament  of  Toulouse  in  1560 — the  case  of  Martin 
Guerre  and  Arnaud  du  Tilh.t  After  Guerre  had  been  absent  from  his 
home  for  a  period  of  eight  years,  one  Arnaud  du  Tim  claimed  to  be  the 
missing  man.  Guerre's  entire  family,  his  wife,  his  four  sisters,  his  uncle, 
and  his  brothers-in-law,  all  positively  and  without  hesitation  acknowl- 
edged the  identity  of  the  impostor  with  Guerre  himself.  For  three  years 
Arnaud  lived  with  Guerre's  wife,  who  bore  him  two  children  in  the  in-, 
terval ;  but  circumstances  at  last  arose  which  awakened  suspicions  as 
to  his  identity,  and  he  was  brought  to  trial  upon  the  charge  of  having 
falsely  personated  the  absent  Guerre.  The  accused  man,  though  sub- 
jected to  a  most  searching  examination,  showed  a  complete  acquaintance 
with  the  history  and  experiences  of  the  man  whose  name  and  position  he 
had  assumed.  The  place  of  Guerre's  birth,  the  precise  date  of  his  mar- 
riage, the  circumstances  of  his  departure  from  his  home,  and  numberless 
little  incidents  which  had  characterized  his  life — all  these  were  stated 
with  a  minuteness  that  seemed  to  establish  beyond  dispute  the  defend- 
ant's innocence  of  the  crime.  Of  the  witnesses  that  testified  upon  the 
trial — some  hundred  and  fifty  in  all — between  thirty  and  forty  deposed 
that  "  the  defendant  was  really  Martin  Guerre ;  that  they  had  known 
and  conversed  with  him  from  his  infancy ;  that  they  were  perfectly 
acquainted  with  his  person,  air,  tone  of  voice ;  and  that  they  moreover 
were  convinced  of  the  truth  of  what  they  asserted  by  certain  scars  and 
secret  marks  which  it  was  impossible  for  time  to  efface. 

"  On  the  other  hand,  a  great  number  of  witnesses  deposed  positively 
that  he  was  one  Arnaud  du  Tilh,  of  Sagias,  and  was  commonly  called 
Pansette,  and  that  they  were  perfectly  acquainted  with  his  person,  air, 
and  voice.  The  rest  of  the  witnesses,  to  the  number  of  sixty  or  upward, 
declared  that  there  was  so  strong  a  resemblance  between  the  two  per- 
sons that  it  was  impossible  for  them  to  declare  whether  the  accused  was 
Martin  Guerre  or  Arnaud  du  Tilh."     Nearly  all  the  witnesses,  however, 

*  Wharton  on  Evidence,  vol.  i.,  p.  17. 
t  Earn  on  Facts  (3d  Am.  ed.),  p.  400. 


IDENTITY  AJSD   SURVIVORSHIP.  219 

agreed  that  Martin  Guerre  had  two  scars  on  his  face,  that  his  left  eye 
was  bloodshot,  the  nail  of  his  first  finger  was  grown  in,  that  he  had  three 
warts  on  his  right  hand,  and  another  on  his  little  finger ;  and  all  these 
marks  were  found  on  the  accused. 

From  a  judgment  of  conviction  before  the  criminal  judge  of  Rieux,  an 
appeal  was  carried  to  the  parliament  of  Toulouse ;  and  that  tribunal  was 
so  perplexed  by  the  conflicting  testimony  adduced  before  it  that  the 
reversal  of  the  judgment  of  the  lower  court  seemed  highly  probable.  It 
was  only  the  sudden  appearance  of  Guerre  himself  upon  the  scene,  and 
the  direct  comparison  of  the  two  men  by  their  relatives  and  by  the  court, 
that  dispelled  the  doubts  of  the  judges,  and  led  to  Arnaud's  conviction 
of  the  crime  with  which  he  had  been  charged. 

In  this  remarkable  ease  nearly  every  element  by  which  the  identity  of 
a  person  can  be  established  was  proved  by  clear  and  cogent  and  unhesi- 
tating proof.  Many  of  its  features  are  so  extraordinary  as  to  suggest  at 
least  a  doubt  with  reference  to  the  sincerity  of  the  impostor's  witnesses. 
That  a  man  should  fraudulently  personate  another  in  an  action  in  the 
courts,  that  he  should  so  closely  resemble  the  missing  man  as  to  cause 
the  relatives  of  the  latter  to  testify  in  the  claimant's  behalf,  that  he 
should  even  in  some  way  have  so  acquainted  himself  with  the  life  and 
history  of  the  absent  man  as  to  withstand  a  searching  examination 
directed  to  these  points, — all  this  in  itself  is  marvelous  enough.  But  that 
for  three  years,  in  all  the  relations  of  daily  life,  in  all  the  manifold  inci- 
dents by  which  character  and  temperament  are  revealed,  with  all  else 
that  goes  to  make  up  our  notion  of  identity — that  in  all  these  details  the 
impostor  should  have  satisfied  the  doubts  of  those  who  had  been  closest 
to  the  missing  man,  is  a  fact  that  must  tend  to  inspire  renewed  convic- 
tions of  the  fallibility  of  every  form  of  proof. 

It  is  related  that  the  members  of  the  parliament  were  somewhat  incred- 
ulous as  to  the  possibility  of  practicing  a  deception  upon  the  wife  of  the 
missing  man  for  so  long  a  period  of  time ;  and  many  of  them  were  dis- 
posed to  believe  that  the  lady  had  wearied  of  her  single  life,  and  were 
inclined  to  adjudge  her  a  party  to  the  scheme ;  but  her  character,  it  is 
said,  in  point  of  modesty  and  prudence,  and  the  fact  that  many  of  the 
closest  relatives  of  Guerre  had  been  similarly  misled,  caused  the  parlia- 
ment to  resolve  their  doubts  in  her  favor  and  to  acquit  her  of  the  charge 
of  any  intentional  wrong.  Guerre  himself,  according  to  the  report,  was 
less  charitable  in  his  judgment,  and  maintained  that  a  wife  coidd  not 
thus  be  imposed  upon,  "  unless  she  had  secretly  cherished  an  inclination 
to  be  deceived." 

A  case  of  much  more  recent  date,  which  excited  popular  interest  and 
discussion  to  a  marked  degree,  and  which  seems  to  sum  up  within  itself 
most  that  can  be  said  upon  the  problem  of  identity  in  its  relations  to 
legal  medicine,  is  the  famous  case  of  the  claimant  to  the  Tichborne 
estate.  Almost  all  those  circumstances  from  which  identity  may  be  in- 
ferred— almost  all  those  elements  of  which  our  notion  of  identity  is  com- 
pounded— were  there  testified  to  by  those  witnesses,  of  all  the  world, 
whose  testimony  on  such  a  topic  might  most  implicitly  be  believed.  The 
mother  of  the  absent  man,  the  family  solicitor,  seventeen  servants  of  the 
Tichborne  household,  and  a  host  of  other  witnesses — all  swore  that  the 
claimant  was  the  real  Sir  Roger.  The  charge  of  Chief-Justice  Cockburn 
presents  with  rare  ability  the  difficulties  that  attend  the  solution  of  prob- 


220  A   SYSTEM  OF  LEGAL  MEDICINE. 

lems  of  this  kind,  and  demonstrates  that  even  the  most  direct  testimony 
is  subject  to  the  gravest  possibilities  of  mistake.  He  is  speaking  of  the 
meeting  of  Lady  Tichborne  with  the  alleged  heir  to  the  estate,  and  of 
the  mother's  acknowledgment  of  the  claimant  as  in  reality  her  child. 
"  Were  there  not  several  things,"  he  asks,  "  which  ought  to  have  made 
Lady  Tichborne  hesitate  in  accepting  the  defendant  as  her  son,  even  if 
the  defendant  in  his  appearance  had  presented  the  outward  and  external 
appearance  of  the  son  whom  she  had  lost?  Were  there  not  circumstances 
which  ought  to  have  made  her  hesitate,  and  certainly  not  decide,  before 
she  had  an  opportunity  of  asking,  in  the  words  of  the  Patriarch,  '  Art 
thou  vay  very  son  ? ' " 

That  maternal  instinct,  which,  it  was  urged,  outweighed  a  score  of 
opposing  witnesses,  outweighed  the  weightiest  arguments  of  labored 
proof,  is  not,  as  Lord  Cockburn  clearly  saw,  an  instinct  at  all.  "  It  is 
not,"  he  says,  "an  impulse  of  nature  stronger  than  human  judgment 
or  human  reason ;  something  which  carries  you  irresistibly  on  to  some 
particular  person."  It  is  the  product  of  long  and  close  association,  of 
watching  by  day  and  by  night,  and  for  year  after  year ;  "  it  arises  from 
being  familiarized  by  daily  habit  with  everything  that  appertains  to 
personal  identity — features,  form,  gestures,  everything  which  constitutes 
the  sum  total  of  identity." 

"  We  must  not  allow  ourselves,"  said  the  court,  "  to  be  carried  away 
by  declamatory  commonplace  about  a  mother's  instinct,  but  must  look 
to  see  how  far  we  can  trust  to  the  mother's  judgment.  We  should  listen 
with  all  due  respect  to  the  opinion  of  the  mother;  we  should  take  it  as 
a  circumstance  calculated  to  weigh  strongly  in  the  scale ;  but  if  our  con- 
viction, having  taken  into  account  the  large  range  and  variety  of  facts 
which  we  know  and  which  the  mother  did  not  know,  is  that  she  must  be 
wrong,  no  appeal  that  is  made  to  your  feelings,  or  addressed  to  you  in 
the  name  of  the  departed  mother,  ought  to  influence  your  judgments. 
Take  it  as  a  most  important  circumstance  in  the  case,  but  not  as  conclu- 
sive as  the  learned  counsel  would  make  it.  If  it  were  so,  what  need  of 
all  this  long  and  protracted  inquiry  ? " 

And  yet,  in  spite  of  certain  points  of  diversity,  which  are  noted  in  the 
charge  of  the  court,  the  claimant,  so  far  as  physical  traits  were  concerned, 
went  far  toward  satisfying  the  most  exacting  tests.  Both  in  general 
appearance  and  in  certain  physical  peculiarities,  the  resemblance,  though 
not  complete,  was  at  least  sufficiently  marked  to  forbid  the  hasty  rejec- 
tion of  the  claim.  The  collapse  of  the  plaintiff's  case  and  his  subsequent 
conviction  for  perjury,  as  we  shall  later  have  occasion  to  note,  illustrate 
the  place  which  mental  traits  occupy  in  our  notion  of  identity — a  place 
which,  if  less  prominent,  is  perhaps  more  constant  and  determining  than 
that  which  is  occupied  by  any  traits  of  the  physical  organism  alone. 

But  the  Tichborne  case  is  only  a  single  instance  of  a  type  of  which 
numberless  examples  may  be  found.  Cases  involving  similar  errors, 
though  on  a  less  imposing  scale,  are  scattered  through  all  the  journals 
and  reports.*  There  is  the  well-known  case  of  The  Peojrfe  vs.  Moag  t  — 
a  prosecution  for  bigamy — where  twelve  witnesses  testified  to  the  identity 

*  Some  curious  eases  may  be  found  cited  in  the  opinion  of  Mason,  J.,  in  Euloffvs. 
The  People,  3  Parker's  Crim.  Rep.  401,  446.  See  also  an  article  in  the  Albany  Law 
Journal  of  September  28,  1872,  p.  230. 

t  Ram  on  Facts  (3d  Am.  ed.),  p.  412. 


IDENTITY  AND   SURVIVORSHIP.  221 

of  the  defendant,  apparently  from  long  and  intimate  personal  acquaint- 
ance. His  innocence  was  established  by  the  equally  positive  testimony 
of  six  witnesses,  and  more  particularly  by  evidence  as  to  the  absence 
•of  a  distinctive  scar.  There  is  the  equally  Well-known  case  of  Luther 
Hause,*  where  a  young  man  personated  the  part  of  a  son  who  had  been 
lost  in  childhood,  and  took  up  his  abode  for  a  long  period  of  time  as  an 
acknowledged  member  of  the  household.  Nor  is  there  any  lack  of  in- 
stances where,  after  the  conviction  and  execution  of  supposed  criminals, 
upon  the  most  direct  and  unfaltering  evidence  of  their  identity,  the  ap- 
pearance of  the  real  offender  has  demonstrated  anew  the  infirmity  of 
every  form  of  proof.  The  poor  vagabond  who  in  1727  was  put  to  death 
at  York,t  protesting  vainly  that  his  identity  had  been  mistaken,  while 
witness  after  witness  with  confident  emphasis  denounced  him  as  Geddely, 
the  thief,  found,  in  the  fullness  of  time,  a  tardy  vindication — long  after 
his  prosecutors  had  hurried  him  out  of  the  world.  There  is  a  grim  pathos 
in  the  narrative  of  the  trial  of  Shaw,  who  was  executed  for  murder  in 
1721.  Years  afterward,  when  the  poor  fellow's  body  had  been  resting 
quietly  in  his  dishonored  grave,  the  truth  of  the  case  came  out.  And  so  in 
token  of  his  innocence  they  fastened  a  flag  upon  the  grave ;  they  set  the 
flag  flying  in  the  wind ;  and  that  was  the  way  that  they  undid  the  wrong.$ 

Yet  it  is  easy  to  exaggerate  the  number  and  even  to  exaggerate  the 
importance  of  cases  of  this  kind.  The  sacrifice  is  one  that  every  system 
of  remedial  justice  must  involve;  and  it  will  not  do,  fastening  our  gaze 
upon  the  instances  of  error,  to  forget  the  manifold  instances  where  the 
right  has  been  attained.  Conspicuous  cases  of  doubt  or  of  injustice  have 
so  fixed  the  popular  attention  as  possibly  to  engender  a  belief  in  the  un- 
certainty of  inquiries  as  to  identity,  which  almost  outruns  the  distrust 
that  the  difficidties  of  the  problem  might  reasonably  inspire. 

Impressions  of  general  resemblance  have,  however,  so  often  proved 
themselves  at  fault  that  courts  have  been  eager  to  discover  some  surer 
token  by  which  identity  might  be  revealed.  They  have  found  in  evidence 
of  special  traits  or  peculiarities  of  feature  or  of  form  a  test  by  which  the 
vagueness  of  general  impressions  might  safely  be  corrected. 

(b)  Physical  Peculiarities. — Physical  peculiarities  have  been  a  most 
common,  and  in  many  respects  a  most  satisfactory,  means  for  the  solu- 
tion of  problems  of  identity ;  yet  even  here,  as  we  have  already  seen,  the 
possibility  of  error  exists.  In  Guerre's  case,  as  has  been  shown,  the 
correspondence  of  certain  physical  peculiarities  of  the  missing  man  with 
those  of  the  impostor  was  most  striking  and  complete.  In  the  Tichborne 
case,  too,  "  the  claimant  gave  proof  of  a  fish-hook  wound  on  the  eye ;  of 
a  mark  of  bleeding  on  the  ankle ;  and  of  a  peculiar  scar  on  the  head, 
which  a  hair-dresser  swore  had  been  seen  upon  the  head  of  the  real  Sir 
Roger."  Yet  due  allowance  being  made  for  these  and  other  conspicuous 
instances  of  error,  the  existence  of  any  distinctive  physical  trait,  when 
coupled  with  a  general  impression  of  resemblance,  not  only  affords,  to 
say  the  least,  the  strongest  corroborative  proof,  but  frequently  furnishes 
the  only  data  from  which  a  witness  may  be  enabled  to  recall  the  personal 
appearance  of  a  man  who  has  been  hastily  observed. 

(1)  Physical  Marls. — Congenital  marks,  marks  of  tattooing,  and  the 

*  Ram  on  Facts  (3d  Am.  ed.),  p.  432. 
t  Ruloffvs.  The  People,  :i  Parker,  401. 
{  Ram  on  Facts  (3d  Am.  ed.),  p.  4:»:!. 


222  A   SYSTEM  OF  LEGAL  MEDICINE. 

scars  left  by  wounds  and  by  disease  have  been  repeatedly  employed  in 
cases  of  disputed  identity  as  instruments  of  proof.  In  the  case  of  Salome 
Miller,*  who  was  held  as  a  slave  in  Louisiana,  and  who  brought  suit  for 
her  liberty  in  the  courts  of  that  State,  the  existence  of  two  small  >ki  ri 
materni  upon  the  inside  of  each  thigh  was  the  medium  by  which  her 
identity  was  established  and  her  liberty  secured.  In  the  Hoag  case,t  as 
we  have  seen,  the  innocence  of  the  accused  defendant  was  demonstrated 
by  the  absence  of  a  scar  which  a  cut  with  a  scythe  was  known  to  have 
left  upon  the  foot  of  the  man  for  whom  the  defendant  was  mistaken ; 
yet  it  is  to  be  noted  that  in  the  existence  of  a  scar  upon  the  forehead  the 
physical  peculiarities  of  the  two  were  proved  to  coincide.  The  Hause 
case  |  is  a  still  more  curious  instance  of  the  frequent  correspondence 
of  marks  of  violence  upon  different  men;  for  the  impostor  exhibited 
numerous  scars  which  agreed  in  the  most  striking  manner  with  the  scars 
of  the  missing  son.  From  the  French  tribunals  conies  the  record  of  the 
case  of  a  man  named  Lesurgues  who  was  convicted  and  executed  upon 
a  charge  of  murder  in  1794 ;  and  not  only  did  the  real  murderer,  who 
was  subsequently  discovered,  resemble  Lesurgues  in  general  form  and 
feature,  but  on  the  forehead  and  the  hand  of  both  a  similar  scar  was  to 
be  found. § 

Artificial  marks  have  been  equally  common  as  a  medium  of  proof.  The 
Tichborne  trial  for  perjury  again  supplies  a  pointed  illustration.  It  was 
shown  by  a  number  of  witnesses  that  Sir  Roger  had  upon  the  inside  of 
his  left  forearm  certain  tattoo  marks  of  a  blue  color,  representing  a  cross, 
a  heart,  and  an  anchor.  Lord  Bellew,  a  school-fellow  of  Sir  Roger,  tes- 
tified that  he  had  seen  the  symbols  on  Roger's  arm,  and  that  he  himself 
had  imprinted  there  in  addition  the  letters  R.  C.  T.  The  defendant  not 
only  could  show  no  similar  marks  upon  his  person,  but  he  denied  that 
he  had  ever  been  tattooed  at  all.  The  proof  of  the  existence  of  these 
emblems  upon  the  real  Tichborne  heir  at  the  time  when  he  was  lost  at 
sea  in  April,  1854,  was  so  abundant  and  convincing  as  to  contribute 
doubtless  in  no  slight  degree  to  the  ultimate  detection  of  the  fraud. 
" Unless  we  are  prepared  to  admit,"  says  Dr.  Taylor,  ||  "that  a  man  can 
be  tattooed  and  have  no  knowledge  of  the  fact,  and  having  been  thus 
unconsciously  tattooed,  that  all  the  marks  had  disappeared  before  he 
saw  them,  it  is  impossible  that  this  claimant  could  have  been  the  Roger 
Charles  Tichborne,  the  heir  to  the  estates." 

In  an  early  case  in  this  Stated]  the  identity  of  a  man  who  was  found 
murdered  was  established  in  the  main  by  the  presence  upon  the  leg  of 
the  initial  letter  of  his  name ;  and  the  courts  of  some  States  have  even 
gone  so  far  as  to  permit  the  forcible  inspection  of  distinctive  marks  for 
the  purpose  of  identifying  a  suspected  criminal.  In  a  case;  for  example, 
that  came  before  the  courts  of  Nevada,**  where  a  witness  had  testified  that 
the  defendant  had  certain  tattoo  marks  on  his  person,  the  defendant  was 
compelled  by  the  court  to  exhibit  these  marks  to  the  inspection  of  the 

*  Beck's  Medical  Jurisprudence,  vol.  i.,  p.  661. 

t  Earn  on  Facts  (3d  Am.  ed.),  p.  412. 

X  Ibid,,  p.  432. 

§  Taylor's  Medical  Jurisprudence,  p.  347;  Earn  on  Facts  (3d  Am.  ed.),  p.  420. 

||  Taylor's  Medical  Jurisprudence,  p.  361. 

II  People  vs.  Wilson,  3  Parker's  Crim.  Eep.  199. 

**  People  vs.  Ah  Chuey,  14  Nev.  89;  s.  c.  33  Am.  E.  530. 


IDENTITY  AND  SURVIVORSHIP.  223 

jury.  Not  a  little  diversity  of  opinion,*  however,  lias  existed  with  refer- 
ence to  the  propriety  of  such  procedure,  and  the  weight  of  authority 
would  seem  to  sustain  the  view  that  to  compel  the  prisoner  to  exhibit  the 
marks  upon  his  body  is  to  compel  him  to  give  evidence  against  himself, 
and  is  therefore  a  violation  of  his  constitutional  immunity.  A  distinction 
has,  however,  been  drawn  between  those  cases,  on  the  one  hand,  where 
the  prisoner  has  been  required  to  expose  to  view  marks  not  commonly 
visible,  and  those  cases,  on  the  other  hand,  where  he  has  sought  to  con- 
ceal his  form  or  features  by  the  use  of  a  mask  or  a  veil  or  some  other 
disguise.!  The  constitutional  immunity  extends  to  cases  of  the  one 
class,  but  it  is  doubtful  whether  the  immunity  is  broad  enough  to  cover 
cases  of  the  other. 

Probably  of  all  marks  upon  the  body,  marks  of  tattooing,  by  reason 
of  their  frequent  presence,  have  most  often  played  a  part  in  judicial  in- 
quiries as  to  personal  identity ;  and  the  common  introduction  of  such 
evidence  has  raised  extended  discussion  as  to  whether  these  symbols  may 
not,  in  the  course  of  years,  spontaneously  disappear.  The  conclusion 
arrived  at  by  Dr.  Taylor  |  after  a  careful  resume  of  the  recorded  cases — 
a  conclusion  which  seems  in  harmony  with  the  prevailing  current  of 
authority — is  "that  tattoo  marks  once  properly  made  in  the  cutis  are 
practically  indelible ;  but  that  when  the  operation  is  imperfectly  per- 
formed, the  marks  may,  in  the  course  of  many  years,  become  lighter  and 
disappear.  .  .  .  The  only  methods  by  which  such  marks  admit  of  removal 
are  by  excision  of  the  cutis  or  the  application  of  actual  cautery  or  es- 
charotics  to  destroy  the  skin.  In  such  cases,  cicatrices  remain,  which 
under  a  proper  examination  may  lead  to  detection." 

A  curious  instance,  which  will  serve  as  an  illustration  of  the  questions 
that  arise  in  this  connection,  is  cited  by  Dr.  Taylor  §  from  the  records  of 
the  courts  of  France.  "  A  man  named  Aubert  was  charged  with  having 
committed  a  robbery  in  1843.  His  defense  was  that  he  was  at  that  date 
confined  in  a  certain  prison  under  the  assumed  name  of  Solignon.  On 
searching  the  prison  register  it  was  found  that  a  man  named  Solignon 
was  there  confined  at  the  date  assigned,  and  the  description  of  the  pris- 
oner showed  that  he  was  tattooed  on  both  arms — on  the  left  there  were 
two  hearts,  a  dog,  and  other  emblems ;  on  the  right,  a  man,  a  woman,  a 
dog,  and  two  hearts.  On  examining  the  prisoner  Aubert  no  marks  of 
tattooing  were  seen  upon  his  arms,  although  he  affirmed  that  he  had 
been  tattooed  by  a  friend  in  1840  and  again  in  1846  with  a  blue  vegetable 
ink,  but  that  he  had  some  months  ago  removed  the  marks  by  a  chemical 
process.  He  also  described  the  marks ;  those  on  the  right  arm  repre- 
sented the  bust  of  a  woman  and  the  letters  J.  S.,  and  on  the  left  arm  a 
tomb,  with  foliage,  etc.  In  1846  a  hunting  scene  had  been  added,  but 
this  was  the  faintest  of  all.     By  close  examination  of  the  skin  with  a  lens 

*  See  22  Alb.  Law  Jour.  144;  People  vs.  McCoy,  45  How.  Pr.  216;  State  vs.  Gar- 
rett, 71  N.  C.  85;  s.  c.  17  Am.  R.  1;  Black-well  vs.  State,  67  Ga.  76;  s.  c.  44  Am.  R. 
717;  Stokes  vs.  State,  5  Baxt.  619;  s.  c.  30  Am.  R.  595;  Boyd  vs.  United  States,  116 
U.  S.  616;  ef.  Counselman  vs.  Hitchcock,  142  U.  S.  547.  Contra,  Walker  vs.  State,  7 
Tex.  Ct,  of  App.  245;  s.  c.  32  Am.  R.  595;  and  see  State  vs.  Graham,  74  N.  C.  646. 

t  So  it  has  been  held  permissible  to  summon  a  defendant  to  the  bar  for  the  pur- 
pose of  identification.     People  vs.  Mount,  1  Wheeler's  Crim.  Cases,  411. 

X  Taylor's  Medical  Jurisprudence,  p.  355.  See  also  Wharton  and  Still6's  Medical 
.Jurisprudence,  vol.  ii.,  p.  261. 

§   Taylor's  Medical  Jurisprudence,  p.  356. 


224  A   SYSTEM  OF  LEGAL  MEDICINE. 

in  a  strong  light,  M.  Tardien  was  able  to  detect  faint  white  marks  like 
cicatrices,  representing  the  outline  of  a  tomb  with  two  hearts,  and  the 
marks  indicative  of  two  letters  were  also  detected  on  the  skin  of  the 
other  arm  by  the  same  means.  By  these  observations,  the  non-identity 
of  the  accused  Aubert  with  the  former  prisoner  Solignon  was  clearly 
proved.  Both  were  tattooed,  but  the  tattoo  designs  were  quite  different, 
and  under  less  skillful  hands  than  those  of  M.  Tardien,  Aubert  might 
have  escaped  the  punishment  which  he  merited." 

A  similar  inquiry  has  been  raised,  and  analogous  cases  have  arisen, 
with  reference  to  the  possible  effacement  of  cicatrices  or  scars ;  but  the 
physicians  are  apparently  agreed  *  that  "  all  scars  resulting  from  wounds 
and  from  cutaneous  diseases  which  involve  any  loss  of  substance  are  in- 
delible ;  the  only  exception  that  can  be  made  being  in  regard  to  trifling 
punctured  wounds,  where  but  little  violence  has  been  done  to  the  skin." 

(2)  Teeth. — Some  very  striking  instances  of  the  recognition  of  per- 
sons by  peculiarities  of  teeth  are  reported  in  the  books.  The  trial  of 
Professor  Webster  for  the  murder  of  Dr.  Parkman — one  of  the  classics 
of  the  criminal  law — is  perhaps  the  most  notable  illustration  of  the  em- 
ployment of  this  form  of  proof.t  The  body  had  been  consumed  in  a 
furnace ;  but  the  artificial  teeth,  being  composed  of  an  infusible  materialr 
remained  substantially  intact.  It  was  shown  by  the  dentist,  Dr.  Keep, 
that  a  pecidiar  set  of  teeth  had  been  constructed  by  him  for  the  murdered 
man ;  and  the  production  of  the  trial-plate  and  the  mold  of  the  jaw,  and 
the  correspondence  of  the  teeth  found  iu  the  furnace  with  the  peculiar 
formation  of  the  plate  and  mold,  pointed  with  almost  convincing  force 
to  the  identity  of  the  victim.  So,  in  a  case  which  came  before  the  courts- 
of  New  York,  the  body  of  a  man  was  found  six  months  after  a  supposed 
murder,  and  the  inquiry  turned  upon  the  question  of  the  man's  identity. 
A  dentist  who  testified  that  he  had  extracted  some  teeth  for  the  person 
believed  to  have  been  murdered,  proved  also  that  on  the  teeth  remaining 
there  were  certain  peculiar  marks.  Evidence  was  offered  that  the  same 
teeth  were  absent  from  the  jaw  of  the  body  that  had  been  found ;  and 
similar  marks  in  the  other  teeth  were  shown  to  exist.f 

(3)  Hair. — The  same  case  affords  an  illustration  of  the  possibility  of 
identifying  a  body  by  peculiarities  in  the  color  of  the  hair  or  beard.  It 
has  been  held,  however,  that  an  expert  witness  who  has  made  a  study  of 
human  hair,  on  being  shown  hair  from  the  head  of  the  victim  of  a  mur- 
der and  hah*  found  with  blood  on  it  upon  a  wheelbarrow  belonging  to' 
the  accused,  may  not  be  permitted  to  give  his  opinion,  founded  only  on 
the  ordinary  appearance  of  the  hair,  that  the  two  were  from  the  same 
head.§  That  is  a  conclusion  to  be  drawn  only  by  the  jury  from  the 
points  of  resemblance  or  diversity  which  the  evidence  may  disclose. 

(4)  Size  and  Stature. — In  Lindsay's  case,  the  measurement  of  the  body 
was  one  of  the  tests  adopted  for  the  purpose  of  identifying  the  victim ; 
and  in  the  case  of  The  People  vs.  Wilson,  the  correspondence  of  the  height 
of  the  body  which  had  been  washed  ashore  with  that  of  the  man  believed 
to  have  been  murdered,  coupled  with  the  fact  of  an  unusual  length  of 

*  Wharton  and  Still  e's  Medical  Jurisprudence,  vol.  ii.,  §  301 ;  Taylor's  McdiceU  Juris- 
prudence, p.  348. 

t  Com.  vs.  Webster,  5  Cnsh.  295. 

t  Lindsay  vs.  The  People.  63  N.  Y.  143;  and  see  State  vs.  Vincent,  24  Iowa,  570. 

§  Knoll  vs.  The  state,  55  Wis.  249;  s.  c.  42  Am.  R.  704. 


IDENTITY  AND  SURVIVORSHIP.  225 

face,  facilitated  the  solution  of  the  problem  of  identity.  So  in  the  trial 
of  Arnaud  before  the  parliament  of  Toulouse,  a  shoemaker  testified  "  that 
Guerre's  foot  reached  to  the  twelfth  size,  whereas  the  foot  of  the  accused 
reached  no  further  than  the  ninth." 

It  is  remarked  by  Mr.  Burrill  in  his  treatise  on  circumstantial  evi- 
dence *  that  size  is  the  circumstance  "  which  ordinarily  makes  the  first 
impression  on  the  sense  of  vision  when  directed  toward  a  particular  per- 
son ;  and  where  it  exists  in  excess  or  the  reverse,  as  where  the  person  is 
unusually  large  or  unusually  small,  much  below  or  much  above  the  com- 
mon height,  it  always  arrests  the  attention  and  impresses  the  memory. 
The  impression  it  makes  is  an  instantaneous  one,  and  may  be  received 
under  circumstances  admitting  any  exercise  of  the  faculty  perceiving  it. 
Hence,  it  may  be  observed  under  circumstances  of  imperfect  light  or 
hurried  motion,  which  would  not  admit  of  the  observation  of  minuter 
peculiarities.  If  there  be  light  enough  to  see  an  individual  with  any  dis- 
tinctness at  all,  the  outline  of  his  person,  which  suffices  to  give  an  idea 
of  his  size  or  stature,  must  be  visible.  It  is,  moreover,  a  circumstance 
which  cannot,  ordinarily,  be  disguised  by  artificial  means,  like  other  per- 
sonal peculiarities."  t 

(5)  Voice, — Singularities  of  voice  have  sometimes  served  as  an  impor- 
tant aid  in  judicial  inquiries  touching  the  identity  of  men.  In  Hoag's 
case,  a  peculiar  shrill  tone  and  the  presence  of  a  slight  lisp  were  among 
the  marks  of  correspondence  of  which  evidence  was  given.  In  Harri- 
son's case,|  which  is  cited  by  Wharton  and  Stille  in  their  book  on  medical 
jurisprudence,  "  a  witness  testified  that  on  the  night  when  the  deceased 
was  found  strangled  in  a  hackney-coach  in  the  street,  she  saw  a  coach 
stop  at  a  place  named,  and  heard  a  person  in  the  coach  tell  the  coach- 
man  to  go  to  a  certain  house,  and  when  he  did  not  go  fast  enough  she 
heard  the  passenger  swear  at  him  for  going  so  slow.  Afterward  she  saw 
the  coachman  return  with  the  deceased,  who  entered  the  coach.  The  wit- 
ness upon  hearing  the  voice  of  the  prisoner  declared  that  it  was  the  same 
she  heard  swear  at  the  coachman  on  the  night  in  question,  and  in  this 
way  led  to  an  entire  identification."  § 

The  principle  that  evidence  of  voice  is  a  legitimate  means  for  the 
solution  of  questions  of  identity  finds,  I  suppose,  a  logical,  if  somewhat 
startling,  extension  in  the  rule  announced  by  a  decision  in  New  York 
that  the  identity  of  a  dog  may  be  shown  by  the  peculiarity  of  its  bark.|| 

(6)  Dress. — In  connection  with  the  subject  of  the  identification  of 
persons  by  means  of  bodily  peculiarities,  mention  may  appropriately  be 
made  of  cases  where  a  man's  dress  or  other  articles  connected  with  his 
person  have  furnished  a  decisive  clew  to  his  identity.  Cases  of  this 
character,  as  might  reasonably  be  expected,  are  extremely  numerous. 
In  Howe's  case,lj  for  example,  a  fawn-skin  waistcoat  was  particularly 
noticed  as  an  article  of  the  prisoner's  dress ;    and  "  the  absence  of  an 

*  Burrill,  Circumstantial  Evidence,  p.  638. 

t  For  other  illustrations  of  identification  by  means  of  stature,  see  Barbofs  Case, 
18  State  Trials,  1267;  Rex  vs.  Brook,  31  id.  1137;  state  vs.  Avery,  Burrill,  Circ.  Ev., 
p.  621.  So  a  man's  carriage — for  example,  a  habit  of  stooping  or  of  carrying  the  head 
on  one  side — may  serve  to  identify  him.     Regina  vs.  Brush,  Burrill,  Circ.  Ev.,  p.  638. 

t  12  State  Trials,  850,  860. 

§  See  also  Com.  vs.  Scott,  123  Mass.  222. 

||  Wilbur  vs.  Hubbard.  35  Barb.  303. 

1[  Wills,  Circumstantial  Evidence,  p.  234;  Burrill,  Circumstantial  Evidence,  p.  639. 


226  A   SYSTEM   OF  LEGAL   MEDICINE. 

article  of  apparel  usually  woru  out-of-doors,  such  as  a  hat,  constitutes  an 
observable  circumstance  by  which  a  person  may  be  identified."  *  It  has 
frequently  happened  that  in  cases  of  death  by  violence,  where  the  body 
of  the  victim  was  no  longer  recognizable,  the  discovery  of  his  clothing, 
hat,  or  papers  has  been  the  sole  agency  through  which  the  question  of 
his  identity  could  be  solved.t  In  a  recent  case  in  this  State,  the  body 
of  the  victim,  supposed  to  be  one  Bernard,  was  in  a  decomposed  and 
mutilated  condition.  A  satchel  near  the  body  containing  an  almanac  on 
which  the  name  "Bernard"  was  written,  keys  on  the  body  which  fitted 
the  lock  of  the  satchel,  shoes  and  other  articles  of  clothing  recognized  as 
belonging  to  the  murdered  man,  were  the  only  tokens  by  which  identity 
could  be  revealed.f 

Not  only  the  dress  of  the  victim,  but  the  peculiar  nature  of  any  other 
object  in  his  possession,  may  thus  become  important.  Cases,  for  exam- 
ple, may  be  cited  where  evidence  as  to  the  color  of  a  man's  horse  has 
opened  the  door  to  the  solution  of  problems  of  this  kind.§ 

Akin  to  these  cases  in  principle  are  cases  where  articles  belonging  to 
the  prisoner  have  been  found  near  the  scene  of  the  murder  ;||  or  where 
articles  known  to  have  belonged  to  a  person  believed  to  have  been  mur- 
dered are  found  in  the  possession  of  the  prisoner  himself .J[ 

Peculiarities  of  dress,  like  peculiarities  of  stature,  are  wont  to  arrest 
the  attention  of  the  observer  and  to  stamp  themselves  sharply  upon  the 
memory.  They  enter  largely  into  our  notion  of  a  man's  general  appear- 
ance ;  and  more  often  perhaps  than  any  strictly  physical  qualities  have 
they  played  a  part  in  the  solution  of  questions  of  this  character. 

(c)  Mental  Traits. — It  has  frequently  happened,  however,  that  with 
the  most  striking  similarity  of  bodily  form  and  features,  the  mental  at- 
tributes of  two  men  have  been  proved  to  be  so  radically  divergent  as  to 
exclude  the  hypothesis  of  their  identity.  Evidence  as  to  the  mental 
powers  and  attainments  of  persons  whose  identity  is  at  issue  has  been 
frequently  received,  and  often  with  the  most  telling  force. 

Thus,  in  Guerre's  case,  Arnaud's  ignorance  of  fencing — an  art  in 
which  Guerre  was  proved  to  have  been  expert — was  noted  as  repelling 
the  inference  of  the  identity  of  the  claimant  with  the  absent  man.  In 
Hause's  case,  a  circumstance  that  had  led  to  the  acknowledgment  of  the 
defendant  as  the  missing  son  was  his  familiarity  with  certain  local  tales 
which  the  son  was  known  to  have  learned.  But  the  most  conspicuous 
instance  of  the  potency  of  evidence  of  this  kind  may  be  found  in  the 
Tichborne  case,  to  which  reference  has  been  so  often  made.  The  claim- 
ant, as  we  have  seen,  had  been  acknowledged  by  Sir  Roger's  mother  as 
her  son ;  a  host  of  witnesses  had  corroborated  the  mother  in  declaring 
that  he  was  the  true  heir  to  the  estate ;  and  yet  in  the  face  of  all  this 
proof,  in  the  face  of  the  most  striking  similarities  of  feature  and  of  form, 

*  Burrill,  Circumstantial  Evidence,  640.  See  also  Barbot's  Case,  18  State  Trials, 
1229;  Wills,  Circumstantial  Evidence,  96;  Com.  vs.  Beardon,  4  Gray,  420. 

t  Taylor  vs.  State,  35  Tex.  97;  State  vs.  Williams,  7  Jones,  446;  Regina  vs.  Hopkins, 
8  C.  &  P.  591 ;  People  vs.  Beckwith,  108  N.  Y.  67,  73. 

X  People  vs.  Palmer,  109  N.  Y.  110. 

$   Williams  vs.  State,  24  Tex.  App.  17. 

||  People  vs.  Hamilton,  137  N.  Y.  531 ;  State  vs.  Rainsburger,  74  la.  196  ;  Caldwell  vs. 
State,  14  S.  W.  Rep.  122:  Bun-ill,  Circumstantial  Evidence,  p.  642. 

tf  Taylor  vs.  State,  35  Tex.  97;  State  vs.  Wagner,  61  Me.  178;  Burrill,  Circumstantial 
Evidence,  p.  642. 


IDENTITY  AND  SURVIVORSHIP.  227 

the  disparity  in  the  intellectual  acquirements  of  the  two  men  stamped 
the  claim  as  a  scheme  of  perjury  and  fraud.  The  claimant's  "  ignorance 
of  the  mother-tongue  of  the  real  Sir  Roger ;  his  ignorance  of  the  town 
in  which  the  first  sixteen  years  of  the  life  of  Sir  Roger  had  been  passed ; 
his  ignorance  of  the  rudiments  of  knowledge  which  Sir  Roger  was  shown 
to  have  possessed ;"  his  want  of  those  instinctive  tendencies  of  mind 
which  a  man  of  Sir  Rogers  1  tilth  and  breeding  could  never,  it  was  felt, 
have  lost — all  this  combined  to  overthrow  the  formidable  fabric  of  proof 
that  had  been  reared  in  his  behalf.  It  could  not  be  that  in  twelve  years 
a  man  who  was  still,  by  concession,  a  keen,  an  intelligent,  an  able  man, 
•could  have  lost  every  distinctive  trait  of  mind  that  had  marked  him  off 
from  others  in  the  past. 

And  yet  the  case  raises  an  interesting  doubt,  Is  it  in  fact  true  that 
the  things  of  the  mind  are  to  such  a  degree  more  constant  and  immut- 
able than  those  of  the  body  ?  Hundreds  of  years  ago,  as  we  have  seen, 
Zacchias  did  not  hesitate  to  answer  to  his  inquirers  that  toil  and  hard- 
ship, exposure  and  suffering,  the  thousand  incidents  of  a  busy  and  active 
life,  might  change  the  form  of  the  man  of  mature  years  beyond  recog- 
nition by  the  friends  of  the  youth.  Can  the  same  answer  be  made  of 
the  things  of  the  mind  ?  Do  they  survive  and  defy  all  the  conflicts  and 
storms,  all  the  errors  and  weaknesses,  of  a  tumultuous  or  a  dissolute  life  ? 
We  cannot  answer  with  assurance  that  they  do ;  and  yet  we  feel  that, 
more  perhaps  than  any  trait  of  feature  or  of  form,  the  possessions  of 
the  mind  are  indeed  a  possession  to  us  forever.  The  mind,  of  course, 
may  be  blotted  out ;  its  powers  ma}'  be  atrophied  or  dulled ;  but  while 
general  intelligence  apparently  survives  unimpaired,  we  can  hardly  con- 
ceive but  that  some  vestiges  of  its  past  attainments,  a  scrap  or  tatter  of 
its  bygone  powers,  would  outlive  the  wreck  and  ruin  of  the  past.  Some 
faint  and  feeble  echo,  some  elusive,  mocking  memory  of  what  was  once 
its  own,  would  haunt  it  with  a  sense  of  latent  force,  and  stir  it  sometimes 
with  resurgent  powers.  There  have  been  cases,  doubtless,  where  for  long 
days  and  nights,  as  George  Eliot  has  said  of  her  own  Baldassarre, 
"memory  has  been  little  more  than  the  consciousness  of  something 
gone  " ;  there  have  been  eases  where  by  some  passing  emotion  the  vibra- 
tions of  that  memory  have  been  stirred,  and  the  old  scenes,  the  old 
Knowledge,  the  old  associations  have  struggled  forth,  and  waked  the 
mind  at  last.  But  these  were  cases  of  mental  decay  or  of  mental  stupor 
which  affected  the  mind  in  its  entirety.  They  do  not  make  it  the  easier 
to  believe  that,  along  with  present  ability  and  mental  force,  complete  loss 
of  past  acquirements  should  coexist.  We  can  conceive,  in  short,  of  the 
destruction  of  the  mind ;  we  can  conceive  of  the  impairment  of  its  fac- 
ulties ;  but  we  can  hardly  conceive  that  with  the  mind  still  existent,  with 
general  intelligence  still  surviving,  with  no  trace  of  idiocy  or  senility  at 
hand,  the  mind  should  be  substantially  a  different  mind  from  that  which 
once  it  was.  We  can  conceive  of  it  as  annihilated,  we  can  conceive  of 
it  as  impaired;  but  with  difficulty  can  we  conceive  of  it  as  transformed. 

Yet  the  inference  of  the  identity  of  the  Tichborne  claimant  with  the 
missing  heir  to  the  estate  was  not  only  overborne  by  the  diversity  of 
their  mental  traits;  it  was  overborne  by  the  very  theory  and  basis  of  the 
claim.  Why  Sir  Roger  Tichborne  should  have  led  this  wandering  life, 
why  he  should  have  left  his  home  to  act  as  a  horse-breaker,  a  stock-driver, 
and  ultimately  a  butcher,  why  he  should  have  abandoned  the  splendors 


228  A   SYSTEM  OF  LEGAL  MEDICINE. 

of  his  former  life  for  the  hardships  and  privations  which  apparently  he 
courted,  what  intelligible  motive  could  have  existed  for  such  a  course, 
there  was  little  effort  to  suggest.  One  feels  that,  on  the  claimant's  own 
theory  of  the  case,  the  temperament,  the  tastes,  the  passions  of  the  two 
men  were  inherently  at  variance.  It  was  not  only  that  the  man  who 
had  returned  had  lost  the  traits  of  mind  of  the  boy  who  had  gone  forth ; 
it  was,  that  the  life  which,  of  his  own  volition,  he  had  led,  did  violence 
to  every  impulse  and  desire  that  the  true  Sir  Roger  would  naturally  have 
felt. 

(d)  History  and  Experiences.— And  just  as  the  disparity  of  mental 
traits  is  a  corrective  of  the  errors  to  which  bodily  resemblance  may  give 
rise,  so  too,  by  proof  of  the  agreement  or  the  diversity  of  the  history  of 
men,  of  the  incidents  of  their  careers,  of  the  course  and  tendency  of  their 
lives,  the  conclusion  of  identity  may  be  defeated  or  sustained.  A  case 
came  before  the  courts  of  this  State  but  a  few  years  ago,*  where  a  woman, 
claiming  to  be  the  child  of  a  testator,  instituted  proceedings  to  contest 
the  validity  of  his  will.  It  was  shown  by  the  discrepancy  between  the 
lives  and  records  of  the  testator  and  of  the  contestant's  father,  that  the 
hypothesis  of  their  identity  could  not  for  a  moment  be  sustained.  It 
was  proved  that  the  father  of  the  contestant  was  an  illiterate  man  who 
had  been  a  farm-laborer,  a  policeman,  and  a  convict,  and  who  signed  his 
name  with  a  mark.  It  was  proved  that  the  testator  had  been  a  tutor  in 
prominent  families,  a  professor  of  anatomy,  and  a  physician.  The  infer- 
ence of  identity  that  might  have  been  drawn  from  the  correspondence 
of  their  names,  the  similarity  of  their  stature,  and  the  agreement  of  their 
places  of  residence  was  held  to  be  utterly  repelled  by  this  evidence  of  the 
diversity  both  of  their  mental  attainments  and  of  the  incidents  of  their 
careers. 

Yet  here,  as  in  so  many  other  phases  of  the  problem,  experience  tells 
us,  I  think,  that  though  evidence  of  diversity  may  justify  us  in  refusing 
to  draw  the  inference  of  identity,  evidence  of  agreement  is  a  far  less 
trustworthy  and  certain  guide.  The  most  striking  coincidences  may 
occur,  and  the  conclusion  of  identity  be  still  unwarranted.  The  knowl- 
edge that  Arnaud  exhibited  as  to  the  details  of  the  life  of  Guerre  went 
far  to  baffle  the  court,  and  to  induce  a  belief  in  the  good  faith  of  the 
impostor.  The  avenues  by  which  knowledge  of  another's  past  may  be 
acquired  are  so  numerous,  the  chance  of  tracing  such  knowledge  to  its 
root  is  so  remote,  that  we  should  hesitate  long  before  assigning  decisive 
force  to  an  apparent  correspondence  between  the  histories  of  men. 

(e)  Incriminating  Circumstances. — If,  however,  the  question  at  issue 
be  not  simply  the  question  of  the  identity  of  a  given  person  with  one 
who  was  known  to  us  in  the  past,  but  rather  of  his  identity  with  the  un- 
known perpetrator  of  some  given  deed,  the  possible  sources  for  the  solu- 
tion of  the  problem  are  multiplied  a  hundred-fold.  We  are  in  the  broad 
field  of  what  is  commonly  denominated  as  circumstantial  proof ;  and  its 
forms  are  at  once  as  various  as  the  possible  combinations  of  cause  and 
of  effect,  and  as  complex  as  the  lives  and  the  passions  of  mankind.  To 
catalogue  them  is  impossible  ;  to  reduce  them  to  any  consistent  principle 
is  vain.  They  have  no  other  test  of  their  validity  than  the  experience 
of  the  race  that  the  conjunction  of  two  circumstances  may  be  of  such  a 

*  Be  Darling,  6  N.  Y.  Supp.  191. 


IDENTITY  AXD   SURVIVORSHIP.  229 

nature  or  so  often  repeated  as  to  suggest  a  causal  relation  existing  be- 
tween the  two.  I  can  frame  no  more  definite  statement  of  the  principle 
which  sanctions  evidence  of  this  kind  than  that  which  I  adopted  at  the 
outset  of  the  discussion :  any  fact  that  would  in  the  ordinary  course  of 
events  have  preceded  or  have  followed  the  perpetration  of  the  act  in  issue 
by  a  given  man,  will  be  evidence  from  which  the  agency  of  the  act  may 
legitimately  be  inferred. 

It  may  be  objected  that  this  statement  does  not  leave  us  much  wiser 
than  when  we  started ;  that  it  does  not  afford  us  a  test  by  which  the 
ordinary  course  of  events  may  be  accurately  gauged  and  measured.  And 
this,  I  think,  is  entirely  true ;  but  the  difficulty,  as  I  have  already  tried 
to  show,  is  inherent  in  the  very  nature  of  the  inquiry.  Reduce  our 
problem  to  rules  or  to  principles  as  we  will,  that  which  we  cannot  force 
within  the  rule,  the  informing  and  animating  life  of  winch  the  rule  is 
but  the  empty  shell — that  life  is  the  common  experience  of  the  race ;  and 
by  the  test  of  this  experience  all  our  problems  must  in  the  end  be  solved. 
That  which  in  common  experience  would  precede,  that  which  in  common 
experience  would  accompany,  that  which  in  common  experience  would 
follow,  the  perpetration  of  a  crime  by  a  given  man,  is  proof  confirmatory 
of  the  hypothesis  of  his  guilt,  and  on  this  account  it  is  admissible  as 
evidence.* 

It  is  in  pursuance  of  this  principle,  and  in  the  main  to  aid  in  determin- 
ing the  identity  of  an  offender,  that  proof  of  motive  has  been  admitted 
to  so  prominent  a  part  in  the  history  of  criminal  trials.  A  very  recent 
case  t  contains  a  clear  recognition  of  the  rationale  of  evidence  of  this  kind. 
"  The  prosecution,"  sa}rs  Judge  Earl,  "  is  never  bound  to  prove  the  motive 
for  the  commission  of  a  crime.  Motive  furnishes  corroboration  in  a  case 
depending  upon  circumstantial  evidence.  But  where  there  is  no  dispute 
about  the  killing,  and  the  other  ingredients  of  the  crime  are  established, 
motive  is  unimportant,  and  a  conviction  may  be  proper  although  no 
motive  for  the  crime  can  be  shown  or  discerned.  It  is  one  of  the  facts 
tending  to  the  identification  of  the  criminal,  or  characterizing  the  criminal 
act,  but  is  never  as  matter  of  law  essential."  In  brief,  the  existence  of 
motive  is,  as  our  experience  tells  us,  a  common  antecedent  condition  to 
the  commission  of  a  crime ;  and  the  fact  that  an  accused  man  had  a 
perceptible  incentive  for  the  commission  of  an  offense  is  a  circumstance 
tending  to  confirm  the  hypothesis  of  his  identity  with  the  perpetrator  of 
the  deed. 

And  just  as  a  fact  that  would  naturally  precede  a  crime  may  be  evi- 
dence of  the  identity  of  its  perpetrator,  so  also  facts  that  would  naturally 
have  followed  it  are  similarly  relevant.  Indeed,  as  Bentham  has  pointed 
out,f  "  the  probative  force  of  posterior  events  in  regard  to  prior  ones  is 
naturally  much  stronger  than  that  of  prior  events  with  regard  to  poste- 
rior ones.  In  all  human  affairs,  execution  is  better  evidence  of  design 
than  design  of  execution,"  because  human  designs  are  so  often  frustrated. 

*  Stephen,  Digest  of  Law  of  Evidence,  Appendix,  note  1 ;  Bentham,  Rationale  of 
Judicial  Evidence,  bk.  v.,  chap.  xiv. 

t  People  vs.  Johnson,  139  N.  Y.  358,  362.  See  also  in  this  connection  Jewett  vs. 
Banning,  21  N.  Y.  27;  Com.  vs.  Robinson,  146  Mass.  571;  People  vs.  Fish,  125  N.  Y. 
1 36  ;  People  vs.  Trezza,  125  N.  Y.  740. 

X  Bentham,  Rationale  of  Judicial  Evidence,  bk.  v.,  chap,  xiv.;  2  Best  on  Evidence,. 
§  354. 


230  A   SYSTEM  OF  LEGAL  MEDICINE. 

The  possession,  for  example,  of  the  fruits  of  theft,  at  a  period  not  too  re- 
mote from  the  date  of  its  commission,  is  a  circumstance  that  would  nat- 
urally have  followed  the  offense,  and  so  their  possession  is  often  cogent 
evidence  of  the  identity  of  the  accused.  The  presence  of  the  prisoner  at 
the  scene  of  the  crime,  the  purchase  by  him  of  weapons  with  which  the 
crime  might  be  committed,  the  flight  of  the  accused,  or  his  demeanor 
upon  the  stand — all  these  are  relevant  as  circumstances  more  or  less 
significant  of  the  identity  of  the  perpetrator  of  the  wrong.  And  these 
circumstances  need  not,  of  course,  be  proved  by  direct  evidence ;  they 
may  be  proved  indirectly  as  well.  The  presence  of  a  prisoner  at  the 
scene  of  a  murder  has  repeatedly  been  evidenced  by  correspondence  be- 
tween the  size  of  his  boots  and  of  footprints  discovered  upon  the  ground* 
And  all  these  elements  of  proof,  motive,  preparation,  subsequent  incrim- 
inating acts  or  words — inconclusive  frequently  alone — may  be  so  com- 
bined as  collectively  to  fix  the  identity  of  the  criminal  to  the  exclusion 
of  every  other  reasonable  hypothesis.! 

The  propriety,  however,  of  leaving  to  circumstantial  proof  the  identi- 
fication of  a  murdered  body  has  not  passed  entirely  unchallenged.  It 
was  a  rule  of  the  common  law  that  the  corpus  delicti  in  cases  of  murder 
had  two  components,  death  as  a  result,  and  the  criminal  agency  of  an- 
other as  the  means ;  and  it  was  only  where  there  was  direct  proof  of  one 
element  that  the  other  could  be  established  by  circumstantial  evidence.! 
That  rule,  however,  was  satisfied  when  the  death  of  some  one  was  directly 
proved ;  the  identity  of  the  victim  might  be  indirectly  shown.  A  case  § 
came  before  the  courts  of  New  York  not  many  years  ago,  in  which  it 
was  claimed  that  the  provisions  of  the  Penal  Code  ||  had  changed  the  rule 
of  the  common  law,  and  required  direct  evidence,  not  of  the  fact  of  death 
alone,  but  of  the  two  facts  of  death  and  of  identity.  The  body  of  the 
victim  had  become  so  decomposed  that  personal  recognition  was  impos- 
sible ;  and  to  sustain  the  prisoner's  claim  would  have  been  to  grant  him 
complete  immunity  from  punishment  for  his  crime.  But  the  court  con- 
strued the  provisions  of  the  statute  in  the  light  of  the  history  of  the 
rule,  and  held  that  the  law  had  not  "  placed  a  premium  upon  the  brutal 
courage  which  can  mangle  and  burn  the  lifeless  body." 

A  wide  range,  it  will  be  found,  has  been  given  by  the  decisions  to  the 
instrumentalities  by  which  identity  may  be  shown.  The  complex  nature 
of  the  problem  has  led  the  courts  to  avail  themselves  of  every  agency  by 
which  a  sound  conclusion  might  conceivably  be  reached.  They  have 
permitted,  with  substantial  unanimity,  the  introduction  of  properly  au- 
thenticated photographs  1]  as  evidence  of  general  appearance  or  of  special 
physical  traits ;  and  important  aid  has  often  thus  been  lent  to  the  deter- 

*  See,  for  example,  Clauverius  vs.  Com.,  81  Va.  787;  Sutton  vs.  Com.,  7  S.  E.  323; 
Caldwell  vs.  State,  14  S.  W.  122  ;  People  vs.  McCurdy,  G8  Cal.  576  ;  People  vs.  Myers,  70 
Cal.  582;  State  vs.  Bead,  89  Mo.  168;  People  vs.  McCallam,  3  N.  Y.  Crim.  Rep.  189. 

t  See,  for  example,  Peopile  vs.  Johnson,  140  N.  Y.  350. 

X  Buloffva.  The  People,  18  N.  Y.  179. 

§  People  vs.  Palmer,  109  N.  Y.  110. 

||  Section  181  of  the  Penal  Code  prohibits  a  conviction  "unless  the  death  of  the 
person  alleged  to  have  been  killed,  and  the  fact  of  the  killing  by  the  defendant  as 
alleged,  are  each  established  as  independent  facts,  the  former  by  direct  proof  and  the 
latter  beyond  a  reasonable  doubt." 

H  Marion  vs.  The  State,  20  Neb.  238 ;  s.  c.  29  N.  W.  211 ;  People  vs.  Cowlei/,  83  N.  Y. 
464 ;  People  vs.  Buddensieck,  103  N.  Y.  487 ;  People  vs.  Fish,  125  N.  Y.  136. ' 


IDENTITY  AND   SURVIVORSHIP.  231 

urination  of  the  issues  in  dispute.  Images  of  a  rude  kind  have  served, 
indeed,  since  early  times  as  a  means  for  identifying  bodies ;  and  Charles  I. 
of  England  was  recognized,*  it  is  said,  by  his  resemblance  to  the  head 
upon  coins  of  the  realm  which  had  been  issued  in  his  reign. 

Nice  problems  of  evidence  in  connection  with  questions  of  identity 
have  frequently  arisen  in  the  course  of  bastardy  proceedings,  and  there 
has  been  some  diversity  of  opinion  t  as  to  whether,  in  passing  upon  the 
identity  of  the  parent,  where  the  child  and  its  putative  father  are  present 
in  the  court,  the  jury  may  take  into  account  the  resemblance  of  the  one 
to  the  other.  The  mere  opinion  of  a  witness,  however,  as  to  the  existence 
of  such  a  resemblance,  has,  it  would  seem,  been  generally  excluded,!  and 
the  courts  have  required  that  the  resemblance  should  be  shown  by  the 
comparison  of  the  two  persons  in  open  court  before  the  eyes  of  the 
jurors.§ 

No  very  definite  statement  can  be  found,  and  none  in  the  nature  of 
things  could  well  be  given,  as  to  the  degree  or  cogency  of  proof  that  is 
required  before  the  inference  of  identity  will  be  drawn.  The  mere  fact 
that  a  witness  hesitates  in  the  identification  of  a  criminal, ||  or  that  his 
evidence  is  in  some  respects  conflicting,^]  has  been  held  insufficient  cause 
for  the  withdrawal  from  the  jury  of  the  issue  of  identity ;  but,  on  the 
other  hand,  if  it  plainly  appear  that  the  testimony  of  the  complainant  is 
little  more  than  a  conjecture  or  suspicion,  the  courts  have  not  hesitated 
to  declare  that  a  conviction  is  unwarranted.** 

The  tendency  of  a  study  of  the  cases  of  disputed  identity  is  to  break 
down  the  supposed  distinction  between  direct  and  circumstantial  proof, 
and  to  lead  to  the  conviction  that,  at  least  in  cases  of  this  character,  the 
latter  form  is  perhaps  the  safer  of  the  two.  From  the  standpoint  of 
psychology,  the  distinction  is  of  doubtful  validity  at  best.  So  little  of 
our  knowledge  is  directly  given  us  by  our  senses,  so  little  of  it  but  is 
the  product  of  association  and  comparison  working  upon  the  raw  material 
which  the  senses  supply,  so  much  that  seems  to  us  immediate  and  direct 
is,  in  reality,  mediate  and  indirect,  that  from  a  philosophical  standpoint 
almost  all  evidence  is  the  evidence  of  a  fact,  not  directly,  but  indirectly 
perceived.  I  find  a  notable  judicial  recognition  of  this  truth  in  Judge 
Gray's  opinion  in  the  recent  case  of  The  People  against  Harris.tt  ''All 
evidence,"  he  says,  "is  in  a  strict  sense  more  or  less  circumstantial; 
whether  consisting  in  facts  which  permit  the  inference  of  guilt,  or  whether 
given  by  eye-witnesses  of  the  occurrence ;  for  the  testimony  of  eye- wit- 
nesses is,  of  course,  based  upon  circumstances  more  or  less  distinctly  and 
directly  observed." 

Such  a  notion  as  this  of  the  inherent  parity  of  seemingly  divergent 
forms  of  proof  was  impossible  for  the  jurists  of  an  earlier  day.     That 

*  Mason,  J.,  in  Ruloff  vs.  The  People,  3  Parker's  Crim.  Eep.  401. 

t  See,  for  example,  50  N.  J.  Law,  490 ;  67  N.  C.  89 ;  contra,  81  Me.  348. 

\  Young  vs.  Makepeace,  103  Mass.  50. 

§  On  the  rule  that  identity  of  name  is  prima  facie  evidence  of  identity  of  person, 
see  Stebbins  vs.  Duncan,  108  U.  S.  32 ;  Spotten  vs.  Eeeler,  22  Abb.  N.  C.  105,  note.  But 
this  presumption  is  not  of  universal  application.  Hoyt  vs.  Neicbold,  45  N.  J.  Law,  219 ; 
S.  c.  46  Am.  R.  757. 

||  People  vs.  Foley,  27  W.  Dig.  217. 

IT  People  vs.  Bracco,  69  Hun,  206. 

**  People  vs.  Stnith,  7  N.  Y.  Crim.  Eep.  425. 

tt  People  vs.  Harris,  136  N.  Y.  423. 


232  A   SYSTEM  OF  LEGAL  MEDICINE. 

it  should  have  found,  as  I  believe  it  has,  a  conscious  lodgment  in  the 
law  at  all,  is  proof  of  the  reaction  upon  legal  science  of  the  other  depart- 
ments of  man's  knowledge  and  advancement.  The  truth  is,  as  every 
student  of  psychology  knows,  that  very  little  of  what  we  seem  to  see  is 
actually  given  us  by  sight  alone.  It  has  been  pointed  out,  I  believe  by 
Mi*.  Mill,  that  the  act  of  mind  which  is  indicated  by  the  words  "  I  see  my 
brother  "  is  not  merely  a  perception,  but  an  inference.  The  cases  which 
legal  medicine  has  collected  show  that  it  is  not  only  an  inference,  but  an 
inference  in  certain  instances  of  the  most  uncertain  and  dubious  kind. 
When  the  Tichborne  claimant,  in  the  words  of  the  lord-chief-justice, 
"  stood  as  it  were  between  two  persons,  between  Arthur  Orton  on  the 
one  hand  and  Roger  Tichborne  on  the  other,  and  while  he  declared  that 
he  was  Roger  Tichborne,  a  host  of  witnesses  declared  that  he  was  Arthur 
Orton,"  the  truth  that  almost  all  evidence  is  a  conclusion,  that  the  differ- 
ence between  the  proof  we  call  circumstantial  and  the  proof  we  call  direct 
is  one  not  so  much  of  kind  as  of  degree, — that  truth  received  an  object 
illustration  which  we  might  hardly  expect  to  meet  with  in  the  musty  rec- 
ords of  the  law. 

We  commonly  permit  a  witness  to  testify  directly :  "  This  is  the  man 
that  I  have  seen  before."  We  think  of  this  testimony  not  as  an  inference 
or  a  conclusion ;  we  think  of  it  as  a  statement  of  a  fact.  The  psychology 
which  tells  us  we  are  in  error,  we  brush  aside  as  speculative  and  unprac- 
tical in  its  views ;  and  doubtless  for  the  ordinary  purposes  of  life  we  are 
entirely  in  the  right.  None  the  less,  however,  is  a  conclusion  really 
drawn ;  a  conclusion  whose  data  are  the  acts,  the  impressions,  the  mem- 
ories of  a  lifetime ;  a  conclusion  whose  premises  are  so  manifold  and  so 
complex  that  they  are  lost  and  scattered  and  merged  before  the  inference 
has,  almost  unconsciously,  been  reached.  And  the  law  is  quite  consist- 
ent with  itself,  quite  consistent  with  elementary  rules  of  proof,  when  it 
permits  the  witness,  omitting  the  process  which  generated  the  belief,  to 
testify  to  the  resultant  fact.  That  infraction  of  the  cardinal  rule  that 
testimony  as  to  opinions  may  not  in  general  be  received,  is  one  that 
finds  manifold  illustrations  in  the  books.  The  law  recognizes  the  fact 
that  there  are  certain  unconscious  inferences  where  the  average  mind 
can  only  testify  to  the  inference  itself ;  that  there  are  certain  complex 
processes  where  the  individual  links  in  the  chain  of  thought,  if  presented 
one  by  one,  would  lose  their  meaning  and  their  force ;  that  there  are 
certain  opinions  which,  as  the  courts  have  put  it,  are  "  but  abbreviations 
of  the  facts."  *  But  every  now  and  then  a  case  arises  which  puts  the 
problem  in  its  true  light ;  and  the  knowledge  that  seemed  to  us  immedi- 
ate is  seen  to  be  the  result  of  a  long  process  of  reasoning — an  elaborate 
train  of  thought.!  We  are  surprised  and  awakened  at  times  into  a  con- 
sciousness that  there  is  a  practical  side  to  this  analysis  of  the  phenomena 
of  the  mind — that  as  a  working  hypothesis  we  may  treat  it  as  superfluous, 
but  that  it  discloses  a  deep  truth  which  may  not  permanently  be  ignored. 

*  Sloan  vs.  B.  B.,  45  N.  Y.  125 ;  People  vs.  Wriaht,  136  N.  Y.  625 ;  Knoll  vs.  State,  55 
Wis.  249;  Ud<ler~ook  vs.  Com.,  76  Pa.  St.  340;  State  vs.  Dickson,  78  Mo.  438;  People 
vs.  Bolfe,  61  Cal.  540  ;  De  Witt  vs.  Early,  17  N.  Y.  340. 

t  So,  too,  the  identity  of  physical  objects,  it  may  be  noted,  is  generally  to  be  de- 
termined by  the  tests  of  the  popular  understanding;  yet  "even  lawyers  are  occasion- 
ally called  upon  to  consider  more  minutely  in  what  the  identity  of  a  thing  consists." 
Holland's  Elements  of  Jurisprudence,  p.  88;  and  see  Silsbury  vs.  McCoon,  3  N.  Y.  37'.'. 


IDENTITY  AND   SURVIVORSHIP.  233 

There  is  a  case  illustrative  of  this  which  is  reported  in  the  early  deci- 
sions of  the  criminal  courts  of  New  York.*  A  dead  body  with  marks  of 
violence  upon  it  had  been  washed  ashore.  It  was  alleged  that  the  body 
was  the  body  of  Captain  Palmer,  but  personal,  immediate  recognition  had 
long  become  impossible.  "  The  height  of  the  deceased  was  shown,  an 
unusual  length  of  face,  and  a  widening  of  the  end  of  the  little  finger  to 
which  in  a  general  way  the  body  corresponded.  But  a  more  important 
fact  was  that  the  captain  had  imprinted  his  name  upon  his  arm  and  leg ; 
and  on  the  same  portions  of  the  body  found  the  skin  had  been  cut  away, 
except  that  on  the  leg  the  letter  P  remained  visible.  A  brother-in-law 
of  the  deceased,  who  had  seen  the  body,  was  asked  the  direct  question 
whose  body  it  was ;  but  the  court  would  not  permit  an  answer,  saying 
that  the  question  was  not  the  ordinary  one  of  personal  identity,  since  the 
bod}^  had  been  submerged  for  five  months,  but  was  one  of  an  inference 
from  resemblances,  which  the  jury  and  not  the  witnesses  must  draw." 

In  all  this,  as  I  have  already  said,  the  law  is  thoroughly  consistent. 
Systems  of  law  must  deal  with  the  acts  of  the  mind  as  the  common  ap- 
prehension deals  with  them.  The  subtleties  of  psychological  analysis 
cannot  be  permitted  to  disturb  the  current  of  forensic  proof.  Whether 
or  not  the  so-called  philosophy  of  common  sense  be  a  sound  system  of 
metaphysics,  it  is  the  only  metaphysics  on  which  a  body  of  law  can  be 
built.  The  rudest  and  the  most  developed  systems  alike  are  constrained 
to  adopt  as  their  final  or  at  least  prevailing  tests  the  hasty  and  superficial 
notions  of  the  popular  intelligence.  Primitive  law  never  attempts  in  the 
slightest  degree  to  penetrate  back  of  the  common  understanding  of  things 
and  into  their  essential  nature.  It  sees  only  the  outward  forms  of  trans- 
actions ;  it  is  blind  to  their  inherent  substance.  The  spoken  word  is  bind- 
ing, though  it  was  spoken  under  the  coercion  of  fraud  or  of  mistake.t 
We  of  to-day  have  shaken  ourselves  free  from  that  primitive  subordina- 
tion to  the  external  shows  of  things ;  we  have  striven  to  some  extent  to 
.substitute  the  ideal  for  the  popular  conceptions ;  but  the  tendency  has 
its  limits  that  are  well  defined ;  they  are  defined  both  by  the  inherent 
purpose  of  law  itself  and  by  the  possibilities  of  human  proof.  The  law 
is  concerned  with  "  objective  conformity  to  a  rule  " ;  and  if,  as  it  would 
seem  to  be,  the  history  of  legal  progress  has  been  the  history  of  a  de- 
velopment from  form  to  substance,  from  that  which  is  accidental  to  that 
which  is  essential,  from  a  sort  of  legal  anthropomorphism  to  a  sort  of 
legal  spiritualism,  it  is  still  true  that  the  law  was  made  for  a  work-a-day 
world ;  that  it  must  often  rest  satisfied  with  external  standards,  and 
govern  itself  by  rules  which  it  knows  are  but  provisionally  true. 

I  think,  therefore,  that  in  its  solution  of  problems  of  identity,  and  in 
its  answer  to  the  questions  of  evidence  involved,  the  common  law  has 
shown  a  vigorous  and  healthy  spirit.  It  seems  to  me  to  have  pursued 
the  just  mean  between  the  dangerous  extremes  of  metaphysical  refine- 
ment upon  the  one  hand  and  superficial  formalism  upon  the  other.  And 
that  healthy  and  vigorous  spirit  which  the  law  has  manifested  here,  it 
has  preserved  in  its  treatment  of  other  and  analogous  questions  that  often 
remain  to  be  solved  after  the  preliminary  question  of  identity  has  been 
settled.  The  bodies  of  persons  who  have  perished  in  a  common  calamity  are 

*  People  vs.  Wilson,  3  Parker's  Crim.  Rep.  199;  and  see  statement  of  Finch,  J.,  in 
People  vs.  Palmer,  109  N.  Y.  110. 

t  Maine,  Ancient  Law,  pp.  303,  304. 


234  A   SYSTEM  OF  LEGAL   MEDICINE. 

found ;  the  resources  of  science  are  taxed  in  the  effort  to  determine  their 
identity  ;  and  that  question  being  answered,  the  inquiry  will  still  remain, 
Which  of  the  two  persons  was  the  first  to  die ;  which  of  them  was  the 
survivor  ? 

Survivorship. — It  is  the  tendency  of  all  systems  of  law  as  they  de- 
velop to  narrow  the  field  of  presumptions.  Like  the  fictions  which  with 
early  law  supply  the  place  of  legislation,  presumptions  find  their  widest 
field  in  the  infancy  of  legal  systems.  The  refusal  of  our  law  to  adopt  a 
formal  or  artificial  doctrine  as  to  the  survivorship  of  those  who  have  died 
in  a  common  calamity  is  quite  in  harmony  with  the  course  and  history 
of  the  development  of  its  rules  of  proof. 

Yet  it  is  a  somewhat  noteworthy  fact  that  almost  every  system  of 
law  has  solved  problems  of  this  character  by  certain  fixed  and  formal 
tests.  We  are  referred  to  the  Mahometan  law  of  India,  and  are  told 
that  where  relatives  perished  together  it  was  presumed  that  the  same 
moment  marked  the  death  of  all*  We  turn  to  the  Roman  law,t  and  we 
find  that  it,  too,  had  its  fixed  and  a  priori  rules.  Where  husband  and 
wife  were  lost,  the  former  was  adjudged  the  survivor.  Where  father 
and  son  had  died  together,  the  son,  if  below  the  age  of  puberty,  was 
deemed  the  first  to  have  succumbed ;  if  above  that  age,  he  was  deemed 
to  have  been  the  survivor.  In  the  same  spirit,  the  Code  Napoleon  f  de- 
clares that  if  those  who  perished  together  were  under  fifteen  years,  the 
oldest  should  be  presumed  the  survivor ;  if  they  were  all  above  sixty 
years,  the  youngest  should  be  presumed  the  survivor ;  if  some  were  under 
fifteen,  and  others  above  sixty,  the  former  should  be  adjudged  the  surviv- 
ors ;  if  those  who  had  perished,  together  had  completed  the  age  of  fifteen 
years,  and  were  under  sixty,  the  male  should  be  presumed  the  survivor, 
where  ages  were  equal,  or  the  difference  did  not  exceed  a  year ;  if  they 
were  of  the  same  sex,  that  presumption  should  be  admitted  which  would 
open  the  succession  in  the  order  of  nature ;  thus,  the  younger  should  be 
considered  to  have  survived  the  older.  The  same  rules,  it  is  said,  were 
in  force  in  the  territory  of  Orleans  at  the  time  of  its  cession  to  the  United 
States,  and  have  since  been  incorporated  into  the  code  of  Louisiana.§ 

The  principles  of  the  Roman  law  regulated  for  many  centuries  the 
practice  and  speculations  of  European  jurists,  and  statutory  enactments 
of  more  recent  date  have  served  in  some  instances  to  perpetuate  these  or 
similar  presumptions.  It  is  not  unnatural,  therefore,  that  when  the 
question  first  presented  itself  to  an  English  court,  the  common  law, 
awed,  it  may  be,  by  the  imperious  authority  of  Roman  jurisprudence, 
should  have  faltered  for  an  appropriate  reply.  The  question  arose  in 
1766,  after  the  loss  by  shipwreck  of  General  Stanwix  and  his  daughter. 
On  the  one  hand  the  nephew  of  General  Stanwix,  on  the  other  hand  the 
maternal  uncle  of  the  daughter,  laid  claim  to  the  personal  estate.  It  was 
urged  that  the  general,  a  soldier  and  a  man  of  courage,  might  reasonably 
be  supposed  to  have  struggled  long  and  earnestly  against  the  fury  of  the 
waves.  It  was  urged  on  the  other  hand  that  the  general  was  old  and 
feeble,  and  that  the  chance  of  survival  was  rather  with  the  daughter,  who 


* 


Greenleaf,  Evidence,  vol.  i.,  §  29;  Cowman  vs.  Bodgers,  73  Md.  403. 
t  Dig.  Lib.  34,  tit.  5;  Greenleaf,  Evidence,  vol.  i.,  §  29. 

t  Code  Civil,  §§  720-722;  Coi/e  vs.  Leach,  8  Met.  371;  Greenleaf,  Evidence,  vol.  i. 
§  29;  Beck's  Medical  Jurisprudence,  vol.  i.,  p.  626. 

§  Civil  Code  of  Louisiana,  arts.  930-933 ;  Greenleaf,  Evidence,  vol.  i.,  §  29. 


IDENTITY  AND   SURVIVORSHIP.  235 

retained  her  youth  and  health.  The  learned  court  was  so  impressed  with 
the  force  of  the  arguments  upon  both  sides  that  it  confessed  its  inability 
to  arrive  at  any  conclusion,  and  the  case  is  authority  for  nothing,  except 
for  the  complexity  of  the  problem.* 

Yet  the  courts  seem  at  an  early  day  to  have  felt  that  the  question, 
if  it  was  to  be  solved  at  all,  should  be  solved  by  evidence,  and  not  by 
d  priori  rules.  Even  in  the  familiar  case  which  is  cited  by  Blackstoue,t 
where  a  father  and  son  were  hanged  at  the  same  time,  and  the  sou,  being 
observed  to  struggle  longest,  was  decreed  to  be  the  survivor,  the  law,  if 
it  drew  its  inference  from  somewhat  inconclusive  evidence,  was  still  faith- 
ful to  its  requirement  of  proof.  And  though  no  very  satisfactory  dis- 
cussion of  the  true  principles  applicable  to  cases  of  death  by  a  common 
disaster  can  be  found  in  the  early  English  reports,  still  the  trend  of 
judicial  dicta  and  decision  J  was  entirely  in  the  direction  of  the  rule  that 
has  since  become  firmly  established  both  in  that  country  and  in  our  own. 

In  the  United  States  the  question  first  presented  itself  in  connection 
with  the  loss  of  the  steamer  "  Pulaski,"  in  June,  1838.  Among  the  vic- 
tims of  that  disaster  were  a  man  named  Ball,  his  wife,  and  his  adopted 
daughter.  By  the  terms  of  his  will  Ball  bequeathed  to  his  wife,  in  the 
event  that  she  survived  him,  certain  portions  of  his  estate  ;  and  her  rep- 
resentatives brought  suit  in  the  courts  of  South  Carolina,  and  sought  to 
establish  her  rights  as  the  survivor  of  her  husband.  The  opinion  of  the 
chancellor  §  treats  the  question  as  one  that  should  be  determined  not  by 
presumptions,  but  by  proof.  He  discusses  in  much  detail  the  circum- 
stances of  the  loss  of  the  ship  as  narrated  by  survivors  of  the  calamity ; 
he  notes  the  fact  that  Mrs.  Ball  was  the  last  to  be  seen  alive ;  he  notes 
the  fact  that  her  husband  may  possibly  have  escaped  the  explosion  which 
shattered  the  boat,  but  that  she,  as  the  testimony  showed,  had  certainly 
escaped  it ;  he  notes  the  fact  that  her  husband  failed  to  respond  in  an- 
swer to  her  cries,  which  were  heard  above  the  din  of  the  disaster ;  and 
grouping  these  and  other  circumstances  together,  he  reaches  the  con- 
elusion  that  the  husband  was  the  first  to  die.  "  The  right  on  the  part  of 
Mrs.  Ball,'7  says  the  chancellor,  "  is  derivative,  and  the  burden  is  on  the 
plaintiffs  to  prove  that  she  was  the  survivor ;  but  although  bound  to  prove 
it,  it  does  not  follow  that  they  are  to  prove  it  to  demonstration ;  we  must 
take  the  best  evidence  the  case  affords.'7  Unwilling  to  rest  on  the  fact 
that  Mrs.  Ball  was  the  last  person  seen,  he  prefers  "to  put  the  case  upon 
the  ground  of  probability  arising  from  the  evidence  upon  a  belief  en- 
gendered by  a  combination  of  circumstances,  and  upon  the  superiority 
of  positive  proof  over  conjecture  or  even  probability.'7 

Subsequent  decisions  ||  have  perhaps  cast  a  doubt  upon  the  sufficiency 
of  the  evidence  from  which  the  conclusion  of  survivorship  was  drawn  by 
the  chancellor ;  but  the  theory  and  basis  of  the  judgment,  it  would  seem, 
have  never  been  impugned. 

A  few  years  later,  in  1841,  the  courts  of  Massachusetts  were  asked  in 

*  The  King  vs.  Dr.  Ha>/,  1  W.  Bl.  640. 

t  Bl.  Coram. 

|  Wright  vs.  Sarmuda,  2  Phill.  266;  Selwyris  Case,  3  Hagg.  Eecl.  R.  748;  Mason  vs. 
Mason,  1  Meriv.  308. 

§  Pell  vs.  Ball,  1  Cheve's  Ch.  Cases. 

||  Russell  vs.Hallett,  23  Kan.  276;  In  re  Ridgway,  4  Eedf.  226;  Wing  vs.  Angrave, 
8  H.  of  L.  Cases,  183. 


236  A  SYSTEM  OF  LEGAL   MEDICINE. 

a  case  resulting-  from  the  same  calamity  to  apply  the  presumption  that  a 
daughter  of  thirty-three  had  survived  her  father,  a  man  of  seventy  years. 
The  court  declared  *  that  no  legal  presumption  of  survivorship  existed, 
and  that  in  the  absence  of  evidence  as  to  the  time  and  manner  of  the 
death  of  the  victims  the  law  could  frame  no  judgment  as  to  the  relative 
duration  of  their  lives.  The  rules  of  the  civil  law,  it  was  said,  "are 
clearly  arbitrary  rules,  as  in  the  nature  of  things  a  week  or  a  da}r  less 
than  the  respective  ages  named  would  not  usually,  in  any  degree,  affect 
the  ability  of  the  party  to  sustain  and  prolong  life  in  case  of  exposure 
by  shipwreck.  Such  rides,  being  thus  arbitrary  in  their  character,  to 
some  extent,  would  seem  to  require  a  legislative  act  for  cases  of  this 
character  and  description.  But  without  such  legislation  we  do  not  feel 
authorized  to  adopt  any  fixed  period  of  age  "as  decisive  of  the  question 
of  survivorship  of  those  who  perish  in  a  common  disaster,  and  where  no 
facts  or  circumstances  are  known  that  would  aid  in  deciding  the  point 
of  survivorship.  To  a  certain  extent  we  might  well  go,  in  applying  the 
principle  as  to  disparity  of  age.  Thus  it  would  be  proper  and  reasonable 
to  hold  that  one  in  middle  age  and  in  the  full  vigor  of  life  would  ordi- 
narily survive  a  mere  infant,  or  child  of  very  tender  years ;  and  the  same 
would  be  alike  true  as  to  such  person  and  the  man  well  stricken  in  years." 

These  were  the  pioneer  cases  upon  this  troublesome  topic  of  the 
law.  If  their  discussion  of  the  question  was  somewhat  fragmentary  and 
faltering,  they  displayed  at  least  a  sound  intuition  as  to  the  appropriate 
legal  rule.  Subsequent  decisions,  however,  have  considered  the  subject 
•with  a  wealth  of  argument  that  has  withdrawn  the  topic  from  the  realm 
of  the  debatable  problems  of  the  law. 

In  1854,  in  the  case  of  Underwood  vs.  Wing,]  the  courts  of  England 
were  confronted  again  with  the  necessity  of  declaring  the  true  doctrine 
that  was  applicable  to  such  a  case.  "  The  question  of  survivorship,"  they 
declared,  "  is  the  subject  of  evidence  to  be  produced  before  the  tribunal 
which  is  to  decide  upon  it,  and  which  is  to  determine  it  as  it  determines 
any  other  fact.  If  there  be  satisfactory  evidence  to  show  that  the  one 
survived  the  other,  the  tribunal  ought  so  to  decide ;  and  if  there  be  no 
evidence,  the  case  is  the  same  as  a  great  variety  of  other  cases,  more  fre- 
quent formerly  than  at  present,  where  no  evidence  exists,  and  conse- 
quently no  judgment  can  be  formed.  We  have  no  doubt  that  the  scien- 
tific gentlemen  who  were  examined  were  perfectly  sincere  in  their  opinions, 
but  it  is  obvious  that  their  opinions  were  given  having  reference  to  the 
case  of  two  persons  quietly  submerged  in  water  and  remaining  there 
until  drowned,  or  to  the  case  of  two  persons,  one  being  a  swimmer  and 
the  other  not,  and  both  thrown  suddenly  into  the  water  unincumbered, 
and  acting  on  certain  instinct.  The  present  case  is  that  of  two  persons 
clasped  together,  two  boys  clinging  to  one  of  them,  and  standing  pretty 
high  out  of  the  water  on  the  ship's  side,  swept  off  together  by  an  over- 
whelming wave  into  a  raging  sea,  and  one  or  other,  or  both  of  them,  may 
have  been  stunned  by  the  violence  of  the  blow  from  a  wave,  or  they  may 
have  struck  against  a  timber  of  the  ship,  and  may  have,  in  fact,  been 
dead  before  he  or  she  reached  the  water  at  all.  How  is  it  possible,  under 
such  circumstances,  for  any  tribunal,  sitting  judicially,  to  say  which  of 

*  Coye  vs.  Leach,  8  Mete.  37  ;  s.  e  41  Am.  Dec.  518. 

t  Underwood  vs.  Wing,  4  DeG.,  McN.,  &  G.  633 ;  s.  c.  31  Eng.  Law  &  Eq.  293. 


IDENTITY  AND  SUBYIYOESHIP.  237 

•these  two  individuals  died  first  ?    We  may  guess,  or  imagine,  or  fancy, 
but  the  law  of  England  requires  evidence." 

The  opinion  of  Lord-Chancellor  Cranworth,  in  the  same  case,  is  sub- 
stantially to  the  same  effect.  "  I  give  the  medical  gentlemen,"  he  says, 
"  most  entire  credit  for  speaking  scientifically,  and,  as  we  believe,  quite 
accurately.  I  do  not  think  that  they  themselves  even  are  very  confident. 
Indeed,  it  is  idle  when  you  are  calculating  and  reasoning  a  priori  in  this 
way,  as  to  which  of  two  persons  may  have  breathed  a  few  seconds  the 
longest  at  the  bottom  of  the  sea ;  for  that  is  all  it  comes  to.  To  think 
that  one  can  take  that  as  establishing  the  fact  seems  to  me  to  be  quite 
misunderstanding  the  nature  of  human  testimony.  The  medical  men 
may  be  quite  right  in  the  observations  they  have  made  of  persons  dying 
•of  asphyxia ;  that  there  is  a  small  interval,  of  perhaps  half  a  minute,  after 
sensation  has  ceased,  in  which  life  still  continues ;  and  I  think  they  say 
that  that  is,  as  far  as  their  observation  goes,  uniform  in  all  states  of 
health  and  in  all  states  of  strength.  I  dare  say  that  may  be  very  learned 
and  probably  accurate,  as  far  as  science  enables  us  to  form  such  an 
opinion ;  but  happily  the  instances  of  such  events  cannot  have  been 
sufficiently  numerous  to  have  enabled  anybody  to  have  formed  at  all  an 
accurate  and  certain  conclusion  on  such  a  difficult  subject ;  and  I  confess 
that  I  rose  from  the  perusal  of  their  evidence  utterly  unconvinced  that 
those  gentlemen  can  tell  us  which  of  them  died  first  if  they  had  both 
been  taken  and  quietly  submerged  to  the  bottom  of  the  sea.  But  when 
you  add  to  that  that  they  are  all  violently  thrown  by  one  blast  from  the 
side  of  the  ship,  and  may  have  fallen  against  some  spars  (from  what  we 
know,  that  may  have  been  so) ;  and  then  in  the  whirlpool  and  confusion 
■of  the  moment  to  pretend  that  you  can  come  to  any  conclusion  on  which 
you  can  act,  that  these  medical  gentlemen  are  right  in  supposing  the  wife 
did  die  a  few  seconds  before  the  husband,  seems  to  me  to  be  confusing 
and  confounding  the  province  of  human  testimony." 

The  doctrine  of  Underwood  vs.  Wing  received  new  confirmation,  and 
its  limits  at  the  same  time  were  more  sharply  defined,  by  a  decision  of 
the  House  of  Lords,  which  was  rendered  in  I860.* 

"  When  two  persons,"  said  Lord  Chelmsford,  "  are  swept  away  by  a 
calamity  like  that  which  happened  in  this  case,  it  is  possible  that  there 
may  be  evidence  to  prove  distinctly  which  was  the  survivor ;  as  where 
one  of  them  has  been  seen  struggling  with  the  waves  after  the  other  has 
sunk,  and  never  again  appeared  above  the  surface,  or  as  in  this  very  case, 
where  there  can  be  no  doubt  that  there  is  evidence  to  establish  satisfac- 
torily that  Catherine,  the  eldest  daughter,  survived  her  parents  for  some 
short  time,  though  she  afterward  perished  in  the  same  shipwreck.  But 
where  two  persons  are  at  one  and  the  same  instant  washed  into  the  sea 
and  disappear  together,  and  are  never  seen  any  more,  it  is  not  possible 
for  any  tribunal,  called  upon  judicially  to  determine  the  question  of 
survivorship,  to  form  any  judgment  upon  the  subject  which  can  be 
founded  upon  anything  but  mere  conjecture  derived  from  the  age,  sex, 
constitution,  or  strength  of  body  or  mind  of  each  individual ;  and  as  our 
law  has  not  established  any  rules  of  presumption  for  these  rare  and  extra- 
ordinary occasions,  the  uncertainty  in  which  they  are  involved  leaves  no 
greater  weight  on  one  side  or  the  other  to  incline  the  balance  of  evidence 
«either  way." 

*  Wing  vs.  Angrave,  8  H.  of  L.  Cases,  213. 


238  ^   SYSTEM  OF  LEGAL  MEDICINE. 

The  adjudications  of  the  English  courts  upon  this  topic  have  met  with 
general  approval  in  the  courts  of  the  United  States ;  and  the  decisions 
in  the  two  countries  are  in  substantial  conformity.  In  New  York,  in 
Florida,  in  Kansas,  in  Maryland,  in  Colorado,  and  in  Maine  *  the  courts 
have  declared  that  there  is  no  presumption  of  survivorship,  and  that  the 
rights  of  representatives  must  be  established  through  the  ordinary  agen- 
cies of  proof.  In  California,  however,  the  question  has  been  set  at  rest 
by  statutory  enactment ;  and  where  two  persons  perish  in  the  same 
calamity,  such  as  a  wreck,  a  battle,  or  a  conflagration,  and  there  is  no 
evidence  from  which  it  can  be  shown  or  inferred  which  of  them  was  the 
first  to  die,  if  both  are  over  fifteen  and  under  sixty,  and  the  sexes  differ- 
ent, it  will  be  presumed  that  the  male  survived. t  In  a  case  where  a 
husband  and  his  wife  were  murdered  at  their  home  at  the  same  time  and 
the  house  set  on  fire,  the  rule  laid  down  by  the  statute  was  applied,  and 
the  husband  was  adjudged  the  survivor.! 

There  were  dicta  in  some  of  the  earlier  decisions  §  which  intimate  that 
in  these  cases  of  death  by  a  common  calamity,  the  law  would  presume 
that  all  the  victims  perished  at  the  same  time ;  but  later  decisions  have 
united  in  declaring  that  the  presumption  of  death  at  the  same  moment 
is  quite  as  arbitrary  and  illogical  as  the  presumption  of  death  according 
to  some  fixed  and  definite  principle  of  succession.  "  That  two  human 
beings,"  it  has  been  said  by  Lord  Cranworth,||  "should  cease  to  breathe 
at  the  same  moment  of  time  is  hardly  within  the  range  of  imagination. 
I  suppose  that  time,  like  space,  is  infinitely  divisible ;  and  if  we  are  to 
speculate  on  such  a  subject,  one  could  hardly  suppose  that  the  one  did 
not  breathe  a  millionth  part  of  a  second  longer  than  the  other.  There- 
fore, to  adjudicate  on  a  principle  that  they  did  actually  cease  to  breathe 
at  the  same  moment,  would,  I  think,  be  proceeding  on  false  data.  The 
real  ground  to  proceed  on  is  that  it  cannot  be  proved  which  died  first ; 
they  both  probably  died  within  a  few  seconds  of  each  other,  but  which 
died  first  it  is  impossible  to  say.  That  being  so,  what  is  the  result? 
Why,  here  is  a  will  made  in  which  in  one  state  of  circumstances,  namely, 
that  the  wife  died  in  the  husband's  lifetime,  the  property  is  given  away. 
It  is  not  proved  that  that  state  of  circumstances  existed,  and  in  no  other 
state  of  circumstances  is  it  given  away.  Then  it  is  not  given  away  at 
all.  Therefore,  it  is  to  be  taken  as  upon  an  intestacy,  and  must  be  dis- 
tributed among  the  next  of  kin."  ^j 

The  question  whether  all  the  victims  of  the  disaster  will  be  presumed 
to  have  died  together,  or  whether  the  law  will  refuse  to  draw  any  pre- 
sumption whatever,  is,  after  all,  a  question  more  of  form  than  of  sub- 
stance. The  true  principle  doubtless  is  that  no  presumption  at  all  will 
be  entertained ;  but  "  the  practical  consequence,"  as  has  been  remarked 


* 


Newell  vs.  Nicholls,  75  N.  Y.  78;  Smith  vs.  Croom,  7  Fla.  149;  Russell  vs.  Hallett, 
23  Kan.  276  ;  Cowman  vs.  Rodgers,  73  Md.  403  ;  Kansas  <fc.  R.  R.  vs.  Miller,  2  Col.  442  ; 
Johnson  vs.  Merifhew,  80  Me.  111.  The  eases  in  South  Carolina  and  Massachusetts 
have  been  already  referred  to.     See  also  Fuller  vs.  Linzee,  135  Mass.  468. 

t  Cal.  Code  of*  Civil  Procedure,  §  1963,  subd.  40. 

t  Hollister  vs.  Cordero,  76  Cal.  649. 

$  Moehring  vs.  Mitchell,  1  Barb.  Ch.  265;  and  see  cases  cited  bv  Church,  C.  J.,  in 
Newvll  vs.  Nicholls,  75  N.  Y.  78,  90. 

||  Underwood  vs.  Winy,  4  DeC,  McN.  &  G.  633 ;  s.  c.  31  Eng.  Law  &  Eq.  293. 

H  See  also  Newell  vs.  Nicholls,  75  N.  Y.  78. 


IDENTITY  AND  SURVIVORSHIP.  239 

by  Mr.  Best,*  "  is  nearly  the  same,  because  if  it  cannot  be  shown  which 
died  first,  the  fact  will  be  treated  by  the  tribunal  as  a  thing  unascertain- 
able,  so  that  for  all  that  appears  to  the  contrary  both  individuals  may 
have  died  together." 

On  the  other  hand,  the  law  will  not  presume  that  there  was  a  survivor 
any  more  than  that  there  was  a  particular  survivor.  In  a  case,t  therefore, 
where  a  plaintiff's  claim  to  property  might  have  been  sustained  equally 
well  by  the  survival  of  either  of  two  persons,  the  court  ruled  that  the 
claim  of  ownership  had  not  been  adequately  established.  "  It  is  not  im- 
possible," they  said,  "  for  two  persons  to  die  at  the  same  moment,  and 
when  exposed  to  the  same  peril  under  like  circumstances,  it  is  not,  as  a 
question  of  probability,  very  unlikely  to  happen.  At  most  the  difference 
can  only  be  a  few  brief  seconds.  The  scene  passes  at  once  beyond  the 
vision  of  human  penetration,  and  it  is  as  unbecoming  as  it  is  idle  for 
judicial  tribunals  to  speculate  or  guess  whether  during  the  momentary 
lif  e-struggle  one  or  the  other  may  not  have  ceased  to  gasp  first,  especially 
when  the  transmission  of  title  to  property  depends  upon  it ;  and  hence, 
in  the  absence  of  other  evidence,  the  fact  is  assumed  to  be  unascertain- 
able,  and  property  rights  are  disposed  of  as  if  death  occurred  at  the  same 
time.  This  is  done,  not  because  the  fact  is  proved,  or  that  there  is  any 
presumption  to  that  effect,  but  because  there  is  no  evidence  and  no  pre- 
sumption to  the  contrary." 

But  questions  of  survivorship  do  not  only  arise  as  a  consequence  of 
the  death  of  several  persons  in  some  common  disaster ;  they  arise  also 
where  persons  have  left  their  homes,  and  have  remained  absent  from 
their  relatives  and  friends  for  an  extended  period  of  time.  It  is  a  pre- 
sumption of  the  law,  based  upon  the  known  stability  of  certain  human 
conditions,  that  a  person  once  proved  to  have  been  born  is  still  alive  % — a 
presumption  which,  in  general,  is  only  defeated  by  the  lapse  of  time  so  great 
that  continuance  of  life  woidd,  in  our  experience,  be  palpably  impossible.§ 

But  where  a  man  has  departed  from  his  home,  and  for  seven  years 
no  tidings  have  been  received  from  him  by  those  who  would  naturally 
have  heard  from  him  were  he  alive,  it  is  a  doctrine  of  the  law,  sanctioned 
by  a  long  series  of  decisions,  that  his  death  must  be  presumed.) |  The 
period  of  seven  years  was  adopted  by  the  courts  in  analogy  to  an  early 
English  statute,^]  which  exempts  from  the  penalties  of  bigamy  "  any  per- 
son whose  husband  or  wife  shall  be  continually  remaining  beyond  the 
seas  by  the  space  of  seven  years  together,  or  whose  husband  or  wife  shall 
absent  himself  or  herself,  the  one  from  the  other,  by  the  space  of  seven 
years  together,  in  any  parts  within  the  king's  dominions,  the  one  of  them 
not  knowing  the  other  to  be  living  within  that  time."  Mere  absence  is 
not  sufficient  to  satisfy  the  requirements  of  the  rule  ;**  those  who  would 

*  Best  on  Presumptions,  §  144. 

t  Newell  vs.  Nicholls,  75  N.  Y.  78. 

t  Gveenleaf,  Evidence,  vol.  i.,  §  41 ;  Stephen,  Digest  of  Law  of  Evidence,  art.  99 ; 
Eagle's  Case,  3  Abb.  Pr.  218;  CPGara  vs.  Eisenlohr,  3*8  N.  Y.  296. 

§  92  Am.  Dee.  704,  note ;  Sprigg  vs.  Moale,  28  Md.  497. 

||  Eagle's  Case,  3  Abb.  Pr.  218;  McCarter  vs.  Camee,  1  Barb.  Ch.  455;  Davie  vs. 
Briggs,  97  U.  S.  628;  Greenleaf.  Evidence,  vol.  i.,  §  41. 

IT  1  Jae.  1,  ch.  11.  §  2;  and  see  Penal  Code,  §  299,  subd.  1.  Compare  the  statute 
relating  to  persons  on  whose  lives  an  estate  in  lands  or  tenements  depends.  19  Car., 
ii.,  ch.  6,  §  2;  and  see  1  Eev.  Stat.  749,  §  6;  5  Barb.  339,  354. 

**  Estate  of  Tobin,  15  N.  Y.  St.  Rep.  749. 


240  A   SYSTEM  OF  LEGAL  MEDICINE. 

naturally  have  heard  from  the  absent  man  must  have  failed  to  receive 
the  tidings  they  might  reasonably  expect ;  and  even  in  such  cases  the 
presumption  of  death  which  arises  is  not,  of  course,  an  irrefragable  pre- 
sumption ;  it  may  be  overcome  either  by  conflicting  presumptions  *  or  by 
countervailing  proof.t 

On  the  other  hand,  it  is  not  always  essential  that  a  period  of  seven 
years  should  elapse  before  the  conclusion  of  death  will  be  drawn  by  the 
law.  If,  in  addition  to  the  fact  of  a  man's  absence,  it  be  shown  that  the 
circumstances  attending  his  departure  were  such  as  to  expose  him  to  the 
chance  of  peril  or  disaster,  the  law,  upon  proof  of  these  circumstances,, 
may  infer  that  his  death  occurred  before  the  expiration  either  of  seven 
years  or  of  any  specific  period  of  time.!  Where,  for  example,  a  man  at- 
tempts suicide  and  the  attempt  is  frustrated,  but  the  following  day  he 
disappears,  the  law  is  justified  in  drawing  the  conclusion  that  death  oc- 
curred about  the  time  of  his  departure,  and  the  property  rights  of  the 
survivors  will  be  regulated  accordingly.§  And  similarly  where  the  vessel 
in  which  a  man  has  set  sail  from  his  home  has  long  been  past  due  at  the 
port  of  its  destination,  and  is  believed  to  have  foundered  in  a  storm,  the 
fact  of  death  may  be  inferred  before  the  usual  period  has  expired. || 

A  recent  case  in  this  State  illustrates  the  application  of  these  doc- 
trines.^] The  missing  man  had  set  sail  on  his  yacht  for  Kingston,  Ja- 
maica, and  nothing  was  heard  from  him  except  that  a  vessel  resembling 
the  yacht  was  sighted  twenty-nine  days  after  his  departure.  On  March 
13,  1888,  the  day  succeeding  his  departure,  a  great  storm  occurred ;  and 
the  probable  situation  of  the  yacht  was  within  the  radius,  if  not  within 
the  center,  of  the  hurricane.  Pieces  of  wreckage  resembling  parts  of  the 
vessel  were  found  a  few  days  afterward ;  and  though  for  six  months,  by 
cablegrams  and  letters,  diligent  search  was  made,  no  tidings  of  the  miss- 
ing man  were  received.  The  court  held  that  his  death  must  be  presumed, 
and  that  his  will,  accordingly,  should  be  admitted  to  probate. 

Where,  however,  the  law  presumes  that  a  man  is  dead  by  reason  of 
his  absence,  unheard  of,  for  a  period  of  seven  years,  it  will  not  presume 
that  his  death  occurred  at  any  specific  date  within  that  period  of  time. 
As  in  the  case  of  death  by  a  common  disaster,  it  refuses  to  indulge  in 
any  arbitrary  rule ;  and  the  precise  date  of  death  is  left  to  be  established 
through  the  ordinary  agencies  of  proof.**     Such,  at  least,  is  the  doctrine 

*  Bex  vs.  Twining,  2  B.  &  Ad.  336. 

t  Stouvenal  vs.  Stevens,  2  Daly,  319 ;  Davie  vs.  Briggs,  97  U.  S.  628.  So  a  title  to  real 
estate  which  depends  for  its  validity  on  the  application  of  this  presumption  may  not 
be  free  from  reasonable  doubt.  Vought  vs.  Williams,  120  N.  Y.  253;  and  compare 
Ferry  vs.  Sampson,  112  N.  Y.  415. 

t  Greenleaf.  Evidence,  vol.  i.,  $41;  Wharton,  Evidence,  $  1283;  Davie  vs.  Briqgs, 
97  U.  S.  628 ;  Sheldon  vs.  Ferris,  45  Barb.  124 ;  Oppenheim  vs.  Wolf,  3  Sandf .  Ch.  517 ; 
Webster  vs.  Birchmore,  13  Ves.  362;  Matter  of  Acker  man,  2  Eedf.  521. 

§  In  re  Ketcham's  Estate,  5  N.  Y.  Supp.  566. 

||  Oppenheim  vs.  Wolf,  3  Sandf.  Ch.  517  ;  Gerry  vs.  Tost,  13  How.  Pr.  118. 

11  Estate  of  Stewart,  3  N.  Y.  Supp.  284. 

**  Davie  vs.  Briggs,  97  U.  S.  628 ;  In  re  Phene's  Trust,  L.  R.  5  Ch.  App.  139 ;  Nepean 
vs.  Doe,  5  Barn.  &  Adol.  86  ;  Xepeau  vs.  Knight,  2  Mees  &  W.  894 ;  McCartcr  vs.  Camee, 
1  Barb.  Ch.  456  ;  Prudential  Assur.  Co.  vs.  Edwards,  L.  R.  2  App.  Cases,  487  ;  Re  Ehodes, 
36  Ch.  D.  586  ;  Matter  of  Thompson,  L.  R.  12  Prob.  D.  100  ;  WHteley  vs.  Eq.  Assur.  Co., 
72  Wis.  170;  Hancock  vs.  Am.  L.  I.  Co.,  62  Mo.  30;  Johnson  vs.  Meritheio,  80  Me.  Ill ; 
but  see  Burr  vs.  Sim,  4  Whart.  150;  Whiting  vs.  Nichott,  46  111.  230;  Naisor  vs.  Brock- 
way,  Rich.  Eq.  Cas.  449;  and  cf.  Eagle's  Case,  3  Abb.  Pr.  218.  See  also  91  Am.  Dec. 
526,  note. 


IDENTITY  AND  SURVIVORSHIP.  241 

of  the  best-considered  decisions ;  and  the  authorities  to  the  contrary  are 
comparatively  few. 

In  the  determination  of  problems  of  survivorship,  as  in  the  determi- 
nation of  problems  of  identity,  a  wide  range  has  been  given  by  the  law 
to  the  instrumentalities  of  proof.  In  the  effort  to  attain  satisfactory 
evidence  of  death,  the  usual  rides  that  govern  the  admission  of  testimony 
have  been  to  a  greater  or  less  degree  relaxed.  Common  reputation  among 
the  kindred  of  the  deceased  ;*  even  hearsay  statements  t — the  declarations 
of  persons  who  have  themselves  since  died,  and  who  were  related  by 
blood  or  marriage  to  the  missing  man — have  been  deemed  admissible  evi- 
dence both  of  the  fact  of  death  and  of  the  date  of  its  occurrence.  In  any 
case  involving  pedigree,  hearsay  evidence  of  deceased  members  of  the 
family  is  admissible  ;  and  the  term  "  pedigree,"  within  the  meaning  of  the 
law,  embraces  not  only  descent  and  relationship,  but  birth,  marriage,  and 
death,  and  the  times  when  those  events  occurred 4 

Yet,  in  spite  of  this  latitude  of  proof,  the  principles  which  have  become 
so  firmly  established  in  our  law  as  a  guide  to  the  determination  of  ques- 
tions of  survivorship  leave,  it  will  be  seen,  but  little  opportunity  for  the 
application  to  those  questions  of  the  teachings  of  medical  science.  In 
cases  where  persons  have  been  found  dead,  the  relative  degree  of  putre- 
faction has  not  infrequently  served  as  a  material  guide  to  the  determina- 
tion of  the  comparative  duration  of  their  lives.  In  the  case  of  the  death 
of  mother  and  child  in  childbed,  there  was,  among  continental  jurists,  a 
strong  presumption  that  the  former  survived,  for  there  was  prima  facie 
evidence  of  still-birth  ;  but  many  recorded  instances  attest  the  fact  that 
an  unborn  child  may  in  fact  survive  its  mother.§  In  some  instances, 
too,  where  proof  of  the  attendant  circumstances  of  a  disaster  has  been 
furnished,  medical  evidence  as  to  the  comparative  susceptibility  to  various 
destructive  agencies  of  the  old  and  the  young,  of  males  and  of  females, 
may  serve  to  confirm  the  hypothesis  of  the  survivorship  of  one  from 
among  a  number  of  the  victims.  Thus,  in  cases  of  suffocation,  a  woman, 
by  reason  of  a  diminished  liability  to  asthma,  is  presumed,  it  is  said,  to 
survive  a  man.||  In  cases  where  persons  have  been  buried  alive  by  earth- 
quake or  beneath  some  fallen  weight,  the  younger,  it  is  said,  are  likely 
to  survive  the  older.fl  Yet  the  probative  force  of  such  evidence  is  weak- 
ened by  the  fact  that  the  conclusions  of  medical  science  on  these  topics 
are  subject  to  variation  through  manifold  disturbing  causes. 

Medical  testimony,  indeed,  finds  its  widest  scope  not  in  lieu  of,  but  in 
aid  of,  the  other  agencies  of  proof.  Where  men  have  perished  away 
from  human  sight,  the  mystery  of  the  order  in  which  they  met  their  death 

*  Morrill  vs.  Foster,  33  N.  H.  379;  Am.  Ins.  Co.  vs.  Rosenagle,  77  Pa.  St.  507;  Mason 
vs.  Fuller,  45  Vt.  29;  Anderson  vs.  Parker,  6  Cal.  197;  Dupont  vs.  Davis,  30  Wis.  170; 
Clark  vs.  Owens,  18  N.  Y.  434 ;  Jackson  vs.  Ety,  5  Cow.  414. 

t  Wilson  vs.  Broicnhe.  '24  Ark.  586;  91  Am'.  Dee.  523;  Jackson  vs.  King,  5  Cow.  237; 
Fulkerson  vs.  Holmes,  117  U.  S.  389,  397;  Greenleaf,  Evidence,  vol.  i.,  §"l03. 

t  Eisenlord  vs.  Clum,  126  N.  Y.  552.  But  where  questions  of  birth,  death,  age,  or 
relationship  are  merely  incidental  to  the  inquiry,  and  the  controversy  is  not  purely 
genealogical,  hearsay  evidence  is  inadmissible.  Eisenlord  vs.  Clum,  supra,  p.  566 ; 
Haines  vs.  Guthrie,  L.  R.  13  Q.  B.  D.  818;  see,  however,  Wilson  vs. Brownlee,  24  Ark. 
586 ;  91  Am.  Dec.  523. 

$  Wharton  and  Stille's  Medical  Jurisprudence,  vol.  ii.,  $  1054. 

II  I  hid.,  $  1025. 

H  Ibid.,  §  1051. 


242  A  SYSTEM   OF  LEGAL   MEDICINE. 

is  one  that  can  never  be  solved  with  much  assurance  of  success  hy  any 
general  consideration  of  medical  laws.  "  The  scene,"  as  Judge  Church 
has  said,  "passes  at  once  beyond  the  vision  of  human  penetration;"  and 
attempts  to  solve  the  mystery  leave  one  but  the  more  impressed  with  the 
futility  of  the  effort.  A  thousand  circumstances  may  be  suggested  to 
shatter  the  theory  of  the  survivorship  of  the  one  or  the  other  of  the  vic- 
tims. A  thousand  unknown  forces  may  operate  to  neutralize  the  forces 
on  which  we  had  counted  and  on  which  our  theory  had  been  based ;  and 
so  our  law  has  said,  and  wisely,  as  it  seems  to  me,  that  the  general  rules 
of  hygiene  will  not  avail  to  reveal  to  us  that  which  no  eye  has  seen  and 
no  ear  has  heard.  Those  rules  find  their  true  application  when  they  are 
used  as  corroborative  of  conclusions  that  known  facts  may  legitimately 
yield.  They  will  not  of  themselves  suppty  the  need  of  proof ;  they  will 
not  of  themselves  enable  us  to  evolve  the  known  from  the  unknown. 

There  are  cases,  of  course,  where  any  determinate  rule  is  better  than 
no  rule  at  all.  There  are  rules  like  the  rule  of  the  road,  which,  as  it  has 
often  been  observed,  might  as  well  be  one  way  as  the  other ;  only  let  the 
way  be  certain  and  defined.  And  arbitrary  presumptions  as  to  survivor- 
ship can  find  their  vindication,  if  they  can  find  it  at  all,  only  in  some 
such  consideration  of  the  needs  and  the  policy  of  the  law.  Yet  it  is  very 
doubtful  whether  questions  of  the  comparative  duration  of  the  lives  of 
men  are  such  as  to  demand  an  artificial  and  determinate  test.  Instances 
of  its  possible  application  are  hardly  numerous  enough  to  make  the  rule 
in  any  event  an  urgent  necessity ;  and  the  determination  of  the  property 
rights  of  the  living  by  a  fixed  and  arbitrary  standard  cannot  but  involve 
injustice  at  times  to  those  whose  rights  are  excluded  or  denied.  I  can 
never  believe,  for  my  part,  that  it  is  wise,  unless  in  matters  whose  solu- 
tion is  essentially  indifferent  or  where  some  solution  is  imperatively  re- 
quired, to  solve  the  problems  of  the  law  by  artificial  and  formal  tests.  I 
can  never  believe  that  it  is  wise  to  place  the  doctrines  of  the  law  out  of 
relation  either  to  the  teachings  of  experience  or  to  the  promptings  of 
reason ;  and  it  seems  to  me  that  courts  of  justice,  by  frankly  admitting 
their  inability  to  solve  a  problem  which  in  its  nature  is  insohible,  will 
better  promote  the  ends  of  their  existence  than  by  the  forced  assumption 
of  a  knowledge  which  it  is  not  given  them  to  have. 


HOMICIDE  AND  WOUNDS. 

BY 

LEWIS  BALCH,  M.D.,  Ph.D. 

Homicide  defined.— The  penal  code  of  the  State  of  New  York  defines 
homicide  as  "  the  killing  of  one  human  being  by  the  act,  procurement, 
or  omission  of  another."  (Penal  Code  179.)  The  manner  of  the  death, 
its  cause,  its  time,  and  the  means  or  weapons,  with  the  wounds  found  on 
the  body,  are  all  questions  properly  referred  to  medical  experts,  they 
being  questions  of  which  one  educated  to  observe  the  various  phenomena 
of  life  and  the  morbid  changes  produced  by  disease  or  injury  is  expected 
to  have  the  special  knowledge  necessary  to  aid  the  course  of  justice 
Homicide  by  itself  will  not  be  further  treated,  but  as  it  appears  in  con- 
junction with  the  consideration  of  wounds  made  with  criminal  intent. 

Wounds  defined. — Under  the  old  English  law  a  wound  had  neces- 
sarily to  be  an  injury  which  in  some  way  divided  the  true  skin.  But 
this  would  leave  out  of  the  category  injuries  with  such  weapons  as  would 
not  cut  or  divide  the  skin,  and  which,  nevertheless,  would  cause  death. 
In  surgery,  wounds  are  variously  classed  as  incised,  contused,  lacerated, 
gunshot,  and  punctured  or  penetrating  wounds,  while  fractures  of  bone, 
although  done  by  violence  inflicted  by  another,  are  placed  in  a  different 
list,  to  which  is  generally  added  dislocations.  I  fail  to  see  any  good  reas<  »n 
why  in  medical  jurisprudence  all  injuries  which  are  caused  by  the  attack 
of  one  person  upon  another  should  not  be  considered  as  wounds,  whether 
it  is  a  bruise,  cut,  or  break ;  for  in  a  severe  contusion  we  have  in j un- 
done to  the  soft  parts,  apt  to  be  followed  by  death  of  the  part  so  injured, 
and  the  consequent  danger  of  septic  poisoning  as  the  resultant ;  and  the 
contusion  may  cause  rupture  of  an  organ  such  as  liver  or  kidney,  which 
should  certainly  be  considered  as  a  wound.  A  broken  bone,  when  the 
break  is  by  violence,  in  contradistinction  to  one  done  for  the  refracture 
of  a  badly  united  bone,  wounds  for  a  greater  or  lesser  extent  the  muscles 
at  the  point  of  fracture,  although  the  wound  does  not  extend  to  the  outer 
covering.  Likewise  a  dislocation  may  cause  such  a  wounding  to  nerve 
tissue  as  to  occasion  instantaneous  death,  and  yet  there  be  no  cutting  or 
tearing  of  the  skin.  Scalds  and  burns  are  not  ordinarily  considered  in 
the  light  of  wounds,  and  are  not  so  if  the  word  is  held  to  mean  only  a 
cut  or  torn  condition  of  the  true  skin  ;  but  they  are  undoubtedly  wounds 
in  a  legal  sense  when  inflicted  unlawfully.  I  am  inclined,  therefore,  to 
consider  a  wound  as  an  injury  produced  by  violence  whereby  solution 
of  continuity  in  hard  or  soft  parts  is  procured,  or  where  loss  of  substance 
from  death  of  the  part  due  to  the  violence  follows  its  infliction.     When 

243 


244  A   SYSTEM  OF  LEGAL  MEDICINE. 

dealing  with  jurors,  medical  witnesses  must  remember  they  are  talking- 
to  men  who  have  not  made  any  study  of  wounds  or  wounding,  and  to 
them  the  word  "  wound  "  carries  the  impression  of  some  injury  caused 
by  a  weapon.  If  the  statement  made  above  is  then  taken  as  the  expla- 
nation of  a  wound,  the  juror  does  not  have  to  try  and  learn  the  various 
kinds  of  wounds  presented  to  medical  students  for  their  instruction,  but 
has  only  to  remember  the  main  fact  that  the  wound  or  injury,  whatever 
its  nature,  was  the  one  causing  the  death,  could  have  been  inflicted  in 
the  manner  claimed,  and  was  of  such  nature  or  in  such  position  that  the 
dead  man  could  not  have  made  it  upon  himself.  He  knows  that  the  in- 
jury talked  of  was  a  wound,  and  that  is  sufficient  for  him. 

Contused  Wounds  and  Ecchymosis. — Wounds  made  by  some  blunt 
instrument  may  leave  such  traces  as  to  lead  not  only  to  a  clear  statement 
as  to  what  kind  the  instrument  was,  but  also  to  the  perpetrator,  as  the 
evidence  given  by  the  marks  inflicted  is  shown  to  be  possible  only  by  the 
use  of  a  particular  weapon  known  to  be  owned  and  in  the  possession  of 
the  prisoner  at  the  time  the  assault  was  committed.  To  detail  these 
signs  would  be  an  easy  task,  but  it  becomes  a  far  different  one  when  such 
distinctive  marks  are  wanting.  A  blow  from  a  cane,  bludgeon,  lead  pipe, 
or  other  such  substance  having  a  smooth  surface  with  rounded  edges, 
gives  no  clue  as  to  the  particular  weapon,  and  the  same  kind  of  injury 
may  often  be  made  by  falls.  It  is  then  only  possible  for  the  medical  wit- 
ness to  state  that  such  a  wound  could  have  been  produced  by  the  weapon 
shown,  if  the  latter  is  of  the  character  given  above. 

Wounds  of  this  kind  generally  give  the  sign  of  a  bruise,  viz.,  the  dis- 
coloration of  the  skin  called  ecchymosis.  When  this  ecchymosis  follows 
immediately  upon  the  reception  of  the  blow,  the  color  is  red  or  blue,  being 
of  deeper  tone  in  its  center ;  and  it  may  not  be  anything  more,  for,  death 
resulting  from  the  blow,  time  is  not  given  for  the  changes  noticed  where 
the  ecchymosis  passes  through  certain  stages  in  the  living  body,  going 
from  blue  to  almost  black,  then  purple,  violet,  green,  yellow,  and  fading 
from  the  last-named  color  to  the  natural  condition.  This  is  due  to  the 
effusion  of  blood  into  the  skin  and  cellular  tissue  from  the  rupture  of 
capillaries  or  small  vessels ;  and  as  the  blood  ceases  to  flow  and  clots,  is- 
followed  by  serum,  and  that  in  turn  by  inflammation,  we  have  the  change 
in  color  as  nature  gathers  her  forces  to  get  rid  of  this  abnormal  condition. 
It  is  to  be  remembered  that  the  ecchymosis  does  not  always  appear  in 
the  spot  wounded.  It  does  do  so  if  it  appears  at  once,  that  is,  in  a  few 
minutes  after  the  blow  is  struck ;  but  the  bruise  does  not  always  show  at 
once,  and  then  the  effusion  is  governed  by  the  resistance  given  to  it  and 
the  guidance  it  receives  as  to  its  course  by  the  arrangement  of  the  tissue 
into  which  the  blood  is  effused.  Thus,  when  the  force  of  the  blow  is 
transmitted  to  the  deeper  parts,  or  when  it  causes  a  fracture,  the  ecchy- 
mosis generally  appears  late,  twenty-four  to  thirty-six  hours  after  the 
infliction  of  the  injury,  and  it  is  also  generally  at  a  distance  from  the 
seat  of  the  true  wound.  This  may  be  misleading  unless  the  fact  is  kept 
in  mind,  for  one  may  say  when  he  saw  the  body  there  was  no  bruise  upon 
it,  and  another  may  be  equally  positive  the  signs  of  severe  bruising  were 
present,  for  even  after  death  the  discoloration  from  the  effused  blood 
wall  make  itself  apparent,  the  laws  of  gravity  and  least  resistance  allow- 
ing of  the  blood  forcibly  driven  from  the  small  blood-vessels  at  the  time 
of  the  violence  to  come  to  the  surface  and  give  the  evidence  of  ecchymosis. 


HOMICIDE  AND    WOUNDS.  245- 

Again,  we  may  have  blows  where  no  ecchymosis  follows.  Contusions 
of  the  abdomen,  owing  to  the  want  of  solid  support  under  the  tissues, 
rarely  show  bruising.  These  injuries  are  sometimes  so  severe  that 
rupture  of  the  internal  organs,  liver,  spleen,  and  kidneys,  takes  place,  and 
yet  no  appearance  of  injury  is  visible  externally.  Falls  may  give  similar 
results,  and  cases  are  reported  where  vehicles  have  run  "over  persons, 
death  following  in  short  order,  and  no  injuries  which  would  draw  the 
attention  of  the  uninitiated  appearing  on  the  surface  of  the  body.  And 
the  condition  a  body  is  in  at  the  time  a  contusion  is  received  has  to  be 
taken  into  account,  for  what  on  the  person  of  a  trained  athlete  would 
leave  no  trace,  would  on  that  of  a  weak  or  diseased  person  cause  a  bruise 
of  much  greater  magnitude  than  would  be  expected  from  the  force  exer- 
cised. When  death  results  suddenly  from  a  blow  or  a  fall  and  no  signs 
of  the  violence  are  given  externally,  it  is  imperative  an  autopsy  be  held, 
the  diagnosis  of  apoplexy  or  heart  failure  being  more  apt  to  be  erroneous 
than  that  death  is  due  to  the  rupture  of  an  internal  organ  in  consequence 
of  the  violence  sustained. 

Contusions  from  "  sand-bags,"  a  favorite  weapon  with  the  criminal 
class,  give  no  external  marks.  The  sand,  being  loose  in  the  bag,  spreads 
in  it  at  the  moment  of  contact,  and  while  the  force  of  the  blow  is  not 
lessened,  the  yielding  nature  of  the  weapon  allows  of  adaptation  to  the 
part  struck,  and  does  not  even  stir  the  cuticle.  But  the  contusion  is  none 
the  less  apparent  on  dissection,  for  it  partakes  of  the  same  character  as 
those  of  the  abdomen,  where  the  effect  of  the  blow  is  felt  in  the  deeper 
parts,  and  ecchymosis  may  follow  in  time.  Generally  these  wounds  are 
made  to  the  head  or  neck ;  and  if  not  immediately  fatal  from  shock  to 
the  nerve  centers,  are  dangerous  from  subsequent  inflammation  and  from 
the  effusion  of  blood,  which  causes  pressure  on  brain  or  spinal  cord. 

Has  a  Given  Contused  Wound  been  made  on  the  Living  or  Dead 
Body? — It  is  readily  understood  that  where  some  swelling  of  the  part 
struck  is  present  or  changes  of  color  at  the  edges  of  the  bruise  have  taken 
place,  the  contusion  was  necessarily  inflicted  during  life,  for,  from  what 
has  already  been  said,  after  the  blood  is  driven  into  the  skin  and  its 
cellular  tissues  by  the  force  of  the  blow,  the  extension  of  the  bruise  is 
due  to  the  effusion  of  serum  from  the  clotted  blood,  and  this  gives  the 
lighter  marginal  color.  Consequently,  if  such  a  condition  be  found  on 
the  dead  body,  the  iuference  is  positive  that  the  injury  was  received  dur- 
ing life.  But  the  case  is  different  when  there  is  only  the  initial  evidence 
of  a  blow.  Here  the  dark  red  to  blue  color  is  from  the  blood  direct,  and 
as  the  blow  or  other  causes  may  be  fatal  immediately,  nature  does  not  go 
on  to  give  the  changes  observed  in  bruises  during  life,  when  the  absorbents 
are  active.  And  here  comes  in  the  question  of  time  of  infliction.  If  the 
blow  causing  the  ecchymosis  at  the  same  instant  causes  death,  the  appear- 
ance of  the  bruise  is  practically  the  same  as  if  death  had  been  delayed 
for  a  few  minutes  or  even  half  an  hour.  Authorities  all  agree  that  it  is 
more  than  doubtful  if  positive  evidence  can  be  given  on  this  point.  The 
experiments  of  Sir  R.  Christison  showed  that  even  up  to  two  hours  after 
death  the  appearances  made  by  a  blow  upon  the  dead  body  were  appar- 
ently equal,  and  not  to  be  positively  told  from  a  bruise  of  like  character 
in  life.  The  force  of  the  blow,  however,  on  the  dead  was  found  to  require 
considerable  augmentation  to  produce  a  similar  appearance  to  a  light 
blow  on  the  living ;  but  as  other  evidences  would  not  be  present  to  show 


24G  A   SYSTEM  OF  LEGAL  MEDICINE. 

how  much  force  had  been  used,  this  point  does  not  help  in  the  decision. 
The  ecchymosis  produced  by  a  blow  should  not  be  confounded  with  the 
discoloration  of  the  skin  which  follows  death,  generally  called  suggilla- 
tion,  but  better  described  by  Dr.  Tajdor  as  cadaveric  lividity.  Here  the 
appearances  may  lead  an  untrained  observer  into  error,  but  one  having 
experience  with  cadavers  will  not  be  in  doubt,  for  the  general  extent  to 
which  this  cadaveric  lividity  is  found  precludes  the  conclusion  that  it  could 
be  from  violence.  While,  then,  the  medical  witness  must  use  caution  in 
stating  that  a  given  bruise  is  the  result  of  a  wound  received  during  life, 
unless,  as  has  been  before  said,  the  changes  in  it  are  such  as  could  not  have 
taken  place  after  death,  if  chance  is  given  for  dissection  the  fact  that  the 
effusion  of  blood  is  in  the  skin — though  it  must  be  borne  in  mind  that 
this  effusion  into  the  skin  does  not  always  take  place  even  in  the  living 
— as  well  as  in  the  cellular  tissue,  would  incline  to  the  opinion  that  the 
injury  was  received  before  death  or  just  at  the  time  of  death. 

In  the  drowned,  or  in  bodies  which  have  begun  to  putrefy,  the  pass- 
ing of  an  opinion  upon  marks  which  appear  to  be  contused  wounds  be- 
comes even  a  more  doubtful  matter.  Where  the  body  has  been  for  some 
time  immersed  in  water  and  putrefaction  has  begun,  it  is  found  to  be 
swollen,  of  a  greenish-blue  sort  of  color,  the  cuticle  comes  off  in  handling, 
the  superficial  veins  are  enlarged,  and  show  dark,  being  easily  recognized ; 
and  a  contused  wound,  or  in  fact  any  other  kind  of  a  wound,  has  under- 
gone such  changes  as  to  make  it  impossible  on  the  part  of  the  medical 
expert  to  say  whether  such  wound  had  been  received  during  life  or  not. 
One  can,  from  careful  examination  of  the  whole  body,  form  a  conclusion, 
but  this  conclusion  can  be  only  a  supposition,  and  cannot  be  a  positive 
one.  The  evidence  given  must  therefore  be  that  of  what  is  apparently, 
from  all  considerations,  the  greatest  probability,  but  cannot  be  positive, 
or  even  approaching  positiveness. 

A  condition  exists  which  has  been  termed  pseudo-ecchymosis,  result- 
ing in  slight  abrasions  of  the  cuticle,  and  giving  a  yellowish  or  brown 
appearance  after  time  has  sufficiently  elapsed  to  allow  of  the  abrased 
surfaces  becoming  dry.  These  are  to  be  taken  into  account  in  the  ex- 
amination of  a  body ;  but  as  they  may  be  made  by  the  body  striking 
against  any  hard  substance  as  it  falls,  either  before  or  after  death,  alone 
they  cannot  be  held  to  be  of  great  significance.  The  noting  of  them 
may,  however,  have  an  important  bearing  in  determining  whether  a 
struggle  has  taken  place,  for  the  cuticle  peels  quite  easily  under  pressure, 
and  the  position  and  direction  of  these  erosions  may  indicate  some  other 
cause  than  a  fall.  Any  one  who  has  been  familiar  with  dissecting-rooms 
will  readily  recall  many  instances  where  these  brownish  patches,  hard 
and  dry,  were  seen  on  cadavers.  It  is  as  easy  to  produce  them  dajrs  after 
death  as  it  is  before  death,  and  the  difference  between  the  two  cannot  be 
determined.  The  epidermis,  if  rubbed  off  from  any  cause,  gives  such  a 
condition  as  the  result.  It  may  be  said  if  the  excoriation  is  a  shade 
deeper  than  the  cuticle,  enough  to  cause  slight  abrasion  of  the  true  skin 
and  draw  blood,  the  result  is  a  scab,  as  it  is  ordinarily  called,  and  this 
would  only  be  present  during  life.  If  a  similar  abrasion  was  made  after 
death,  the  part  would  be  a  darker  brown  and  probably  harder  than  where 
only  the  epidermis  had  been  removed,  and  in  this  way  it  might  fairly  be 
distinguished  as  to  time  of  infliction.  The  scab  would  not,  however,  be 
the  result  if  the  abrasion  was  made  at  the  time  of  death.     It  would  re- 


HOMICIDE  AND    WOUNDS.  247 

quire  from  one  to  two  hours  for  formation,  and  so  if  such  an  excoriation 
was  due  to  violence,  when  death  was  the  immediate  result,  the  appearance 
would  be  the  same  as  if  made  after  life  was  extinct. 

Where  fractures  result  from  blows,  the  skin  not  being  broken,  the 
ecchymosis  not  only  is  not  always  immediate,  but  may  make  its  appear- 
ance at  some  distance  from  the  seat  of  the  injury.  Generally  it  would 
be  expected  that  a  blow  strong  enough  to  cause  fracture  woidd  also  cause 
a  bruise  at  the  place  struck,  and  this  is  true  if  the  wound  be  made  with 
some  weapon  such  as  a  club,  billy,  or  other  hard  substance.  But  if  it  is 
made  with  a  softer  substance,  as  a  sand-bag,  the  result  may  be  identical 
with  the  conditions  noticed  in  fractures  by  indirect  violence.  Unless 
there  be  some  such  external  evidence  to  show  the  wound  was  made  dur- 
ing life,  the  presence  of  the  break  does  not  allow  of  positive  statement 
as  to  the  time  it  took  place,  for  a  fracture  made  in  the  dead  body  at  or 
shortly  after  death,  before  animal  heat  has  departed,  gives  the  same  ap- 
pearance as  one  made  just  before  death,  the  muscles  surrounding  the 
bone  being  similarly  torn,  and  blood  effused  in  the  laceration  in  the  same 
manner  as  it  is  during  life.  If  the  fracture  is  made  some  hours  after 
death,  when  the  body  temperature  is  notably  lowered,  then  we  do  not  have 
as  marked  a  condition  as  in  the  other  cases,  for  here  the  blood  effused  is 
not  so  much  as  when  animal  heat  is  still  present,  unless  a  vein  is  torn, 
and  the  ruptured  muscles  do  not  give  the  appearance  of  sudden  tearing. 

It  is  hardly  necessary  to  call  attention  to  the  different  discoloration s 
of  the  skin  produced  in  eruptive  diseases,  such  as  the  dark  purplish  spots 
of  typhus  fever,  scurvy,  etc.  Any  of  these  petechia?  should  be  readily 
recognized  by  the  physician  as  not  the  products  of  violence,  and  the  his- 
tory of  the  case  will  aid  in  the  diagnosis.  The  appearance  after  death  of 
purpuric  spots  is  very  similar  to  that  of  a  bruise  produced  at  the  time  of 
death,  but  their  size  and  general  connection,  combined  with  the  fact  that 
similar  spots  are  to  be  found  in  the  mucous  membrane  of  the  throat  and 
alimentary  canal,  will  prevent  the  examiner  from  confounding  them 
with  ecchymoses  resulting  from  violence.  In  old  people  it  is  common 
to  find  dark  spots  or  patches  on  the  extremities,  sometimes  enveloping 
the  whole  of  the  limb,  which  are  due  to  imperfect  capillary  circulation, 
and  which  might  be  mistaken  after  death  for  bruises.  The  seat  of  these, 
however,  they  being  almost  invariably  on  the  lower  part  of  the  leg,  and 
their  character,  will  show  their  true  nature.  It  is  but  necessary  to  call 
attention  to  these  different  simulations  of  ecchymosis  to  put  the  medical 
examiner  on  his  guard. 

Wounds  by  Cutting  Instruments. — In  describing  all  wounds,  of 
whatever  nature,  where  the  person  to  whom  the  description  is  given  is 
not  of  the  medical  profession,  it  is  best  to  use  ordinary  plain  language, 
avoiding  all  technicalities.  This  saves  the  trouble  of  explaining  what  is 
meant,  and  allows  those  hearing  the  statement  to  understand  its  import, 
they  not  being  required  to  do  any  hard  thinking  over  unaccustomed 
word  sounds,  and  so  lose  the  thread  of  the  tale  and  the  sense  of  what 
follows  the  scientific  phrase.  And  in  describing  the  position  of  wounds 
on  the  body,  the  medical  witness  should  endeavor  to  use  the  simplest  of 
language  and  the  shortest  of  descriptions  compatible  with  clearness.  To 
too  minutely  describe  every  abrasion,  bruise,  scratch,  cut,  fracture,  or 
any  other  mark  of  violence  that  may  be  found  on  the  body,  is  to  burden 
the  mind  of  the  jury  with  much  that  may  far  better  be  condensed  into 


248  ^   SYSTEM  OF  LEGAL   MEDICINE. 

collective  statements,  which  not  only  prove  less  tedious  but  also  much 
clearer  to  the  listeners.  By  this  is  not  meant  that  careful  note  should 
not  be  taken  of  every  mark  and  its  location  defined,  as  well  as  its  prob- 
able cause  and  probable  time  of  reception,  but  that  where  many  similar 
injuries — small  bruises,  for  instance — are  found  over  the  body,  it  may  be 
stated  in  one  sentence,  one  having-  been  fully  described,  as  "so  many 
similar  bruises,  on  the  body,  arm,  leg,"  or  wherever  the  situation  may  be. 

Cut  or  incised  wounds  are  those  made  by  an  instrument  possessing 
an  edge  which  will  divide  the  integument  as  it  is  drawn  across  or  pushed 
into  it,  as  in  stabs  made  with  knives.  The  instrument  may  be  a  piece  of 
glass,  tin,  or  sheet-iron,  and  the  wound  resulting  be  a  cut,  although,  as  a 
general  rule,  in  homicidal  wounding  axes,  hatchets,  swords,  knives,  and 
such  like  weapons  are  used.  All  these  have  cutting  edges,  and  make 
wounds  very  similar  in  appearance.  When  an  ax  or  hatchet  is  used, 
while  the  edge  cuts,  at  the  same  time  the  weapon  delivers  a  blow,  and  to 
the  cut  may  be  added  the  breaking  of  bone,  or,  if  the  weapon  be  dull,  the 
appearance  of  a  lacerated  or  torn  wound  rather  than  one  incised.  As  in 
contused  wounds,  so  in  cut  ones :  if  the  wound  has  been  made  during 
life  and  sufficient  time  given  for  reparative  process  to  begin,  the  telling 
of  when  it  was  inflicted,  or  a  fairly  approximate  period,  is  not  so  difficult 
a  matter.  If  the  signs  of  the  inflammatory  healing  process  are  present, 
or  if  adhesion  of  part  of  the  wound  has  taken  place,  the  surrounding 
tissues  a  little  swollen,  or  if  pus  be  found,  we  know  the  wound  was  made 
during  life.  But  the  wound  may  be  a  mortal  one,  and  the  victim  pass 
instantly  from  life  to  death.  Here,  then,  is  a  condition  with  other  phe- 
nomena, and  one  requiring  careful  examination  to  give  a  definite  state- 
ment upon.  The  wound  being  a  cut,  if  made  upon  the  living  body  as  a 
general  rule  it  presents  the  characteristics  of  gaping,  the  skin  being  a 
little  everted,  showing  the  deeper  tissues,  while  blood  is  freely  poured 
forth,  especially  if  an  artery  has  been  wounded,  and  clots  of  blood  are 
found  lying  in  the  cut.  The  skin  is  highly  elastic,  and  when  severed  while 
alive,  draws  away  from  the  line  of  incision ;  and  if  the  cut  is  transverse 
to  muscular  fiber,  more  gaping  is  noticed,  on  account  of  the  contraction 
of  the  divided  muscles,  than  when  the  wound  is  in  the  line  of  the  muscle. 
In  a  transverse  cut  is  found  not  only  more  gaping,  but  more  bleeding 
takes  place  than  when  the  cut  is  longitudinal.  The  blood,  being  fresh, 
will  coagulate  where  it  falls,  and  if  an  artery  has  been  involved  with  a 
chance  to  discharge  its  blood  in  spurts,  traces  of  this  sort  of  bleeding  will 
be  seen  on  the  clothes  or  on  the  body,  and  may  also  be  found  on  walls, 
floor,  furniture,  or  other  articles  within  reach  of  the  spurting  vessel. 
This  was  well  shown  in  a  case  of  a  gentleman  who  lived  in  Albany,  N.  Y. 
Having  had  an  operation  performed  for  cataract,  the  day  he  was  told  his ' 
sight  would  be  tried  having  arrived,  he  anticipated  the  visit  of  the  doctor, 
and  while  the  family  were  at  church  got  out  of  bed,  made  his  way  to  a 
shaving-stand  in  the  room,  and  took  off  the  bandages.  Not  finding  his 
sight  as  much  improved  as  he  expected,  he  took  a  razor  from  the  drawer 
of  the  stand  and  cut  his  throat,  severing  the  left  carotid.  The  stand,  its 
glass,  and  the  wall  above  and  on  either  side  were  spattered  with  blood, 
spots  reaching  as  high  as  six  or  seven  feet.  The  man  himself  was  about 
five  feet  ten,  and  was  also  bloody  to  a  great  degree. 

The  blood-marks  from  an  incised  wound,  therefore,  may  be  an  im- 
portant factor,  aiding  the  decision  of  whether  the  wound  was  before  or 


HOMICIDE  AND    WOUNDS.  249 

after  death  where  the  wound  is  a  cut.  If,  however,  the  wound  is  a  stab, 
and  but  the  size  of  the  blade  making  it,  no  vessel  being  severed  in  its 
course,  the  appearance  of  the  wound  may  be  such  as  to  make  the  exam- 
iner hesitate  as  to  its  time  of  infliction.  Casper  relates  a  case  where  a 
man  stabbed  his  wife  in  the  breast,  causing  instant  death  by  the  sever- 
ance of  the  aorta,  and  yet  the  wound  through  the  chest  walls  showed 
no  sign  of  bleeding,  and  was  to  all  appearances  identical  with  a  wound 
made  upon  the  cadaver.  The  autopsy  will  do  much  to  clear  up  any 
doubt  in  wounds  of  this  character.  If  no  other  condition  can  be  found 
to  which  death  could  possibly  be  ascribed,  and  a  mortal  wound  is  dis- 
covered, the  logical  inference  can  only  be  that  it  was  made  before  death 
uud  was  the  cause  of  death.  For  if  the  wound  had  been  made  after 
death,  unless  the  cause  be  shock,  some  evidence  of  other  destroying 
means  would  be  seen,  and  then  the  study  of  not  only  the  wound  itself, 
but  the  deductions  to  be  drawn  from  the  internal  evidences,  would  be 
the  guides  to  a  conclusion  as  to  whether  death  was  prior  to  the  wounding 
or  not.  As,  for  instance,  where  a  throat  has  been  cut  to  simulate  suicide 
and  hide  the  crime  of  murder  by  suffocation.  Here  we  have  a  wound 
which  may  give  all  the  signs  of  having  been  made  during  life  with  the 
exception  of  one,  viz.,  the  bleeding,  and  the  autopsy  would  find  the  char- 
acteristic evidences  of  death  from  suffocation.  The  wound  would  bleed 
freely,  but  the  absence  of  arterial  action,  the  very  fluidity  of  the  blood, 
combined  with  the  other  post-mortem  appearances  of  death  from  inter- 
ference with  respiration,  would  lead  the  examiner  to  the  conclusion  of 
homicide,  and  that  the  cut  was  made  after  death. 

A  wound  made  immediately  after  death  will  present  the  same  appear- 
ances as  a  wound  made  before,  but  the  hemorrhage  will  be  different,  and, 
unless  some  large  vein  has  been  cut,  not  so  copious.  We  may  even  find 
coagula  in  the  wound  and  the  gaping  and  evected  edges  if  infliction  has 
been  done  before  the  elasticity  of  the  skin  is  lost;  but  the  bleeding  is 
venous  and  follows  the  laws  of  gravity,  does  not  spread  so  widely  as 
when  the  heart  still  acted,  even  if  it  gave  but  one  or  two  beats ;  and  this 
fact  of  itself  calls  for  most  careful  search.  While  it  is  possible,  as  in 
the  case  quoted  from  Casper,  that  a  mortal  wound  may  present  only  the 
appearance  of  one  made  on  the  dead,  if  the  wound  has  been  made  on 
the  body  after  death  has  been  established  for  half  an  hour  or  more  and 
the  death  could  be  attributed  to  another  cause,  such  as  a  blow  upon  the 
head,  the  question  of  the  wound  having  been  made  on  the  living  would 
properly  be  decided  in  the  negative,  the  majority  of  evidence  pointing  to 
another  cause  for  death,  and  all  the  appearances  of  the  cut  being  those 
of  wounds  on  the  cadaver.  Still  doubt  might  be  raised,  for  the  wound 
to  the  head  might  be  such  as  could  be  received  by  the  body  falling ;  and 
as  the  fall  would  be  simultaneous  with  the  wound  and  with  the  death, 
the  question  of  which  injury  took  life  would  be  one  of  difficulty.  I  con- 
sider great  stress  should  be  laid  upon  the  hemorrhage  from  the  wound, 
for  the  heart  is  the  last  part  of  man  to  die,  and  while  its  action  may  be 
treble  by  reason  of  the  nature  of  the  injury,  if  the  cut  was  made  before 
death  took  place  more  bleeding  could  properly  be  expected,  and,  as  said 
before,  of  an  arterial  character.  In  1859,  at  Lyon's  Falls,  N.  Y.,  a  Mrs. 
Priscilla  Budge  was  found  dead  in  bed,  cold,  and  with  her  throat  cut. 
Her  husband,  the  Rev.  Mr.  Budge,  was  arrested  for  murder,  but  the  ver- 
dict of  acquittal  was  rendered  by  direction  of  the  judge,  as  clever  cross- 


250  A    SYSTEM  OF  LEGAL  MEDICINE. 

examination  of  counsel  had  confused  one  of  the  people's  medical  experts, 
and  if  the  statements  he  made  were  correct,  conviction  could  only  be 
had  on  probabilities.  The  evidence,  however,  of  the  body  and  its  sur- 
roundings, as  reported  by  Dr.  Swinburne,  showed  a  transverse  cut  of 
the  throat,  below  the  thyroid  and  severing  the  cricoid  cartilage,  going 
so  deep  on  the  left  side  as  to  cut  the  transverse  process  of  the  fifth  cer- 
vical vertebra,  the  periosteum  and  substance  of  the  vertebra  also  cut,  and 
then  the  soft  parts  of  the  light  side  of  the  neck.  The  cut  was  evidently 
from  right  to  left,  from  the  manner  of  its  beginning  and  ending,  and  the 
bedclothes,  which  were  undisturbed,  as  well  as  the  nightdress  of  the 
woman,  were  free  from  blood.  Blood  had  flowed  from  both  sides  of  the 
wound  down  the  neck  and  soaked  the  mattress.  There  was  no  spatter- 
ing of  blood  anywhere,  and  the  defense  was  suicide  while  in  bed,  the 
weapon  being  a  razor  found  lying  near  the  right  hand.  The  autopsy, 
which  was  not  held  until  four  months  after  death,  but  which,  owing  to 
the  winter  weather,  hard  frost,  and  character  of  soil  in  which  the  body 
was  buried,  was  still  a  valuable  autopsy,  gave  the  signs  of  death  from 
suffocation.  The  appearances  of  the  wound  as  the  woman  lay  in  bed 
were  in  every  way  the  same  as  if  it  had  been  made  during  life.  The  only 
difference  was  that  the  blood  flowed  by  gravity,  and  was  not  thrown  for- 
cibly by  the  per  saltern  action  of  the  heart.  Had  the  medical  man  who  first 
saw  the  case  been  familiar  with  the  rudiments  of  medical  jurisprudence 
or  been  a  close  observer,  the  fact  that  there  was  an  absence  of  blood  over 
the  bed,  walls,  floor,  face,  hands,  or  anywhere  else  that  a  live  artery  could 
throw  it,  he  would  not  have  been  so  ready  to  consider  the  case  one  of 
suicide,  but  would  have  made  proper  examination  of  the  body  for  other 
cause  of  death.  Comparing  this  case  with  the  one  of  throat-cutting  pre- 
viously quoted,  the  immediate  difference  is  noted :  the  body  living  and 
but  one  carotid  severed,  the  walls,  shaving-stand,  floor,  everything  around 
covered  with  blood ;  the  body  dead,  heavy  oozing  of  blood,  flowing  in 
the  line  of  gravity,  no  spattering  of  spots  anywhere  about. 

Lacerated  Wounds. — These  may  be  caused  by  other  than  sharp  in- 
struments, or  even  by  them,  for  the  injury  is  where  the  wound  is  torn 
and  not  clean  cut.  A  marked  feature  is.  they  are  generally  attended 
with  but  little  hemorrhage,  the  vessels  being  severed  by  tearing,  the 
ragged  edges  entangle  the  blood  so  it  rapidly  clots,  and  prevents  further 
bleeding.  A  limb  may  be  torn  completely  off  and  not  so  much  hemor- 
rhage follow  as  would  from  a  severe  cut.  Still,  death  from  bleeding 
as  the  result  of  a  lacerated  wound  can  and  does  take  place.  The  chief 
danger,  however,  is  from  the  extent  of  the  injury  and  the  shock  to  the 
nervous  system.  The  appearance  of  a  lacerated  wound  made  during  life, 
unless  it  is  of  some  days'  standing,  is  not  to  be  distinguished  from  one 
made  immediately  or  shortly  after  death.  Coagula  are  found  in  the 
wound  in  both  cases,  for,  as  shown  above,  the  blood  does  not  lose  its 
power  of  coagulation  until  the  body  has  lost  its  heat.  Consequently,  if 
the  wound  is  made  near  to  the  time  of  death  the  blood  effused  will  be 
found  more  or  less  clotted  in  it.  And  the  arteries  being  torn,  we  do  not 
have  the  free  spurting  seen  when  they  are  cleanly  cut.  The  evidence  to 
be  relied  upon  as  to  the  wound  having  been  made  upon  the  living  is 
chiefly  the  history  of  the  case  to  be  obtained  from  those  who  first  saw 
the  body.  Naturally,  if  witnesses  of  the  wounding  can  be  found  the 
question  is  easy  of  solution ;  but  where  none  such  are  obtainable  the  de- 


HOMICIDE  AND    WOUNDS.  251 

cision  has  to  be  very  guarded,  nothing  being  positive  about  the  wound 
itself. 

An  injury  of  this  nature  may  present  some  of  the  characteristics  of 
one  incised,  for  a  blow  delivered  on  a  part  under  which  lies  a  ridge  of 
bone,  while  not  causing  the  cut  by  the  weapon,  may  by  the  force  cause  a 
division  of  the  skin  and  subsequent  parts  by  the  power  with  which  they 
are  driven  upon  the  bony  ridge  or  protuberance.  And  thus  made,  the 
cut  may  appear  more  like  an  incised  wound.  A  similar  result  may  be 
obtained  where  the  bone  under  the  tissue  struck  is  smooth,  for  if  the 
tissue  is  not  thick  the  force  of  the  blow  may  cause  a  wound  sufficiently 
clean  cut  in  character  to  allow  of  an  artery  divided  in  it  to  spurt  blood 
to  quite  a  distance.  In  the  case  of  O'Shea,  tried  for  the  murder  of  his 
wife  in  Washington  County,  N.  Y.,  in  1881,  evidence  was  presented  of  a 
fight  between  the  two,  and  lacerated  and  contused  wounds  were  found  on 
the  woman  in  different  positions.  The  three  principal  ones  were :  first, 
over  the  right  eye,  severing  the  anterior  branch  of  the  temporal  artery ; 
second,  on  the  back  of  the  head  below  the  occipital  protuberance ;  and 
third,  on  the  left  lower  jaw,  probably  cutting  the  facial  artery  where  it 
crosses  the  body  of  the  bone.  The  woman  was  found  dead  in  her  bed  in 
a  small  room,  and  blood  in  spots  wras  noted  on  the  walls,  windows,  and 
ceiling,  as  well  as  on  the  bed  and  floor.  It  was  claimed  by  the  people 
that  these  blood-spots  were  from  the  cut  over  the  eye,  and  it  was  shown 
the  distance  they  had  to  be  thrown  was  from  three  to  five  feet.  From 
the  body,  as  it  lay  on  the  bed,  to  the  ceiling  was  about  four  feet,  and  it 
was  claimed  that  the  temporal  artery  could  throw  the  blood  up  to  the 
ceiling  from  the  bed.  The  woman's  hair  was  done  up  in  a  knot  behind 
her  head,  the  ends  of  which,  however,  hung  loose,  and  were  wet  with 
blood.  It  was  claimed  by  the  defense  that  the  spots  were  more  liable  to 
come  from  blood  being  thrown  from  these  ends  of  hair  in  the  fight  which 
took  place,  as  the  artery  could  not,  in  all  probability,  have  sufficient  force 
to  raise  a  jet  of  blood  four  feet.  It  was  a  drunken  brawl,  and  the  jury 
brought  in  a  verdict  of  murder  in  the  second  degree.  In  this  case  the 
wounds  were  all  lacerated  and  contused,  and  yet  hemorrhage  to  a  con- 
siderable amount  took  place.  I  am  more  inclined  to  the  belief  that  the 
spots  of  blood  on  ceiling  and  walls,  especially  if  they  reached  their  desti- 
nation from  a  distance  of  four  to  five  feet,  were  more  probably  caused 
by  the  flirting  of  the  hair  in  the  struggle,  than  directly  from  the  artery, 
» 'specially  as  a  few  weeks  after  the  trial  I  saw  a  case  where  a  young  man 
had  been  cut  in  exactly  the  same  spot  on  the  right  forehead  by  a  brick 
thrown  with  force,  which  caused  a  clean,  lacerated  wound,  allowing  the 
anterior  branch  of  the  temporal  to  give  characteristic  arterial  hemorrhage. 
In  this  case  the  man  was  standing,  for  the  blow  did  not  knock  him  down 
or  render  him  insensible,  and  the  extreme  distance  to  which  the  artery 
threw  the  blood  was  three  and  a  quarter  feet,  and  when  I  saw  the  case 
the  vessel  was  still  bleeding,  though  not  with  such  force. 

From  the  foregoing  it  will  be  seen  that  as  much  care  must  be  exer- 
cised by  the  medical  examiner  in  passing  judgment  upon  a  lacerated 
wound  as  upon  one  incised,  supposing  the  former  to  have  been  made 
during  life.  In  the  case  cited  small  wounds  have  been  given  as  examples. 
If,  however,  large  arteries  are  cut  by  the  blow  of  the  bludgeon  or  other 
blunt  weapon  and  the  wound  be  fairly  sharp  in  outline,  the  bleeding  may 
be  more  that  of  an  incised  wound  than  a  torn  one,  and  caution  is  neces- 


2.")1)  A   SYSTEM  OF  LEGAL  MEDICINE. 

sary,  for  the  wound  may  be  the  direct  cause  of  death ;  and  yet  if  it  is 
considered  to  be  an  incised  one,  it  is  not  sufficient  to  be  fatal,  the  concus- 
sion from  the  blow  making'  the  wound  being  the  death  producer,  the 
wound  being  but  an  additional  injury  and  not  one  which  would  be  con- 
sidered dangerous  to  life. 

Gunshot  Wounds. — This  class  of  injuries  are  generally  produced  by 
missiles,  chiefly  lead,  fired  from  some  sort  of  pistol  or  gun,  the  propelling- 
force  being  powder.  And  this  is  in  fact  what  one  mainly  meets  in  legal 
practice ;  but  it  is  still  to  be  remembered  that  the  same  character  of 
wound  may  be  made  by  any  projectile,  no  matter  of  what  it  is  composed, 
and  no  matter  what  the  propelling  force.  As,  for  example,  a  small  stone 
or  pebble,  resembling  a  bullet  in  size,  thrown  by  a  blast  or  any  sufficient 
force,  will  give  what  is  technically  known  as  a  gunshot  wound,  and  it  is 
such  a  wound,  only  not  one  caused  by  the  use  of  fire-arms. 

Where  the  injury  is  by  a  bullet  fired  from  a  gun  or  rifle  we  have 
certain  characteristics  which  are  common  to  this  class  of  wounds.  The 
effect  of  a  ball  striking  the  soft  tissues  of  the  human  body  is,  first,  that 
of  contusion,  and  the  degree  of  this  contusion  is  in  proportion  to  the 
velocitj*  of  the  bullet.  Ordinarily,  when  traveling  at  the  usual  velocity, 
a  bullet  does  not  at  first  sight  appear  to  have  bruised  the  tissues,  but  the 
force  is  so  great,  the  speed  is  so  swift,  the  contusion  reaches  the  point  of 
disintegration  of  the  tissue  struck,  and  we  see  but  the  open  wound  of 
entrance  and  the  corresponding  one  of  exit.  The  track  is  open  in  all  its 
■course,  for  the  contusion  was  so  strong  the  tissue  in  the  course  of  the 
ball  was  rapidly  and  instantaneously  reduced  to  a  pulp.  Shreds  of  it 
may  lie  in  the  course  of  the  wound,  but  what  remains  is  dead  tissue,  all 
life  having  been  done  awny  with  by  the  terrible  force  of  the  blow.  There 
is  added  to  a  gunshot  injury,  which  of  itself  may  not  be  dangerous  either 
from  the  part  shot  or  the  amount  of  blood  lost,  the  factor  of  sloughing 
and  the  healing  by  second  intention,  and  a  slight  wound  may  under  these 
considerations  become  a  dangerous  one.  The  contusion  is  so  complete 
and  the  time  of  the  bruising  force  so  short  that  the  surrounding  parts 
are  not  involved,  and  ecchymosis  is  rarely  seen.  It  is  different,  however, 
if  the  ball  is  a  spent  one  or  one  traveling  at  a  very  low  rate  of  velocity. 
Here  the  skin  may  not  be  broken  and  the  contusion  constitutes  all  the 
wounding,  although  that  contusion  may  have  deep  effects,  and  bruise  in- 
ternal organs  in  a  way  to  cause  death.  The  signs  externally  would  be 
the  ones  already  described  in  other  like  wounds  made  by  any  blunt,  hard 
instrument,  and  the  size  and  appearance  of  the  bruise  would  be  in  accord 
with  the  missile  making  it. 

When  a  bullet  has  entered  or  traverses  a  body,  supposing  it  does  not 
touch  bone,  its  track  mav  be  followed  on  dissection  and  shown  as  a 
blood-stained  line,  as  well  as  the  openings  in  the  various  tissues  pene- 
trated. If  the  recipient  has  survived  the  wound  a  few  days,  two  or  three, 
while  the  track  is  then  not  an  open  one,  it  is  nevertheless  as  easily  fol- 
lowed, for  slight  inflammation  having  by  this  time  started  in  the  course 
of  the  ball,  the  sharp  red  line  is  plainly  seen  against  the  other  tissues. 
If  bone  be  struck,  something  more  happens,  for  the  bullet,  being  of  soft 
lead,  is  more  or  less  "upset,"  as  the  saying  is,  and  if  it  penetrates  the 
bone  it  loses  some  of  its  lead  by  attrition.  The  fracture  thus  caused  is 
generally  radiating  in  character.  The  ball  may  disintegrate  bone  in  the 
isame  way  it  does  the  soft  parts,  especially  when  the  bone  struck  is  of 


HOMICIDE  AND    WOUNDS.  253 

hard  and  brittle  constituency.  And  when  this  is  the  case,  the  ball  loses 
■even  more  of  its  lead  than  when  merely  piercing  a  bone  or  lodging  in  one. 

In  these  days  the  majority  of  fire-arms  throwing  bullets  are  rifled, 
and  the  ammunition  used  is  called  "  fixed,"  from  the  fact  that  ball  and 
•cartridge  form  one  package,  the  cartridge-shell  being  of  metal  and  the 
ball  being  set  firmly  in  it  direct  upon  the  powder,  wads  being  no  longer 
interposed  between  the  two.  These  facts  alter  somewhat  our  dealings 
with  this  class  of  wounds.  Formerly,  when  smooth-bore  muskets  and 
pistols  were  in  common  use,  with  round  balls,  as  such  weapons  gave  but 
a  low  velocity  and  comparatively  small  penetrating  power,  a  bullet  was 
often  deflected  by  encountering  bone  or  even  by  tendons,  when  these 
were  struck  at  an  acute  angle,  and  the  bullet  changed  its  course  in  the 
body.  I  do  not  mean  to  say  bullets  from  rifled  weapons  are  never  de- 
flected, but  their  higher  rate  of  speed,  their  greater  power  of  penetration, 
the  form  of  the  ball  being  long  and  pointed,  the  rotary  motion  imparted 
by  the  rifling  of  the  barrel,  tend  rather  to  send  the  bullet  in  a  straight 
line  to  its  destination,  boring  its  way  through  bone  or  all  obstacles,  than 
to  let  it  be  turned  one  way  or  another  by  tissues  lying  in  its  course.  And 
this  should  be  remembered,  for  it  may  have  an  important  bearing  in  the 
opinion  expressed  on  a  given  wound  as  to  its  danger. 

In  the  early  eighties  a  man  was  shot  at  Fonda,  N.  Y.,  in  the  neck, 
Left  side  Three  days  afterward  he  was  paralyzed  on  the  right  side,  and 
died  in  about  a  week.  The  surgeon  in  attendance  supposed  from  the 
paralysis  being  on  the  right  side  that  the  bullet  had  turned  on  the  trans- 
verse process  or  on  the  bodies  of  the  cervical  vertebra?,  probed  further 
for  the  ball,  and  his  probe  passed  easily  its  entire  length  up  toward  the 
head.  At  the  autopsy,  however,  he  found  no  wound  or  clot  or  other 
injury  to  the  brain,  and  then  began  dissecting  the  neck,  following  the 
wound  of  entrance.  In  a  straight  line  from  where  the  bullet  entered  it 
passed  to  lodge  between  the  fifth  and  sixth  vertebra?,  cutting  the  left 
vertebral  artery  completely  in  two.  The  cause  of  the  paralysis  was  then 
apparent.  The  weapon  used  was  a  small  revolver,  but  with  rifled  barrel 
and  conoidal  ball. 

Wounds  made  by  shot-guns,  unless  they  are  loaded  with  buckshot  or 
ball,  depend  upon  the  distance  from  which  the  shot  was  fired  for  their 
appearance.  If  fired  at  close  range,  before  the  charge  of  shot  has  had 
time  to  separate  a  tearing  wound  of  large  size  is  made.  The  edges  are 
not  as  clean  as  when  a  rifle-ball  has  entered,  for  the  charge  is  not  a  com- 
pact one.  If  fired  from  a  greater  distance,  then  we  find  shot  in  a  larger 
area,  some  deeper  than  others  in  penetration,  and  the  shot  go  in  singly 
or  in  groups,  depending  on  how  carefully  they  were  put  into  the  car- 
tridge. If  not  fatal  outright  and  if  not  entering  a  cavity,  the  wounds  are 
dangerous  only  from  the  inflammation  that  may  follow. 

Gunshot  wounds  may  be  fatal  without  any  external  mark,  for  the 
weapons  may  be  discharged  into  the  mouth,  or  the  bullet  may  enter  by 
the  vulva  or  anus.  During  the  War  of  the  Rebellion,  a  general  officer 
of  the  Federal  forces,  riding  in  a  fog  up  to  a  picket,  discovered  it  to  be 
the  enemy.  He  wheeled  his  horse,  and  leaning  down  on  him  as  far  as 
possible,  drove  in  the  spurs.  The  picket  fired  a  volley.  The  general's 
horse  carried  him  into  our  lines,  but  the  general  was  dead.  A  bullet  had 
entered  the  anus,  leaving  no  mark  of  its  entrance,  and  ended  its  course 
in  the  thorax. 


254  A   SYSTEM  OF  LEGAL  MEDICINE. 

Marks  of  Discharge  upon  Clothing  or  Skin. — To  burn  all  the  pow- 
der used  as  an  ordinary  charge,  a  gun  would  have  to  have  a  barrel  about 
fourteen  feet  long.  The  "  flash  "  of  fire-arms  so  eloquently  written  about 
is  from  particles  or  grains  of  burning  powder  not  fully  consumed.  The 
smoke  is  from  that  part  of  the  powder  completely  burned.  It  is  clear, 
then,  that  the  burning  grains  will  cause  fire-marks  on  clothes  or  skin  if 
the  discharge  is  near  enough  to  the  body.  The  distance  the  muzzle  of 
the  piece  has  to  be  from  the  body  depends  upon  the  kind  of  arm  used, 
its  caliber  and  charge.  All  vary,  and  experiments  made  with  the  alleged 
weapons  are  the  only  guides  which  can  be  truly  relied  on.  In  general, 
it  may  be  said  the  muzzle  must  be  almost  touching  for  burns  of  clothing 
or  skin  to  be  present,  but  here  again  we  find  some  cloths  take  fire  more 
readily  than  others.  The  skin  is  more  uniform  in  this  particular,  and 
burning  of  it,  or  the  numerous  implantations  of  powder-marks,  shows  the 
weapon  to  have  been  held  within  a  short  distance. 

In  1883  a  man  named  Heigham  shot  another  to  death  in  Watertown, 
Jefferson  County.  Self-defense  was  claimed,  and  the  distance  the  weapon 
was  from  the  body  when  the  shot  was  fired  became  an  important  ques- 
tion in  the  case.  As  part  of  the  evidence  to  decide  this  question  was 
how  far  powder  would  be  imj^lanted  in  the  skin,  the  subject  was  referred 
to  Dr.  James  D.  Spencer,  of  Watertown,  one  of  the  medical  experts  for 
the  people.  The  doctor  consulted  me,  and  together  we  made  certain 
experiments  to  see  how  far  the  weapon,  described  in  the  notes  as  an 
"English  bull-dog  pistol,  self -cocking,  .32-inch  caliber,  9  grains  of  pow- 
der, 88  grains  of  lead,  made  by  Smith  &  Weston,"  would  carry  unburned 
powder  and  plant  it  in  human  cuticle.  On  the  8th  of  December,  1883, 
in  the  dissecting-room  of  the  Albany  Medical  College,  we  fired  at  a  piece 
of  skin  which  had  been  taken  from  a  fairly  fresh  subject,  and  which  is 
described  as  having  been  "  nine  inches  square,  with  cadaveric  rigidity." 
Shots  were  also  fired  at  cloth.     The  notes  say : 

Shin. 

Result. 

Flashed. 


No.  of  Shot. 

Distance. 

Direction. 

Result. 

1 
2 
3 

6  feet. 

8    " 

10    " 

Direct. 

a 

a 

Powder  too  numerous  to  count. 
25  to  30  grains.     Flashed. 
8  to  12         "                " 

Scalp  with 

Coarse  Hair. 

1 
2 
3 
4 
5 

2  feet. 

2  " 

3  " 
3    " 
3    " 

Direct. 
tt 

a 

tt 
a 

Hair  singed. 
u         a 

a           it 
it           tt 
n           it 

On  Cloth  of  Coat. 

4  feet.  Direct.  Lubricant  on  cloth  around  bullet-hole. 

Two  Cloths  over  Cotton  Shirt,  Undershirt,  and  Shin. 

5  feet.  Direct.  Lubricant  around  bullet-hole. 


2 

4 

it 

a 

a 

tt 

tt 

3 

6 

It 

it 

a 

a 

a 

4,  twice 

7 

it 

a 

tt 

a 

a 

5,      " 

8 

a 

te 

it 

a 

a 

6,  thrice 

10 

a 

tt 

tt 

n 

tt 

7,      " 

10 

a 

tt 

Original 

cloth  over 

skin  torn ;  bullet-hole ; 

no  lubricant. 

8,      " 

10 

it 

tt 

Same  as 

No. 

7. 

HOMICIDE  AND    WOUNDS. 


255 


4*  • 

A  Or 

•      •  *   *  L ' 


.   .  ••• 


•; 


'     '    •.I:'.1:'  '■■  '''.W^ilfflP'^     j       > 


0        .         '-'  '•''&» 


<Ht%  »•  ■     . 


Fig.  61.— 13  Centimeters. 


<? 


y 


-    > 


,  #  •   .    *     »  *    . 
.  « •    *  .*     .  . 


j    -      *  *     #    * 


•'•  ;;:::':'^IiL^v';:-:':.':-'-:'':' 

•••:•  •  •  .:.*■::•:••.••::..••.•  -« 


-  •    • 

»  • 


•  *   « 


»  •  4       . 


.# 


»        • 


»     •    •    • 


.  *  *  • 

» 


<*./u 


•    .  • .  . 


»    < 


Fig.  62.—  20  Centimeters. 
Powder  tattoo-marks  made  by  revolver  at  various  distances.    (Tourdes.) 


256 


A  SYSTEM  OF  LEGAL  MEDICINE. 


.:  41  %  $  A  9 


'  -  .   .     • 


«     '  *       • 

*  ■*  •  '9 


*         ■»         • 


^1.     '    .    '     / 


Fig.  63.— 30  Centimeters. 


f    'llllllllllllllllllfflllllllllfl 

Fig.  64.—  95  Centimeters. 
Powder  tattoo-marks  made  by  revolver  at  various  distances.    (Tourdea) 


HOMICIDE  AND    WOUNDS.  257 

On  December  25tli  further  experiments  were  made  in  the  same  place 
on  human  skin. 


No.  of  Shot. 

Distance. 

Direction. 

Powder-marks  and  lubricant. 

Flashed 

1 
2 
3 
4 
5 
6 

7  feet. 
6     " 
5    " 
5    " 
4    " 
3    " 

Direct. 
it 

it 

it 

a 

tt 

Too 

n 

25  to  30  powder. 
25  to  30        " 
15  to  20        " 
15  to  20        " 
i  numerous  to  count. 

it                   a 

Yes. 

it 

a 

a 
l( 

a 

7 
8 

3 

4 

n 

it 

Oblique. 
it 

tt 
n 

it                    a 
a                   a 

a 

it 

Experiments  were  then  made  as  to  powder-marks  on  cloth  in  frames 

with  canton-flannel  behind  at  the  armory  of  the  Tenth  Battalion,  N.  G. 
S.  N.  Y. 

No.  of  Shot.  Distance.  Direction.  Result. 

1  6  feet.  Oblique.  Lubricant  on  cloth  and  frame. 

O  K     a  "  a                      a                      »' 

3  4    "  "  Lubricant  on  cloth  and  frame,  and  powder-marks. 
5 

6  1  foot. 

7  6  feet.  Direct.  Lubricant  on  cloth  and  frame. 

o  c     <  i  a  a                      it                  it 

Q  <         it  It  il                                  It                             it 

i(l  q     a  a  a                    a                 a 

11  2    "  "  Lubricant  on  cloth  and  frame,  and  powder-marks. 

12  1  foot. 


o     a  a  a  a  a  a  a 

a  a  a  a  tt 


a  it  u  it  ti  it 


From  one  to  five  feet,  some  scorching. 

Fm*ther  experiments  to  determine  radius  of  powder-marks.  Paper 
was  fired  at  so  stretched  as  to  allow  of  a  smooth  surface. 

Shot  Distance.  Direction.  Radius.  Result. 

1  6  feet.  Direct.  2  feet.  Powder  too  numerous  to  count. 

2  5    "  "  2     "  "  "  " 

3  4    "  "  18  inches.  Paper  scorched. 

4  2    "  "  Most  in  12  inches.  "  " 

5  lfoot.  "  "      12      "  Paper  scorched ;  fire. 

Powder  was  driven  through  paper  in  all  experiments. 

While  these  experiments  are  valuable,  it  must  be  remembered  they 
are  the  results  of  only  one  kind  of  fire-arm.  Another  pistol  of  the  same 
caliber  but  with  a  longer  barrel  would  show  differently,  or  if  the  caliber 
were  smaller,  variations  would  be  found.  They  give,  however,  some  idea 
of  what  may  be  expected  of  fire-arms  in  general. 

Gunshot  wounds  on  the  dead  body  give  the  same  appearance  as  in 
the  living.  The  only  difference  may  be  bleeding,  for  on  the  cadaver, 
unless  the  bullet  cut  a  vein,  no  bleeding  follows  the  shot.  The  size  of 
the  wound  on  the  dead  does  not  differ  from  ones  made  in  life.  The  en- 
trances and  exits  bear  about  the  same  relation  to  each  other,  and  in  all 
other  respects,  to  give  an  opinion  only  on  the  evidence  of  the  orifices, 
without  taking  every  circumstance  obtainable  into  consideration,  would 
be  to  give  but  negative  testimony.  The  track  of  the  wound  internally  in 
the  dead  body,  unless,  as  said  before,  the  bullet  had  traversed  a  vein, 


258  ^   SYSTEM   OF  LEGAL   MEDICINE. 

would  not  give  the  same  color  from  blood-staining-  as  we  find  in  like 
wounds  before  death.  While  practice  and  care  may  make  the  distinction, 
it  is  not  one  that  can  be  considered  as  positive  proof,  although  it  may 
aid  in  the  conclusion  when  coupled  with  other  revelations  of  the  autopsy. 

Self=inflicted  Gunshot  Wounds. — To  state  that  a  given  wound  could 
not  be  made  upon  a  body  by  the  person  himself  is  to  put  one  side  the 
known  peculiarities  of  suicides.  The  most  improbable  means  as  well  as 
the  most  unexpected  methods  are  practiced  at  times  by  those  bent  on 
self-destruction.  One  fact  is  generally  present,  and  that  is,  where  deter- 
mination to  die  is  the  cause  of  inflicting  a  wound,  what  is  supposed  to 
be  a  vital  spot  is  always  chosen,  into  which  the  shot  is  discharged.  And 
the  pistol  or  gun  is  more  apt  to  be  held  near  than  to  be  fired  from  a  dis- 
tance. The  results  of  near  fire  would  then  be  present,  and,  added  to 
other  circumstances,  show  the  wound  to  have  been  self-inflicted. 

Wounds  may  be  given  with  fire-arms  which,  while  fatal,  are  entirely 
accidental.  One  often  sees  accounts  of  such  accidents  to  sportsmen,  who 
in  carelessly  handling  their  guns  receive  dangerous  or  fatal  injuries,  or 
who,  in  some  careless  way,  shoot  a  companion.  In  wounds  of  this  kind, 
while  the  wound  itself  may  have  all  the  appearance  of  being  homicidal 
and  not  accidental,  surrounding  circumstances  have  much  weight.  A 
man  found  dead  from  a  gunshot  wound  in  the  back,  murder  would  not 
be  thought  of  if  he  was  out  shooting,  and  his  gun  was  found  hanging 
in  a  hedge  or  close  by  a  fence  which  gave  evidences  of  having  been 
passed  by  the  man  himself.  Wounds  of  this  character  may  not  be  so 
close  as  to  give  burning  or  bruising,  but  attendant  proof  will  show  how 
they  came  to  be  inflicted. 

Danger  and  Severity  of  Wounds. — If  one  considers  that  any  injury 
done  to  a  human  body,  from  chances  of  inflammation  or  absorption  of 
some  septic  matter,  or  on  account  of  a  speculative  condition  of  the  wounded 
that  he  may  have  disease  of  the  kidneys,  stomach,  or  what  not,  prove  in 
time  a  dangerous  injury,  all  assailants,  no  matter  what  the  result  of  their 
assault,  should  be  confined  until  such  time  as  all  remote  danger  from 
whatever  cause  is  entirely  removed.  The  law,  however,  does  not  so  hold, 
and  medical  men  should  be  able  to  place  some  fair  limit  to  the  danger 
zone,  as  they  must  be  able  to  state  why  a  given  injury  is  dangerous  to 
life. 

Wounds  which  involve  cavities  like  the  chest  or  abdomen,  cut  large 
vessels,  cause  great  laceration  or  crushing  of  soft  tissues,  create  com- 
pound fractures  of  the  larger  bones,  contuse  or  fracture  the  skull  or 
spinal  column  so  the  nerve  tissues  are  directly  injured — in  short,  any 
wound  that  does  such  grave  harm  that  the  danger  to  life  is  imminent,  is 
one  upon  which  the  prisoner  would  be  held  until  the  issue  as  to  life  or 
death  is  decided.  It  is  well  known  that  even  slight  wounds,  cuts,  or  lac- 
erations may  be  attacked  by  erysipelas  and  the  patient  die,  but  the  "  may- 
be's  "  are  not  to  be  taken  into  consideration,  unless  the  chance  of  their 
developing  is  almost  immediate ;  the  "  is  "  is  what  must  decide  the  ques- 
tion. A  kick  or  severe  blow  to  the  abdomen  would  have  to  be  judged 
by  the  condition  of  the  patient  just  after  the  receipt  of  the  injury,  and 
the  physician  would  properly  state  that  such  an  injury,  judging  from 
the  collapsed  state  of  the  patient,  was  one  he  could  not  give  a  positive 
statement  upon  as  to  its  danger,  but  must  wait  two  or  three  days  to  de- 
termine if  internal  lesion  of  serious  character  had  not  been  done.    Here. 


HOMICIDE  AND    If 0  VXDS.  259 

then,  reasonable  time  is  taken,  and  taken  because  of  the  alarming  condi- 
tion of  the  patient  shortly  after  his  receiving  the  injury.  In  the  case  of 
a  man  suffering  concussion  of  the  brain  and  insensible,  the  surgeon  gives 
his  opinion  at  once  that  the  wound  is  dangerous  to  life.  In  the  case  of 
the  blow  to  the  abdomen,  the  patient  not  insensible,  but  evidently  badly 
hurt,  he  takes  a  reasonable  time  and  states  his  reasons  therefor. 

A  wound  may  not  be  immediately  dangerous  to  life  and  yet  be  a  seri- 
ous wounding,  one  which  may  become  dangerous  in  a  few  hours,  or  may 
not  assume  any  such  change.  Here  the  committing  magistrate  is  to  be 
guided  by  the  requirements  of  the  law,  the  doctor  merely  stating  the 
wound  is  a  serious  one,  but  if  nothing  out  of  the  ordinary  occurs,  it  is 
not  necessarily  dangerous  to  life.  The  medical  opinion  must  not  only  be 
founded  upon  the  nature  of  the  injury,  but  also  upon  the  condition  and 
history  of  the  patient,  for  what  would  only  be  a  severe  wound  in  one 
person  would  be  a  dangerous  one  in  another,  and  the  surgeon's  knowledge 
of  his  profession  enables  him  to  differentiate  between  the  two.  It  may 
be  a  difficult  and  trying  position  for  the  medical  man,  and  one  where, 
whichever  way  he  decides,  he  may  be  severely  criticised  ;  but,  "  for  this 
we  are  doctors." 

Evidence  of  Wounds,  Weapons,  and  other  Articles. — After  the 
examination  of  a  body  dead  under  circumstances  which  call  for  legal  in- 
vestigation, the  medical  examiner  has  to  make  deductions  from  all  the 
different  appearances  of  the  case  as  to  the  questions,  Was  the  death 
from  homicide,  suicide,  or  accident?  To  do  this,  everything  about  the 
body  and  the  Mounds  must  be  carefully  noted,  and  the  weight  due  each 
in  the  general  summation  carefully  balanced.  The  question  will  be 
asked,  Was  there  a  weapon  used,  and  if  so,  what  kind  of  a  weapon  ? 
This  is  to  be  answered  from  the  evidences  of  the  wound  itself,  the  cloth- 
ing, and  the  autopsy.  Where  death  is  from  an  incised  wound  the  char- 
acter of  the  cut  indicates  the  knife.  In  the  case  of  Mrs.  Budge,  ah-eady 
cited,  the  defense  claimed  her  throat  was  cut  by  the  razor  found  on  the 
bed  near  to  her  right  hand.  The  wound  was  undoubtedly  an  incised  one, 
and  it  is  described  as  being  "  on  the  right  side,  three  and.  one  half  inches 
below  the  lobe  of  the  ear ;  on  the  left  side,  about  three  and  one  quarter 
inches  below  lobe  of  ear;  four  and  one  half  inches  below  center  of  chin 
on  medium  curved  line,  severing  the  cricoid  cartilage,  oesophagus,  arteries, 
veins,  pneumo-gastric  nerves,  and  all  the  muscles  of  the  anterior  part  of 
the  neck.  Circumference  of  neck  above,  or  at  the  wound,  twelve  inches ; 
curved  length  of  cut,  five  and  one  half  inches.  Depth  of  cut  in  a  direct 
line,  two  inches  back  to  the  vertebra1,  cutting  through  the  periosteum 
and  into  the  osseous  matter  of  the  fifth  vertebra,  and  also  shaving  off  a 
lateral  portion  of  the  transverse  process  of  this  vertebra.  Skin  on  the 
right  side  cut  down  one  half  to  three  quarters  of  an  inch  lower  than 
tissue.  Tissue  on  left  side  cut  deeper  than  skin  about  one  half  to  three 
quarters  of  an  inch,  and  extending  down  into  the  muscles  external  to 
the  vertebra1,  so  that  the  skin  at  the  termination  of  the  cut  on  the  left 
side  appeared  as  if  stretched  and  rounded  instead  of  being  sharp,  or  an- 
gular. Trachea  and  tissues  retracted,  so  that  wound  gaped  about  two 
indies."  It  was  claimed  by  defense  the  death  was  suicidal,  but  the  evi- 
dence of  the  wound  puts  this  assertion  in  doubt.  It  is  to  be  noticed  on 
the  right  side  the  skin  is  cut  further  than  the  muscles,  the  incision  tails 
off  in  the  skin.     To  do  this  the  knife  must  have  been  drawn  gradually 


260  A   SYSTEM  OF  LEGAL  MEDICINE. 

from  the  cut.  On  the  right  side,  however,  the  skin  is  not  cut  as  far  as 
are  the  muscles  underneath  it  by  half  an  inch.  From  what  has  been 
said  before,  the  first  evidence  of  this  wound  would  be  that  it  started  on 
the  right  side  and  finished  on  the  left,  for  the  known  elasticity  of  the 
skin  gives  this  evidence.  It  is  divided  first  at  the  beginning  of  the  in- 
cision before  the  knife  sinks  into  deeper  tissue,  as  is  always  the  case 
unless  the  knife  be  plunged  in  at  right  angles  to  the  surface  as  deep  as  it 
is  intended  the  incision  should  be  made,  and  then  drawn  on.  At  the  left 
end  of  the  incision  we  have  the  skin  divided  less  than  the  deeper  tissues. 
It  yields  before  the  force  of  the  knife,  and  resumes  its  position  after  the 
force  is  withdrawn. 

The  wound  tells  more.  It  goes  down  to  the  backbone,  strikes  and 
shaves  off  a  portion  of  the  transverse  process  of  one  of  the  vertebra?, 
then  sinks  a  little  into  its  body ;  and  when  released  from  this  hard,  re- 
sisting substance,  suddenly  sinks  deeper  on  the  left  side  than  it  did  on 
the  right  in  the  softer  tissues,  cutting  them  beyond  where  the  skin  is 
divided.  The  evidence  of  the  wound,  clean  cut  and  evidently  made  with 
one  stroke,  points  to  strong  muscular  effort  and  a  strong-bladed  knife  as 
well.  Could  a  cut  of  this  nature  be  made  from  left  to  right,  be  made  by 
a  not  over-powerful  woman  as  she  lay  in  bed,  and  with  a  razor  ?  The 
evidence  of  the  razor  should  be  noted.  It  was  but  little  bloody,  and  not 
nicked.  Could  the  highly  tempered  blade  of  a  razor  cut  through  a  trans- 
verse process  and  into  a  vertebral  body  and  not  be  nicked  or  broken  on 
its  edge  ?  And  finally,  could  such  a  wound  be  made  by  a  razor  in  the 
manner  this  wound  was,  the  cut  to  start  on  the  left  side  ?  Would  the 
woman  have  the  strength  to  finish  such  a  cut  as  is  described  on  the  right 
side,  after  cutting  so  deeply  on  the  left?  Would  there  be  sufficient 
muscular  power  left  to  cut  a  transverse  process  after  severing  the  carotid, 
jugular,  and  pneumo-gastric  nerve  on  the  left  side  ?  All  the  evidences  of 
the  wound  and  the  alleged  weapon  point  to  another  conclusion.  The  razor 
could  not  have,  made  such  a  wound  and  remain  intact  in  cutting-edge. 
It  would  have  been  almost  impossible  to  begin  the  cut  with  a  razor  in  the 
manner  this  cut  is  described  as  found  on  the  left  side  of  the  neck.  And 
strength  could  not  have  remained  long  enough  after  the  left  wound  to 
have  made  the  right.  The  cut  clearly  started  from  right  to  left,  was 
done  by  great  force,  and  with  some  knife  strong  enough  to  stand  such 
usage.  The  evidence  presented  by  the  wound  negatives,  therefore,  the 
theory  of  suicide. 

On  August  5, 1873,  the  body  of  John  D.  Weston  was  found  dead  on  a 
farm  near  Albany,  N.  Y.  Weston  was  an  old  soldier,  who  had  lost  his 
left  arm.  Emil  Lowenstein,  who  had  been  a  friend  and  who  was  seen  in 
company  with  him,  was  arrested  as  the  one  who  had  committed  the  crime. 
The  body  not  being  found  until  two  days  after  death,  and  having  during 
that  time  been  exposed  to  the  weather,  was  pretty  well  decomposed.  The 
autopsy  was  held  on  the  8th,  and  the  following  wounds  were  discovered : 
an  incised  wound  of  throat,  about  five  inches  long,  just  above  the  thyroid 
cartilage  and  extending  two  inches  to  the  left  and  three  to  the  right  of 
the  median  line,  dividing  no  large  vessels.  No  mention  is  made  as  to 
the  edge  of  this  wound,  or  whether  it  presented  any  evidence  of  having 
been  made  from  left  to  right  or  rice  versd;  the  coroner  described  it  as 
"  fly-blown  "  when  he  was  called  to  see  the  body  where  it  lay  in  the  wood. 
Along  the  left  side  of  the  face  another  cut,  which  merely  penetrated  the 


HOMICIDE  AND    WOUNDS.  261 

skin,  and  corresponded  to  the  line  of  the  jaw.  A  trifle  to  the  left  of  the 
median  line  and  an  inch  above  the  eyebrow,  almost  in  the  center  of  the 
forehead,  was  an  oblong  opening  or  wound  which  penetrated  the  sknll, 
and  was  apparently  made  by  two  bullets.  Following  this,  two  balls  were 
found  in  the  substance  of  the  brain  far  back,  having  nearly  gone  through 
the  brain.  The  wound  of  entrance  was  a  little  more  than  half  an  inch 
in  one  direction  and  a  little  less  than  half  an  inch  in  the  other.  Another 
gunshot  wound  was  found,  about  two  inches  to  the  left  and  somewhat 
above  the  line  of  the  first  mentioned.  The  bullet  in  this  wound  did  not 
penetrate  the  cavity,  but  was  found  flattened  against  the  bone.  At  the 
termination  of  the  left  eyebrow,  internally,  a  ball  had  entered  and- pene- 
trated about  a  quarter  way  through  the  skull  wall.  Behind  and  at  lower 
edge  of  left  ear  another  bullet  wound,  which  led  downward  into  the 
muscles  of  the  neck.  In  this  case  the  ball  was  not  found.  About  two 
inches  behind  right  ear  was  another  wound,  evidently  also  from  the 
same  pistol,  and  here  the  ball  was  found  in  contact  with  the  skull  and 
more  flattened  than  the  one  before  mentioned.  On  left  side  of  chest  and 
slightly  to  the  left  and  above  the  nipple  a  small  wound,  like  a  bullet 
wound.  The  ball  for  this  was  not  found.  Its  course  was  traced,  how- 
ever, for  about  twelve  inches  downward  and  toward  the  back.  A  little 
lower  down  and  more  toward  the  center  of  the  body,  in  the  fourth 
intercostal  space,  there  was  found  another  gunshot  wound  of  entrance. 
Following  this,  the  ball  was  found  to  have  passed  through  the  heart  and 
lower  lobe  of  the  right  lung,  and  was  recovered  in  the  right  pleural  cavity. 
The  man  had  lost  his  left  arm,  it  having  been  amputated  near  to  the 
shoulder.  In  the  back  of  the  right  hand  another  bullet  wound  was  seen, 
entering  opposite  the  metacarpal  bone  of  the  middle  finger,  which  was 
broken,  and  passing  forward  to  the  base  of  the  thumb,  where  it  was 
lodged.  The  track  of  a  bullet  was  found  leading  to  the  right  upper  jaw 
from  below  and  to  the  left.  It  was  supposed  this  ball  had  entered  the 
left  side  of  the  neck  and  passed  upward,  but  neither  wound  of  entrance 
nor  ball  were  found.  From  the  amount  of  blood  in  the  chest  cavities  the 
wound  in  the  breast  was  considered  to  have  been  made  during  life.  No 
powder-marks  or  burning  of  tissue  were  present  about  any  of  the  gun- 
shot injuries. 

In  this  case  the  evidence  of  the  wounds  is  perfectly  conclusive  that 
they  were  not  self-inflicted.  While  it  is  true,  as  will  be  referred  to  fur- 
ther on,  that  wounds  of  the  heart  are  not  necessarily  immediately  fatal, 
it  is  not  compatible  with  any  theory,  even  supposing  the  deceased  had 
first  cut  his  throat,  and  then,  not  finding  that  wound  sufficient,  shot  him- 
self, he  could  have  inflicted  all  the  wounds  found  before  muscular 
power  had  deserted  him.  The  wound  through  the  heart  was  not  described 
minutely  as  to  what  part  of  that  organ  was  traversed  by  the  bullet ;  but 
it  was  so  cut  that  blood  in  large  quantities  was  poured  out,  sufficient  to 
convince  the  gentlemen  making  the  autopsy  the  wounding  had  taken 
place  during  life.  The  evidence  of  this  particular  wound  was  that  it 
was  fired  from  above  down,  and  from  left  to  right,  for  it  entered  between 
the  fourth  and  fifth  ribs,  passed  through  the  breast  and  lower  lobe  of  the 
right  lung,  being  recovered  in  the  right  pleural  cavity.  This  is  a  wound 
a  person  could  make  upon  himself,  and  there  need  be  no  evidences  of 
the  weapon  being  held  so  close  to  the  body  as  to  give  powder-marks  on 
the  skin  or  edge  of  the  wound ;  for  a  man  could  so  hold  a  pistol  of  small 


262  -4   SYSTEM  OF  LEGAL  MEDICINE. 

size — and  later  in  the  trial  evidence  was  adduced  to  prove  the  weapon 
was  of  this  sort — as  to  send  a  ball  in  this  general  direction.  The  proba- 
bilities are,  however,  against  such  a  theory,  for  it  would  be  not  only 
more  natural,  but  easier,  to  hold  the  weapon  more  at  right  angles  to  the 
chest  than  to  use  the  strained  position  such  a  shot  would  require,  the 
right  hand  being  used.  The  shot  which  entered  the  heart  might  not 
have  proved  instantly  fatal,  and  one  or  more  of  the  other  wounds  could 
have  been  made.  But  suicides  generally  strike  for  vital  points,  and  it  is 
not  compatible  with  known  laws  of  injuries  to  nerve  tissue  that  two 
shots  could  be  fired,  by  the  person  taking  his  life,  into  the  brain,  as  were 
found  in  this  case,  going  in  from  the  forehead.  One  such  bullet  would 
in  all  human  probability  produce  instant  insensibility,  and  the  hand 
would  not  have  been  able  to  give  the  second  shot.  Other  positive  evi- 
dences of  homicide  were  present.  It  has  already  been  said  the  deceased 
had  only  his  right  arm,  and  a  bullet  wound  and  the  ball  were  found  in  the 
back  of  the  right  hand.  This  would  of  itself  be  positive  evidence  of  murder, 
for  it  would  be  impossible  that  this  shot  could  have  been  self-inflicted. 

The  body  was  too  far  advanced  in  decomposition  to  decide  which 
wounds  were  made  before  or  after  death,  and  on  account  of  this  the 
evidences  to  be  deduced  from  the  incised  wound  of  the  neck  are  nil.  A 
razor  found  near  the  body,  from  its  blood-stained  condition,  was  evidently 
the  cutting  instrument.  No  pistol  was  found,  but  one  was  recovered 
from  the  prisoner  which  could  have  fired  the  bullets  taken  from  the 
body.     The  prisoner  was  convicted  and  executed. 

In  the  summer  of  1879  one  Briggs,  a  farmer  living  at  the  lower  border 
of  Albany  County,  was  arrested  for  the  killing  of  a  man  named  Woods, 
employed  by  him  as  general  utility  man  about  the  farm.  Briggs,  having 
had  his  suspicions  aroused  concerning  the  relations  of  his  wife  and 
Woods,  determined  to  investigate,  and  stating  he  would  be  away  on 
business  for  a  few  days,  left  his  farm.  He  did  go  away,  but  returned 
secretly  in  the  night,  and  entered  the  general  living-room  by  means  of  a 
window.  Off  of  this  room,  opposite  to  the  window  by  which  he  climbed 
in,  were  two  small  bedrooms,  one  of  which  was  occupied  by  Mrs.  Briggs. 
The  door  of  this  room  was  open,  and  was  also  the  nearer  to  the  door 
leading  into  the  front  hall.  The  weather  being  warm,  this  hall  was  only 
closed  at  the  house  front  by  a  sash-door  fastened  by  an  ordinary  cast-iron 
bolt,  one  inch  wide  by  one  eighth  of  an  inch  thick.  Woods'  room  was 
upstairs.  Briggs  advanced  to  about  the  center  of  the  living-room,  from 
where  he  could  command  a  view  of  the  bed  in  his  wife's  room.  Some 
slight  noise  made  by  him  caused  a  movement  by  an  occupant  of  the  bed, 
and  Briggs,  his  suspicions  now  converted  into  certainties,  raised  his 
pistol  and  fired.  Woods  sprang  from  the  bed  and  the  room,  turning 
into  the  front  hall.  Briggs  fired  another  shot,  and  then,  changing  his 
position  by  advancing  so  as  to  command  the  hall,  fired  again.  Woods 
had  by  this  time  reached  the  sash-door,  and  not  waiting  to  draw  the  bolt, 
he  threw  himself  against  the  door,  breaking  the  bolt  squarely  in  two,  and 
continued  his  flight  down  the  slight  hill  on  which  the  house  stood  to  the 
nearest  cottage,  about  one  quarter  of  a  mile  away,  where  he  fell  at  the 
door  groaning.  His  fall  and  groans  aroused  the  inmates,  who  got  up, 
opened  the  door,  and  were  considerably  surprised  to  find  a  man  without 
a  stitch  of  clothing  on  him  lying  on  their  doorstep.  Woods  was  carried 
into  the  cottage  and  put  to  bed.     On  the  third  day  he  died. 


HOMICIDE  AND    WOUNDS.  263 

The  autopsy  disclosed  the  gunshot  wounds.  One  through  the  fleshy 
part  of  the  inside  of  the  right  arm,  another  grazing  the  right  side, 
about  on  a  level  with  the  wound  in  the  arm.  Both  of  these  were  clearly 
made  from  behind  forward,  and  neither  was  a  dangerous  wound.  A 
third  wound  of  entrance,  oval  in  shape,  was  found  in  the  left  chest,  in 
the  third  intercostal  space,  penetrating  the  cavity.  On  opening  the 
chest  the  right  cavity  was  found  full  of  blood,  right  lung  compressed  to 
its  smallest  extent,  left  lung  normal.  The  track  of  the  ball  was  clearly 
marked  by  a  red  line,  and  led  to  the  pericardial  sac,  into  and  out  of  the 
right  auricle,  across  the  lower  edge  of  the  right  pleural  cavity  at  its  in- 
ternal angle,  through  the  diaphragm  into  the  liver,  which  it  traversed, 
and  was  found  lying  in  the  fat  and  areolar  tissue  near  the  gall-bladder. 
Brain  and  all  other  organs  were  healthy,  and  no  cause  of  death  except 
the  pistol  wound  was  found. 

The  evidences  here  presented  by  the  wounds  alone  were  most  im- 
portant. The  prisoner  claimed  he  had  shot  Woods  as  he  was  in  the  act 
of  rising  from  the  body  of  Mrs.  Briggs,  and  as  Woods  ran  down  the  hall 
he  had  fired  at  him  twice.  The  wounds  in  the  right  arm  and  side  were 
probably  these  last  two  shots,  they  showing  clearly  the  bullets  had  passed 
from  behind  forward.  The  fatal  wound  could  only  have  been  received 
in  two  ways,  either  as  claimed  by  the  prisoner,  he  standing  and  Woods 
nearly  horizontal,  or  from  above,  the  wounded  man  being  erect.  Of  this 
there  was  no  evidence,  there  being  no  doubt  that  Briggs  entered  the 
room  from  the  window,  and  that  he  fired  from  about  its  center.  The 
ball  nowhere  touched  bone,  was  not  upset,  showed  the  marks  of  the 
"  lands  and  grooves  "  in  the  rifling  of  the  barrel,  had  made  a  straight  line 
in  the  body,  and  gone  as  far  as  it  had  the  power.  It  was  of  .36-inch 
caliber,  the  pistol  being  a  large  one.  I  advised  the  district  attorney  that 
the  evidence  of  the  fatal  wound  substantiated  the  statement  of  the  pris- 
oner.    Briggs  was  convicted  of  manslaughter. 

Another  point  is  brought  to  notice  by  this  case.  The  bullet  cut 
through  the  heart,  and  yet,  after  receiving  what  would  generally  be  stated 
as  a  wound  which  would  be  immediately  fatal  or  at  least  would  incapac- 
itate the  recipient  from  any  strong  muscular  effort,  the  man  jumped 
from  the  bed,  ran  down  the  hall,  broke  an  iron  bolt  one  inch  wide  by  an 
eighth  thick,  ran  about  a  quarter  of  a  mile  before  falling  exhausted,  and 
then  lived  three  days  with  every  pulsation  of  the  heart  pouring  blood 
out  of  it.  There  are  plenty  of  cases  on  record  where  instant  death  did 
not  follow  a  gunshot  wound  of  the  heart,  but  I  do  not  know  of  one  where 
after  being  wounded  by  such  a  large  bullet  the  injured  person  did  so 
much.  It  leads  one  to  be  careful  in  pronouncing  a  decided  opinion  on 
such  a  wound  as  to  its  being  instantly  fatal.  It  certainly  is  one  which 
in  many  would  be  so ;  but  all  considerations  must  be  taken  into  account, 
as  well  as  the  extent  and  character  of  the  wounding,  before  definite  ex 
cathedra  statements  are  made. 

Another  death  from  gunshot  injury  was  that  of  Mrs.  Jesse  Billings, 
who,  while  sitting  sewing  opposite  a  window,  was  killed  by  a  bullet  fired 
from  outside  of  the  house,  and  which  entered  her  head  but  did  not  go 
out  of  it.  Her  husband  was  arrested  for  the  murder  and  twice  tried,  the 
jury  disagreeing  in  the  first  and  acquitting  in  the  second.  The  time  was 
the  evening  of  the  5th  of  June,  1878.  She  was  sitting  with  her  left  side 
toward  the  window  and  about  three  feet  from  it,  the  lamp  on  the  table 


-204  A   SYSTEM  OF  LEGAL  MEDICINE. 

was  burning,  and  the  window-shade  was  up.  As  soon  as  the  shot  was  fired 
she  fell  to  the  floor  dead.  The  autopsy  showed  that  the  ball  had  entered 
the  left  side  of  the  head,  about  half  an  inch  above  the  opening  of  the  ear, 
had  plowed  its  way  across  the  base  of  the  skull  to  the  opposite  side,  where 
it  caused  a  triangular  fracture  of  the  mastoid  portion  of  the  right  tem- 
poral bone,  forcing  this  through  the  skin  so  the  fragment  protruded.  The 
ball  stayed  in  the  skull  at  the  base  of  this  triangular  fragment,  and  partly 
buried  in  the  posterior  surface  of  the  right  petrous  portion.  The  autopsy 
was  carried  no  further  than  the  head,  but  as  certain  questions  concerning 
the  size  of  the  bullet  and  its  action  upon  the  skull  came  up  in  the  first 
trial,  the  body  was  raised  and  head  removed  that  more  careful  examina- 
tion could  be  made  of  it.  The  case  was  evidently  one  of  murder,  and 
many  questions  relating  to  the  killing  and  in  connection  with  the  weapon 
which  the  people  claimed  was  the  one  used  were  relegated  to  the  medical 
witnesses.  It  was  claimed  by  the  defense  that  the  ball  would  have  gone 
through  the  head  if  it  had  been  fired  from  the  rifle  or  carbine  the  people 
put  in  evidence.  It  was  thought  some  little  retarding  of  the  bullet  might 
have  been  caused  by  its  first  going  through  the  window-pane,  and  an- 
other point  raised  by  the  defense  was  that  the  weapon  could  not  carry 
unexploded  powder  a  greater  distance  than  one  foot,  and  at  this  distance 
the  moving  body  of  gases  of  the  discharge  would  blow  the  window-glass 
from  its  frame :  hence  this  point.  Another  apparently  strange  fact  was 
that  the  hole  in  the  glass  through  which  the  bullet  had  passed  was  enough 
smaller  than  the  caliber  of  the  gun  (.44  inch)  as  to  prevent  an  unfired  ball 
going  through  without  breaking  off  the  edge  of  orifice. 

All  these  questions  were  acted  upon  by  the  medical  men  engaged  on 
both  sides,  for  the  answers  had  to  do  with  the  wound  found  in  the  head 
•of  Mrs.  Billings.  The  evidence  of  the  wound  itself  was  that  a  weapon 
of  forceful  fire  and  large  caliber  had  made  the  injury.  The  ball,  at  least 
so  much  of  it  as  was  found  in  the  head,  weighed  but  165  gr.,  while  an 
unfired  ball  of  the  cartridge  used  in  the  carbine  weighed  220  gr.,  and  the 
recovered  bullet  was  very  much  upset.  From  the  wound  and  the  ball 
found  it  was  evident  that  pistol  or  rifle  had  been  used,  for  a  smooth  bore 
was  out  of  the  question,  lines  showing  the  impress  of  the  lands  and 
grooves  of  the  barrel  being  found  upon  the  bullet.  The  district  attorney 
wished  two  questions  definitely  answered,  and  these  were,  What  effect 
would  the  ball  have  upon  the  bone  ?  and,  What  the  bone  upon  the  ball  ? 
To  decide  these  it  was  considered  necessary,  supposing  the  carbine  to  be 
the  weapon,  to  know  what  force  a  ball  fired  from  it  would  have,  for  the 
ball  did  not  go  out  of  the  head.  The  piece  was  therefore  tested  at  the 
United  States  Arsenal  at  Springfield,  Mass.,  permission  to  do  so  having 
been  obtained  from  the  war  department.  It  proved  to  be  a  weapon  of 
low  velocity,  the  mean  being  998.8  ft.  per  second.  This  brought  the 
energy  of  the  ball  down  to  521.1  foot-pounds,  or  about  half  what  it  would 
have  been  had  the  velocity  been  up  to  that  of  an  ordinary  rifle,  as  stated 
by  the  defendant's  experts  to  be — about  1300  to  1400  ft.  per  second.  The 
force  of  the  bullet  was  not  so  very  much  more  than  a  ball  fired  from  an 
army  revolver.  And  the  force  being  found  so  much  less  than  was  ex- 
pected, the  stopping  of  the  bullet  in  the  head  was  not  such  a  mystery, 
especially  when  the  thickness  of  the  skull  was  taken  into  account  (and  it 
was  abnormally  thick  and  dense),  and  also  the  course  of  the  ball.  Tests 
were  also  made  at  the  arsenal  to  determine  whether  the  bullet,  passing 


HOMICIDE  AND    WOUNDS. 


265 


through  glass,  lost  any  of  its  velocity.  It  was  found  that  no  appreciable 
effect  was  made  by  the  glass.  The  ball  struck  almost  its  full  diameter  on 
the  base  of  the  left  petrous  portion,  and  crumbled  this  part  of  the  tem- 
poral bone  so  but  little  of  it  could  be  recognized.  The  ball,  having  plowed 
its  way  through  this  bone,  passed  over  to  the  right  petrous  portion,  into 


Fig.  65. 

Mrs.  Billings'  skull.    Point  of  entrance 
of  ball. 


Fig.  66. 

Mrs.  Billings'  skull.    Hole  made  by  piece  of 
bone  being  driven  outwards  backwards. 


which  it  crushed  a  little,  and  expended  its  force  in  breaking  the  triangular 
piece  of  bone  from  the  mastoid  portion,  and  forcing  this  outward  through 
the  skin  and  tissues.  The  effect  the  ball  had  upon  the  bone  was  to  fract- 
ure the  skull  in  different  directions ;  but  the  most  noticeable  effect  was 
the  almost  complete  disintegration  of  the  left  petrous  portion.  This 
might  be  described  as  being  ground  up 
The  bullet  seemed  to  have  the  effect  on  it 
that  is  produced  on  the  contused  tissue 
when  the  wound  is  in  the  soft  parts,  and 
this  complete  destruction  may  partly  be 
accounted  for  by  the  somewhat  brittle 
character  of  the  petrous  portion,  it  con- 
taining hardly  any  cancellous  bone.  It 
yielded,  therefore,  more  readily  to  a  sud- 
den and  forceful  contusion  or  concussion, 
and  went  all  to  pieces.  Upon  the  rest  of 
the  skull  the  action  of  the  bullet  was  what 
would  be  expected  and  is  usually  seen : 
lines  of  fracture  radiating  from  the  point 
of  contact  and  following  the  general  laws 
of  physics. 

The  action  of  the  bone  upon  the  ball 
was  to  use  up  part  of  its  lead.  The  first 
impact  with  the  bone  did  the  upsetting, 
but  its  having  to  plow  through  such  fine, 

sharp  particles  as  the  fracture  reduced  the  petrous  portion  to,  caused 
more  loss  of  substance  than  would  appear  reasonable  if  it  could  not  be 
shown  by  other  experiments  to  be  probable.  We  may  assume  the  ball  to 
have  been  of  220  gr.  weight  before  firing.  It  was  1G5  gr.  when  found  in 
the  head.  To  see  what  effect  might  be  had  upon  a  bullet  following  as 
nearly  as  possible  the  track  of  this  one,  I  made  six  experiments  of  shoot- 


Fig.  67. 


266 


A    SYSTEM  OF  LEGAL  MEDICINE. 


ing  at  cadavers,  and  then  examining  the  heads  afterward,  care  being 
taken  to  recover  every  particle  of  lead  possible.     In  the  last  of  the  series 


Fig.  68. 


Sixth  shot.     Experiments  on  skulls. 


Fig.  69. 


the  bullet  followed  more  nearly  the  track  of  the  Billings  ball.     The  sub- 
ject was  badly  decayed,  and  the  skull  old  and  very  thin.     But  the  ball 

struck  the  base  of  the  left  petrous  portion 
fairly,  and  had  but  strength  enough  to  fall 
out  of  the  head,  on  the  right  side,  upon  the 
table,  and  then  roll  to  the  floor.  I  give  the 
record  of  this  experiment,  as  made  at  the 
time.  Sixth  shot,  no  glass,  distance  ten  feet 
from  subject : 


Weight  of  ball 

Weight  of  ball  recovered 159.291  gr. 

Weight  of  lead  found 000.000  " 

Total  weight  of  lead  recovered    159.291  gr. 

Lows  not  found 60.709  " 


220  gr. 


Fig.  70. 


The  other  five  bullets  lost  anywhere  from 
3.975  gr.  to  50.557  gr.,  and  by  loss  I  mean 
total  loss,  the  lead  not  being  found  even  in 
small  particles.  But  in  none  of  the  first  five 
experiments  did  tile  bullet  follow  the  line  of 
the  Billings  ball,  and  nowhere  do  we  find  an 
equal  amount  of  weight  lost  until  the  experiment  quoted  where  the  pe- 
trous portion  was  traversed  by  the  bullet.  These  experiments  then  proved 
that  the  ball  taken  from  Mrs.  Billings'  head  could  have  weighed  220  gr. 
before  being  fired,  and  proved  further  that  for  such  a  bullet  to  lose  as 
much  as  was  the  case  in  the  Billings  ball,  it  would  have  to  travel  through 
considerable  bone,  which  would  cause  enough  attrition  to  reduce  its 
weight. 

But  these  two  questions  out  of  the  way,  and  the  third  one  of  the  gun 
being  of  comparatively  low  force,  how  could  the  bullet  be  for  a  weapon 
of  .44-inch  caliber  when  the  hole  through  the  window-pane  would  not 
admit  of  such  a  ball  passing  through  it  ?     This  was  answered  by  a  num- 


HOMICIDE  AND    WOUNDS.  267 

ber  of  experiments,  firing  at  glass  set  in  sashes,  both  glass  and  sash 
being  similar  in  size  and  weight  to  the  window  through  which  the  fatal 
bullet  had  gone.  The  notes  show  for  these  tests  the  following :  "  Ballard 
carbine,  old  style,  .44-inch  caliber,  long  cartridge,  220  gr.  lead,  28  gr.  pow- 
der. Experiments  made  May  8th  and  10th,  1880,  in  the  Tenth  Regiment 
Armory,  Albany,  N.  Y.  Shots  fired  through  glass  set  in  sashes:  glass, 
28  x  13i  in.,  double  thick,  American  make."  The  distance  from  muzzle 
to  glass  was  generally  ten  feet,  but  other  distances  were  tried,  from 
seventy  feet  down  to  two.  At  the  last  distance  the  glass  was  blown  out 
of  the  frame.     As  a  summary  the  notes  state : 

Balls  unable  to  pass 1 

Balls  barely  passed 3 

Balls  passed  18 

Cartridges  passed 21 

Glasses  blown  out 2 

Total 45 

From  these  tests,  in  forty-five  shots  one  hole  in  the  glass  would  not 
permit  an  unfired  ball  to  go  through  without  further  fracture.  The  force 
with  which  a  bullet  strikes  a  pane  of  glass  acts  precisely  as  it  does  on 
the  tissue  when  it  enters  or  wounds  the  soft  parts  of  the  body.  It  dis- 
integrates by  the  concussion  the  part  struck.  So  in  the  glass  the  action 
is  so  rapid  that  the  part  struck  is  punched  out  before  it  has  time  to  call  on 
the  surrounding  parts  for  help.  And  the  glass  yields  a  trifle  to  the  force, 
resuming  its  natural  position  after  the  momentum  has  passed  on.  Again, 
the  temperature  of  the  air  and  its  humidity  have  something  to  do  with 
the  glass  yielding.  Another  piece  of  evidence  then  in  the  case  under 
discussion  was  shown  to  prove  that  the  carbine  could  have  been  the 
weapon. 

It  was  claimed  by  the  defense  that  the  gun  could  not  carry  uncon- 
sumed  powder  farther  than  one  or  one  and  a  half  feet.  It  should,  Ik  >  w- 
ever,  be  borne  in  mind  that  in  fixed  ammunition  the  bullet  is  driven  into 
the  cartridge  directly  upon  the  powder,  and  generally  the  heel  of  the  ball 
is  greased  before  being  put  into  the  shell.  As  long  as  that  grease  holds 
on  to  the  ball,  just  so  long  may  a  grain  or  two  of  powder  cling  to  it  and 
be  carried  great  distances.  As  the  firing  experiments  at  glass  had  proved 
that  within  the  distance  of  two  feet  the  gases  would  shatter  the  glass,  it 
would  have  been  impossible  for  the  carbine  to  have  been  the  weapon,  if 
it  could  only  carry  unburned  powder  one  foot,  and  powder  or  marks  of 
powder  were  found  in  the  window-sash.  To  determine  this  question 
more  experiments  were  made.  Seven  boards,  of  about  fourteen  inches 
by  ten  inches,  were  fired  at  with  the  carbine,  the  distances  from  the 
muzzle  being  from  ten  feet  to  two  feet.  The  boards  were  produced  in 
court,  and  tests  then  made  of  what  was  supposed  to  be  powder  implanted 
in  them.  The  suspected  grains  were  picked  out  and  put  on  a  piece  of 
glass.  A  platinum  wire-point,  heated  by  a  galvano-cautery  battery,  was 
brought  in  contact  with  the  grain  on  the  glass.  From  eight  feet  down 
to  two  distinct  flash  and  smoke  were  elicited,  showing  the  grains  to  be 
powder.  At  ten  feet  no  rlasli  could  be  gotten,  but  the  marks  were  con- 
sidered to  be  those  of  powder.  The  experiments  were,  however,  proof 
that  the  carbine  could  have  been  the  weapon,  for  at  eight  feet  the  window- 


268 


A   SYSTEM  OF  LEGAL  MEDICINE. 


pane  would  not  have  been  blown  out  by  the  discharge,  and  the  gun  could 
implant  unburned  powder  into  boards  that  far  from  its  muzzle. 

The  evidence  of  the  wound,  therefore,  was  in  support  of  the  proper 
claim  that  the  carbine  shown  by  the  testimony  to  belong  to  the  prisoner, 
and  which  had  been  hidden  in  an  old  well  on  his  farm,  could  have  been 
and  probably  was  the  weapon  with  which  the  crime  was  committed. 
But  as  said  before,  when  speaking  of  the  nearness  of  the  muzzle  to  the 
gunshot  wound  found,  the  fact  that  it  might  have  been  the  weapon  was 
only  conclusively  shown  by  the  various  experiments  made  with  it. 

In  1881,  in  Herkimer  County,  a  boy  named  Klock,  of  sixteen  years 
of  age,  shot  and  killed  a  man  in  a  barn.  The  ball  entered  the  chest 
cavity  and  caused  death  by  hemorrhage,  the  pulmonary  vein  being  cut. 
He  was  tried  for  the  crime  of  murder,  and  set  up  self-defense  as  the 
reason  of  the  killing,  claiming  the  man  was  about  to  attack  him,  when  he 
drew  his  pistol,  stretched  his  arm  to  full  length,  so  that  the  muzzle  almost 
touched  his  assailant's  body,  and  pulled  the  trigger.  The  truth  of  this 
story  was  at  first  doubted,  and  the  district  attorney  wished  to  know  how 
near  the  muzzle  of  the  pistol  had  to  be  in  order  to  scorch  the  clothes. 
The  pistol  was  a  small  one  of  .22-inch  caliber.  Tests  were  made,  part  of 
the  man's  coat  and  waistcoat  being  used,  and  some  cotton  cloth  similar 
to  the  shirt  worn  by  him.  It  was  found  that  the  cloth  would  not  singe 
beyond  a  distance  of  two  to  three  inches,  but  at  this  distance  the  cotton 
would  be  set  on  fire.  As  the  waistcoat  was  singed,  it  showed  that  the 
boy's  story  of  the  nearness  of  the  weapon  was  true,  and  other  evidence 
in  the  way  of  direct  proof  of  the  attack  by  the  deceased  being  produced, 
the  lad  was  convicted  of  manslaughter  and  sentenced  for  four  years.     In 

this  case,  if  tests  had  been  made 
on  other  clothes,  it  might  have 
led  to  the  giving  of  improper 
testimony,  for  the  waistcoat 
was  woolen  fabric,  and  it  did 
not  take  fire  so  readily  as  the 
cotton.  To  rely  on  the  cotton 
alone  would  have  been  im- 
proper. 

In  1880,  on  Christmas  day, 
I  was  summoned  to  Mechan- 
icsville,  Saratoga  County,  to 
hold  an  autopsy  on  the  body 
of  a  man  supposed  to  have 
been  murdered.  External  ex- 
amination showed  a  badly 
contused  wound  over  the  right 
temple.  No  fracture  could 
be  detected.  On  autopsy  a 
fracture  was  found  opposite 
the  contusion,  which  had  al- 
lowed the  inner  table  of  the 
skull  to  cut  the  middle  menin- 
geal artery,  and  a  large  clot  of 
blood  was  effused  between  the  bone  and  membranes,  causing  such  severe 
pressure  that  the  brain  did  not  resume  its  natural  form  after  the  clot  was 


Fig.  71.— Mechanicsville  Case. 

Blood-clot  from  right  middle  meningeal  artery 
effused  between  bone  and  dura  mater. 


HOMICIDE  AND    WOUNDS.  269 

removed.  No  other  mark  of  violence  or  other  cause  of  death  was  found 
by  a  full  examination.  All  the  organs  were  healthy.  The  wound  had 
•evidently  been  made  by  one  blow,  and  with  a  rounded  sort  of  weapon. 
A  piece  of  pine  board,  live  eighths  of  an  inch  thick,  about  ten  feet  long, 
And  four  and  a  half  inches  wide,  was  sirpposed  to  be  the  weapon  which 
had  been  used.  It  appeared  rather  doubtful  if  one  blow  from  such  a 
weapon  could  do  such  an  injury,  and  the  absence  of  laceration  did  not 
.seem  likely  with  the  sharp  edges  of  the  board.  Still,  for  want  of  a 
better,  it  might  have  been  the  weapon.  Examination  of  the  room  where 
the  murder  was  committed  showed  a  low  ceiling  of  not  over  seven  to 
•eight  feet.  There  was  evidence  to  show  that  the  two  men  had  been  quar- 
reling and  were  standing  up  when  the  blow  was  struck.  If  this  evidence 
was  true,  force  enough  could  not  have  been  given  with  the  board  pro- 
duced to  have  resulted  in  such  an  injury.  Searching  brought  to  light  a 
piece  of  log,  cut  so  that  two  limbs,  short,  led  from  the  trunk,  and  which 
had  been  used  as  a  boot- jack.  Tins  was  a  hickory  or  ash  log,  still  had 
the  bark  on,  and  was  heavy.  One  arm  of  the  boot-jack  made  a  conven- 
ient handle,  and  with  such  a  weapon  it  did  not  need  height  of  ceiling  to 
get  full  arm-swing  so  as  to  deliver  a  blow  that  woidd  produce  the  condi- 
tion found  at  the  autopsy.  I  was  inclined  to  look  on  it  as  the  more  prob- 
able weapon,  but  the  case  never  came  to  trial,  the  assailant  being  arrested 
in  Pennsylvania  and  committing  suicide  in  his  cell.  The  evidence  pre- 
sented by  the  wound  was  such  as  to  call  for  more  examination  of  the 
scene  of  the  murder  than  had  been  made,  for  while  it  was  homicide  from 
the  fact  that  the  quarrel  had  been  heard  taking  place  and  the  suspected 
man  had  fled,  the  nature  of  the  injury  was  not  compatible  with  the  weapon 
that  was  at  first  supposed  to  have  been  the  one  used. 

In  May,  1885,  a  woman  was  found  dead  in  the  yard  of  the  house 
where  she  lived,  in  the  village  of  Fort  Edward,  lying  on  her  face,  and 
with  marks  of  violence  on  head  and  other  parts  of  her  body,  with  evi- 
dence of  a  struggle,  from  the  torn  clothing.  The  autopsy  disclosed  sev- 
eral severe  contusions  and  some  laceration  on  left  side  and  back  of  head. 
Also  contusions  on  arms,  and  some  on  trunk.  The  dress  was  torn  in 
front.  On  opening  the  body,  lungs  were  found  to  be  congested.  Heart 
was  fairly  healthy,  right  ventricle  empty,  left  also,  but  fluid  blood  ran 
from  right  auricle  into  the  right  ventricle.  The  stomach  gave  appear- 
ances of  free  indulgence  in  alcoholic  liquors.  The  spleen,  liver,  kidneys, 
and  pancreas  were  all  congested,  the  blood  being  dark  and  fluid.  A 
small  ecehymosis  was  found  on  some  of  the  small  intestines.  Brain  was 
congested.  Clots  were  found  under  the  larger  contusions  in  the  head, 
but  not  fractures.  It  was  stated  by  the  district  attorney  that  the  evi- 
dence he  had  showed  a  drunken  fight  between  the  woman  and  her  hus- 
band, both  being  intoxicated,  that  she  was  struck  with  a  revolver  butt  in 
the  hands  of  the  man,  and  that  she  was  last  seen  alive  walking  toward 
the  outhouse  in  the  yard,  near  which  she  was  found  in  the  morning. 
Some  sand  in  the  nostrils  and  mouth  led  to  further  question.  It 
appeared  that  she  had  fallen,  as  she  staggered  when  walking,  and  when 
found  her  face  lay  in  a  sand-heap  which  was  near  the  outhouse.  It 
rained  a  little  in  the  night,  and  the  sand  was  wet  as  well  as  her  clothing. 
The  husband  was  under  arrest.  The  autopsy  was  thirteen  hours  after 
death,  and  rigor  mortis  was  well  marked. 

While  the  evidences  of  the  different  wounds  showed  a  severe  beat- 


270  ^    SYSTEM  OF  LEGAL  MEDICINE. 

ing,  none  of  them  could  be  considered  mortal  or  dangerous  to  life.  Even 
the  main  contusion  over  the  right  temple,  which  when  received  knocked 
her  down,  was  not  necessarily  a  fatal  injury.  The  appearances  of  the 
internal  organ,  however,  and  the  position  the  body  was  found  in,  face 
downward  in  the  sand,  showed  death  was  from  asphyxiation,  and  not 
from  the  injuries.  The  coroner's  jury  so  found,  and  the  man  was  re- 
leased. 

On  March  4,  1879,  Mr.  W.  J.  Hadley,  a  prominent  lawyer  in  Albany, 
N.  Y.,  was  stabbed  twice  by  a  man  named  John  Hughes.  The  trial  was 
held  at  the  Oyer  and  Terminer  in  March,  1880,  and  resulted  in  a  verdict 
of  murder  in  the  second  degree.  The  assault  was  made  in  Mr.  Hadley's 
office  in  the  morning,  and  from  there  he  was  removed  to  his  home,  where 
he  died  from  the  effects  of  the  wounding  late  in  April.  The  wounds 
were  described  as  incised  wounds,  one  penetrating  between  the  bones  of 
the  left  forearm  a  little  below  its  center,  going  completely  through,  and 
another  in  the  right  side  over  the  short  ribs,  about  two  and  a  half  inches 
to  the  right  of  the  median  line,  its  direction  being  downward  and  back- 
ward for  about  an  inch  and  a  half.  The  wound  penetrated  about  four 
inches.  It  had  not  entered  the  abdominal  cavity.  Blood  was  freely 
scattered  about  the  office  and  on  the  clothing. 

The  patient  was  sixty-five  years  of  age.  The  blow  making  the  stab 
on  the  right  side  was  so  severe  as  to  separate  the  cartilage  of  the  seventh 
rib  from  the  bone,  but  no  displacement  took  place  at  first.  The  prisoner 
was  a  one-armed  man,  and,  as  is  usual  in  such  cases,  the  one  arm  having' 
to  do  the  work  of  two,  it  was  much  stronger  than  had  he  had  the  normal 
number  of  limbs.  The  force  of  the  blow,  therefore,  was  greater  and 
without  any  apparent  increase  of  muscular  action  to  those  who  saw  it 
struck.  The  patient  was  of  highly  nervous  temperament  and  compara- 
tively little  muscular  strength.  He  was  a  well  man,  however,  not  having' 
any  organic  disease ;  but  the  fact  of  his  having  been  struck  down  in  the 
way  he  was,  by  a  client  who  was  demanding  money  of  him,  was  a  nervous 
shock,  from  which  he  at  no  time  recovered.  He  rallied  from  the  physi- 
cal  shock  the  night  of  the  assault.  Pya?mic  abscesses  formed  on  forearm 
and  side,  and  the  autopsy  disclosed  a  circumscribed  peritonitis  around 
the  liver,  the  necrosed  end  of  the  cartilage  having  cut  through  the 
parietes,  and  by  pressure  brought  on  an  ulceration  of  the  liver  and  the 
attendant  inflammation.  Death  was  caused  by  exhaustion  due  to  this 
blood-poisoning  from  the  suppurating  wounds. 

The  evidence  of  the  wounds  themselves  was  that  they  were  made  by 
some  sharp  instrument,  were  stab-wounds,  and  were  made  with  force. 
The  evidence  from  the  autopsy  was  clear  that  death  had  resulted  as  a 
sequence  of  the  wounding,  for  all  the  organs  were  found  in  good  condi- 
tion. The  peculiar  effect  of  the  patient's  mental  condition  is  to  be  noted 
in  the  case.  Had  such  wounds  been  inflicted  on  a  strong,  ordinary  man, 
the  chances  are  they  would  not  have  proved  fatal  and  troublesome. 
Sepsis  might  certainly  follow,  as  in  this  case,  for  the  knife-blade  could 
carry  septic  material  with  it  when  making  the  wounds,  and  in  Mr.  Had- 
ley's case  very  likely  did.  But  even  then,  if  the  wounds  had  been  upon 
one  whose  mental  shock,  if  such  a  term  may  be  used,  had  not  been  so 
great,  they  were  not  wounds  that  would  be  considered  more  than  dan- 
gerous. Here,  however,  the  patient  never  rallied  his  general  mental  tone. 
And  nothing  could  arouse  him.     He  objected  to  the  taking  of  food,  and 


HOMICIDE  AND    WOUNDS.  271 

in  every  way  was  passive.  That  this  was  the  condition  was  of  course  no 
palliation  to  the  crime.  The  intent  to  do  injury  was  shown  by  the  as- 
sault, and  that  the  assatdt  proved  more  severe  than  was  intended  by  the 
prisoner  was  no  mitigation  of  it. 

In  1878,  in  Albany,  N.  Y.,  a  man  named  Mallon  shot  his  wife,  killing 
her  instantly.  The  weapon  used  was  an  old-style  Springfield  rifle,  one 
Mallon  had  carried  in  the  war,  and  it  was  loaded  with  buckshot  and 
slugs.  The  shooting  was  in  a  narrow  hall  of  the  home  they  lived  in,  and 
the  walls  and  ceiling  were  marked  with  blood  and  tissue,  which  the  near 
discharge  of  the  gun  had  blown  over  them.  A  door  behind  Mrs.  Mallon 
was  pierced  in  several  places  by  the  missiles  that  went  by  her.  Mallon 
was  indicted  for  murder,  but  a  miscarriage  of  justice  brought  in  a  verdict 
of  manslaughter  in  the  third  degree. 

I  did  not  see  the  wounds,  and  therefore  in  that  particular  can  only 
speak  from  hearsay,  for  the  records  of  the  autopsy  were  destroyed  by  a 
fire  which  burned  the  city  hall.  The  majority  of  the  wounds  were  in  the 
chest  on  the  right  side,  some,  however,  penetrating  the  abdomen,  and 
the  right  arm  and  forearm  also  suffered  severely.  While,  on  account  of 
the  loss  of  the  records,  the  full  evidence  to  be  drawn  from  the  wounds 
cannot  be  commented  on,  the  evidence  as  to  the  position  of  the  woman 
when  shot  was  clearly  shown  by  the  manner  in  which  blood  and  tissue 
were  thrown  on  the  surrounding  walls.  The  defense  claimed,  and,  by 
the  verdict  of  the  jury,  apparently  established,  that  the  gun  was  accident- 
ally discharged,  and  the  wounding  was  from  the  front  of  the  hall  and 
not  the  back.  But  if  this  was  the  fact,  then  it  was  hard  to  explain  why 
all  the  blood-stains  on  the  wall  were  evidently  and  absolutely  in  the 
opposite  direction.  As  will  be  referred  to  later  on,  the  manner  in  which 
blood  strikes  a  wall  is  indicative  of  the  directing  force.  And  in  the  same 
manner,  if  tissue  is  by  a  tearing  discharge  thrown  on  a  wall  or  any  other 
surface,  the  mark  it  makes  is  a  slight  guide  to  the  direction  it  came  from. 
It  is  a  positive  rule  in  the  giving  of  evidence  that  the  medical  witness 
exhaust  every  means  to  assure  himself  that  but  one  statement  can  be 
made  about  any  given  condition  he  has  to  pass  upon.  It  has  already 
been  said,  as  a  caution  to  medical  witnesses,  that  it  is  the  better  part 
when  giving  testimony  not  to  be  too  minute,  but  to — having  the  fullest 
of  notes  and  examinations — condense  many  things  into  one  general  state- 
ment. The  part  I  played  in  this  trial  emphasizes  this  advice,  and  is  here 
given  for  that  object.  A  piece  of  ceiling-plaster,  without  paper  on  it, 
but  having  in  its  center  a  dark,  dried,  and  blackish-appearing  lump,  was 
brought  me  from  the  district  attorney  with  the  request  that  I  would  tell 
him  what  the  black  stuff  was.  The  officer's  directions  were  to  say  noth- 
ing further.  Sections  being  made,  the  microscope  disclosed  the  fact  that 
this  dried  mass  was  human,  voluntary  muscle.  But  as  a  man  was  on 
trial  for  his  life,  and  the  specimen  was  shriveled  beyond  any  possible 
recognition,  except  by  microscopic  examination,  I  made  further  tests,  tak- 
ing at  the  market  specimens  of  beef,  mutton,  and  pork,  and  from  the 
dissecting-room  voluntary  and  involuntary  muscular  fibers  from  old  and 
fresh  subjects.  The  result  of  all  examination  was  the  positive  conclusion 
that  the  specimen  could  be  nothing  else  than  a  piece  of  voluntary  muscle 
from  a  human  being.  Reporting  the  results  of  the  examinations  to  the 
district  attorney,  he  asked  that  I  state  them  to  the  jury  in  "  plain  Eng- 
lish."    This  was  done.     After  the  verdict  was  rendered — and  if  the  evi- 


272  A   SYSTEM  OF  LEGAL  MEDICINE. 

dence  of  this  piece  of  tissue  and  of  other  blood-stains  was  correct,  the 
woman  could  not  have  been  where  the  defense  claimed  she  was — the 
prosecuting  officer  asked  one  of  the  jurymen  how  he  came  to  render  such 
a  verdict ;  did  he  not  believe  the  evidence  of  the  doctor  ?  The  reply  was 
made :  "  Wall,  if  that  'ere  fellow  had  a-knowed  what  he  was  about  he 
wouldn't  have  taken  so  durned  much  trouble  !  "  It  was  a  lesson  to  me 
that  the  ordinary  juryman  does  not  appreciate  the  reason  why  every  test 
is  made,  but  only  looks  at  the  general  result. 

Where  the  assault  is  with  a  cutting  weapon,  and  vessels  are  severed 
so  that  spurting  follows,  there  is  chance  blood  will  be  found  upon  the 
clothes  of  the  assailant.  That  blood  is  not  found,  however,  may  be  no 
proof  that  the  prisoner  is  not  guilty  of  the  crime,  for  the  cutting  may  be 
so  done  that  no  blood  will  get  upon  his  clothes  or  person.  A  notable 
instance  of  this  is  related  by  Dr.  Taylor  in  the  murder  of  Lord  Russell, 
where  his  throat  was  cut  by  his  valet,  who  wore  no  clothing  when  com- 
mitting the  murder.  Or  the  throat,  or  wound,  whatever  it  may  be,  may 
be  cut  or  made  from  behind,  and  in  that  way  the  evidence  of  blood  upon 
the  clothes  of  the  assassin  may  be  wanting.  In  the  murder  of  Catherine 
Dunsback  by  Latrimouille,  in  Albany  County,  in  1878,  the  murder  was 
by  throat-cutting.  It  was  expected  the  clothing  of  the  prisoner  would 
show  marks  of  blood,  as  the  cutting  was  done  partly  in  front  of  the 
woman,  but  no  blood-stains  were  anywhere  traceable.  The  murderer 
wore  his  hat  at  the  time  of  the  assault.  The  hat,  coat,  waistcoat,  and 
trousers  were  all  carefully  examined,  but  no  blood  found  anywhere. 
It  transpired  later  in  the  case  that  the  prisoner  had  worn  at  the  time  of 
the  crime  a  long  gray  ulster.  What  became  of  it  no  one  knows,  for  it 
was  not  in  his  possession  at  the  time  of  his  arrest,  and  no  trace  of  it 
could  be  discovered.  This  would  lead  to  the  logical  assumption  that  this 
ulster  had  blood  on  it,  and  the  prisoner  had  destroyed  it  to  remove  the 
evidence  it  might  give.  On  other  testimony  presented,  a  verdict  of  guilty 
was  rendered,  and  the  man  executed. 

Evidence  to  be  drawn  from  Blood=stains.  (Also  consult  Blood 
and  Other  Stains.) — A  medical  examiner  should  not  only  see  and  note  all 
marks  upon  a  body  he  is  called  upon  to  inspect,  but  he  should,  where 
possible,  investigate  the  place  and  its  surroundings  where  the  suspected 
crime  had  been  committed.  And  the  clothing  worn  by  the  prisoner  at 
the  time  of  the  assault,  and  any  other  clothes  he  may  have,  should  be 
carefully  looked  over  for  the  evidence  of  stains  from  blood.  Blood, 
when  thrown  from  a  vessel,  if  it  strikes  a  wall  or  furniture  at  an  acute 
angle,  gives  such  a  mark  that  strong  inference  may  be  drawn  as  to  the 
direction  it  came  from.  Being  globular  in  form  while  in  flight,  its  first 
marking  is  a  round  splash  indicative  of  the  size  of  the  globule ;  and  this 
round  splash  tails  off  into  a  point  given  by  the  force  carrying  the  elon- 
gated globule  as  far  on  the  surface  it  impinges  against  as  circumstances 
will  permit.  Specific  gravity  plays  its  part  in  the  formation  of  the  char- 
acteristic mark.  The  stains  point  downward,  according  to  the  point  of 
the  parabola  they  have  reached  at  the  time  of  their  contact  with  the  wall 
or  furniture.  This  gives  an  idea  as  to  the  distance  they  may  have  come 
from,  the  size  of  the  spurting  artery  being  known.  The  tail  of  the  splash 
is  generally  the  darkest,  gravity  having  carried  the  major  portion  of  the 
blood  there,  and  consequently  the  rounded  or  upper  part  of  the  mark  is 
lighter  in  color  than  the  pointed  portion  or  final  ending. 


HOMICIDE  AND    WOUNDS.  273 

The  manner  in  which  blood  flows  from  a  wound  should  also  be 
noticed.  As  a  general  rule  the  greatest  amount  of  blood  will  be  seen 
near  to  the  wounds  themselves,  especially  if  the  patient  has  lain  quiet 
after  the  wounding.  It  should  be  remembered,  however,  that  persons 
dying  from  hemorrhage  become  very  restless,  move  about,  or  try  to  do 
so,  unless  the  wound  is  such  that  motion  is  prevented  by  the  rapidity 
with  which  life  is  lost.  Consequently  the  largest  spot  of  blood  may  be 
at  a  distance  from  the  bod}-,  and  be  only  indicative  of  where  the  wound- 
ing first  took  place.  In  November,  1870,  a  man  cut  his  throat  in  a  hotel 
in  Burlington,  Vt.  The  fact  was  discovered  about  nine  o'clock  in  the 
morning.  Happening  to  be  in  the  house  and  hearing  the  alarm,  I  went 
up  to  the  room  and  noted  the  following:  The  man,  still  alive,  lay  on  the 
floor  about  four  feet  from  the  window  of  the  room  and  about  eight  feet 
from  the  door.  Between  him  and  the  door  there  was  a  pool  of  blood 
about  the  size  of  an  ordinary  saucer.  Another  clot  was  under  his  neck, 
not  so  large  as  the  first.  Two  more,  one  longer  than  the  first  named, 
were  between  the  body  and  the  window.  By  the  window  was  a  rocking- 
chair,  and  in  front  of  it  a  tin  pail,  about  in  the  position  one  woidd  place 
it  if  it  were  set  between  the  legs  of  one  sitting  in  the  chair.  Blood  was 
in  the  pail,  all  over  it,  and  on  the  carpet.  Here,  evidently,  the  greatest 
amount  of  blood  was  lost,  and  here  the  suicide  had  cut  his  throat,  intend- 
ing to  bleed  quietly  into  the  pail ;  but  nature  was  not  to  be  denied,  and 
he  moved  about,  bleeding  a  while  here  and  there  until  he  fell  exhausted. 
All  hemorrhage  had  ceased  when  he  was  found.  In  the  slop-pail  was 
found  the  razor  with  which  the  wound  was  inflicted.  These  points  hav- 
ing been  rapidly  noted,  the  man  was  put  on  the  bed  and  the  wound  ex- 
amined. The  cut  was  not  deep,  did  not  involve  either  carotid,  was  be- 
tween the  cricoid  and  thyroid  cartilages,  and  the  only  vessel  that  could 
be  found  severed  was  the  cricoid-thyroid  artery.  How  such  an  amount 
of  blood  could  have  come  from  this  small  vessel  seemed  a  mystery,  but 
there  was  no  other  wound,  and  no  other  place  from  which  the  blood 
could  have  come.  Death  resulted  in  the  evening,  the  man  not  rallying 
from  the  shock  and  loss  of  blood.  Blood  was  on  his  right  hand  and 
some  on  the  left.  The  clothes  were  bloody  in  different  places,  noticeably 
in  front,  and  it  was  concluded  that  the  other  blood-stains  were  probably 
gotten  when  he  fell  and  tried  to  get  up,  falling  and  rolling  over,  until 
he  lay  quiet  in  the  position  he  was  found  in. 

The  evidence  of  the  blood-stains  in  the  Budge  case,  before  quoted, 
were  very  marked.  From  the  large  wound,  cutting  all  the  great  vessels 
of  the  neck,  blood  only  flowed  down  by  gravity  on  both  sides  of  the 
neck  into  the  feather-bed  underneath.  A  few  sprinkles  of  blood  were  on 
the  right  sleeve  of  the  night-dress,  a  little  blood  on  the  right  hand,  a  few 
spots  on  the  sheet,  and  bloody  marks  on  the  pillow  next  the  one  on  which 
the  woman's  head  lay.  In  all  only  about  one  quart  of  blood  had  been 
lost.  It  was  found  that  great  effort  was  made  to  stop  the  flowing  of  the 
blood,  the  doctor  stuffing  the  wound  with  cotton,  and  even  then  persistent 
oozing  was  noticed.  And  this  after  the  body  had  been  dead  for  twenty- 
four  hours.  With  no  more  blood  on  surrounding  objects  from  such  a 
wound  as  this,  the  proof  is  positive  that  the  heart  had  stopped  its  action 
when  the  cut  was  made.  Where  execution  is  by  decapitation,  the  records 
show  that  a  tremendous  spurt  of  blood  follows  the  falling  head;  it 
springs  from  the  body  like  a  jet  from  a  hose-pipe ;  and  after  that  the 


274  A   SYSTEM   OF  LEGAL    MEDICINE. 

bleeding  stops.  The  want  of  more  blood  on  the  front  of  the  body,  on 
the  hands,  the  night-dress,  the  bedclothes,  the  walls,  the  floor,  every- 
where, in  short,  that  the  action  of  the  heart  could  throw  it,  negatives  the 
claim  of  the  defense  in  this  trial  that  the  wound  was  suicidal. 

I  was  called  one  day  from  my  carriage  to  see  a  woman  who  had  cut 
her  throat.  She  did  it  in  an  outhouse,  and  used  an  ordinary  table-knife, 
which  she  sharpened  by  whetting  on  the  back  steps  of  the  house,  these 
steps  being  of  stone.  When  I  saw  the  body  it  was  in  a  heap  on  the  floor. 
Blood  was  everywhere — walls,  seat,  floor,  dress,  right  arm  and  hand. 
The  cut  had  severed  the  left  carotid.  Two  cuts  were  made :  the  first, 
superficial,  going  but  barely  deeper  than  the  skin  and  crossing  on  the 
left  cornu  of  the  hyoid  bone ;  the  second,  lower,  cutting  part  way  into 
the  trachea.  This  last  took  the  vessel  in  its  course,  and  was  carried  no 
further. 

The  manner  in  which  the  blood  flows  from  the  wound  may  be  indic- 
ative of  the  position  of  the  assailed  at  the  time  of  the  wounding.  If  the 
blood  is  down  the  front  of  the  body  from  a  cut  iu  the  throat  or  a  stab  of 
the  chest,  the  probabilities  point  to  the  erect  position  ;  while  if  it  is  toward 
the  sides  of  the  neck  or  runs  to  the  arm-pits,  the  assumption  would  be 
that  the  wounds  were  inflicted  when  the  body  was  recumbent.  In  the 
case  cited  of  the  man  who  was  hit  with  a  brick,  and  the  temporal  artery 
of  the  right  side  cut,  the  bleeding  after  the  first  spurting  of  the  vessel  was 
over  the  face  and  chest,  it  running  down  upon  the  shirt.  In  October, 
1893,  a  gentleman  was  injured  by  his  horse  falling  at  a  fence  while 
following  hounds.  One  of  the  injuries  received  was  a  cut  underneath 
the  chin.  The  cut  was  caused  by  the  chin  being  suddenly  and  violently 
driven  upon  his  collar,  which  happened  to  be  stiffly  starched.  Although 
rendered  insensible  by  the  fall,  he  was  instantly  picked  up  by  compan- 
ions, and  regained  consciousness  as  soon  as  he  was  on  his  feet ;  the  blood 
from  the  wound  had,  before  hemorrhage  ceased,  covered  his  shirt-front, 
was  liberally  sprinkled  on  coat,  waistcoat,  and  breeches.  From  the 
blood-stains  on  the  clothing  alone,  the  evidence  would  be  properly  drawn 
that  the  person  bleeding  was  in  the  erect  position,  for  the  wound  could 
not  possibly  have  sent  the  blood  where  it  was  found  had  the  man  re- 
mained on  his  back. 

The  stains  made  by  blood  upon  clothing  can  sometimes  be  made  out, 
or  rather  surmised,  long  after  they  have  been  received.  To  tell  when 
they  have  been  made  is  an  impossibility  if  the  marks  have  become  per- 
fectly dry.  A  year  or  more  after  having  in  an  operation  got  some  blood 
on  a  pair  of  trousers,  the  stain  remained,  although  it  had  been  carefully 
washed.  It  was  a  peculiar  brownish  color,  but  whether  made  by  blood 
or  not,  one  not  conversant  with  it  in  the  first  instance  could  not  state 
positively.  It  had  a  suspicious  look,  as  if  it  might  have  been  from  blood, 
but  that  is  all  that  could  be  said.  On  linen  or  cotton,  the  stuff  not 
being  colored,  a  fresh  blood-stain  gives  a  red  color,  which  soon,  however, 
changes  to  brown  ;  and  after  such  change,  and  perfect  dryness  is  present, 
the  time  when  it  was  made  cannot  be  placed,  for  but  little  further  change 
takes  place.  The  dry  blood-stain  is  hard,  giving  the  cloth  the  feeling  of 
being  starched  or  gummed  in  that  particular  spot ;  and  if  freshly  dry, 
there  is  a  glaze  over  the  spot.  If  no  attempt  has  been  made  at  washing, 
and  the  stained  part  be  rubbed  together,  a  brownish  powder  is  produced, 
which,  placed  under  the  microscope,  moistened  with  water  or  glycerine. 


HOMICIDE  AND    WOUNDS.  275 

will  show  blood-corpuscles.  That  the  stain  then  is  blood  may  be  confi- 
dently stated,  but  that  it  is  human  blood  is  another  affair.  While  it  is 
perfectly  well  known  that  the  human  blood-corpuscle  has  a  certain  aver- 
age measurement,  and  differs  from  all  other  animals  to  a  slight  degree  in 
that  measurement,  it  is  equally  well  known  that  when  the  blood  on  cloth- 
ing or  anything  else  has  had  time  to  become  perfectly  dry,  a  shrinking 
of  the  corpuscles  takes  place,  and  although  when  treated  with  water  or 
glycerine  they  resume  some  of  their  natural  shape,  still  it  is  a  mooted 
question  whether  an  expert  can  swear  positively  a  given  blood-stain  was 
produced  by  blood  from  a  human  being,  and  from  no  other  animal.  The 
medical  witness  can  say  it  is  blood  and  blood  alone  which  made  the  stain- 
ing, but  that  is  as  far  as  it  is  considered  safe  to  go.  Other  evidence 
should  be  brought  tc  show  that  there  was  no  other  source  from  which 
the  stains  could  come  than  the  wounds  proving  mortal  to  the  corpus  de- 
licti, and  as  the  medical  witness  says  confidently  the  spots  were  made  by 
blood,  the  corroborative  evidence  proves  the  blood  to  be  human,  and 
from  the  wounds  found.  In  addition  to  this  examination  chemical  tests 
should  be  used,  and  no  means  left  untried  to  prove  conclusively  that 
blood  alone  was  the  agent  making  the  discolorations. 

Blood  upon  Weapons. — The  evidence  that  a  knife  which  is  clean  of 
blade  has  been  lately  used  in  the  cutting  of  tissue  where  blood  would 
get  upon  it,  is  not  difficult  to  deduce  from  the  stains  on  the  blade,  even 
if  but  very  little  blood  had  marked  the  steel.  If,  however,  the  knife  be 
old  and  the  blade  rusty,  the  task  of  deciding  as  to  the  marks  found  hav- 
ing been  produced  by  blood  or  some  chemical  action  upon  the  metal  be- 
comes one  of  delicacy,  and  requires  more  examination  than  mere  visual  in- 
spection. The  rusting  caused  by  the  juice  of  lemons  is  at  first  sight  apt 
to  be  taken  for  blood,  and  so  close  is  the  resemblance  that  chemical  tests 
have  to  be  resorted  to  to  decide  the  question.  Stains  upon  the  blade  of 
the  weapon  are  not  always  the  only  spots  that  may  be  found,  and  every 
particle  of  the  weapon  should  be  carefully  searched  and  tested  before 
stating  no  blood  is  on  it.  Where  a  fixed  handle  is  present,  if  it  is  made 
by  two  pieces  of  wood,  bone,  or  other  substances  being  riveted  to  an  ex- 
tension of  the  blade,  the  rivets  should  be  drawn,  and  every  particle  of 
dust  or  foreign  substance  found  be  examined  in  all  the  ways  known  for 
testing  for  blood.  The  same  where  the  knife  is  a  clasp-knife.  Blood 
may  have  been  plentifully  spread  over  the  blade,  and  the  knife  carefully 
washed  by  the  criminal,  and  still  blood  be  found  in  the  cracks  under  the 
handle  pieces  in  the  hinges,  and  prove  an  important  link  in  the  chain  of 
evidence.  Fire-arms  are  not  so  apt  to  be  marked  by  blood.  They  may 
be  used,  however,  in  clubbing,  where  the  noise  of  the  discharge  would 
be  liable  to  bring  about  discovery.  The  same  condition  may  then  be 
found  as  is  noticed  where  blunt  weapons  are  used,  and  the  blows  struck 
cause  more  or  less  bleeding.  When  the  weapon  is  wood,  the  blood 
makes  its  mark  readily,  and  can  be  studied  in  the  same  way  as  blood 
upon  cutting  instruments.  If  the  bark  is  still  on  the  club  used,  then 
blood  will  be  found  clotted  in  the  interstices  of  the  bark,  and  may  be 
more  readily  detected.  The  weapon  may  be  a  stone,  and  blood  be  found 
upon  it.  In  the  trial  of  Sam  Steenbergh,  a  negro,  for  the  murder  of  one 
Palmer,  at  Fonda,  N.  Y.,  the  murder  was  proved  to  have  been  committed 
by  Steenbergh  pounding  Palmer  on  the  head  with  a  stone,  even  after  the 
body  was  upon  the  ground.    The  skull  was  crushed  and  the  scalp  broken. 


276  ^   SYSTEM  OF  LEGAL  MEDICINE. 

A  stone  having  blood  upon  it  was  found  by  the  body  and  was  the  weapon 
used,  the  wounds  being  of  such  a  nature  as  could  be  made  by  a  stone  of 
like  character.  It  was,  of  course,  but  one  part  of  the  evidence,  but  it 
filled  out  the  perfect  line  of  the  people's  case.  The  verdict  of  guilty  was 
rendered,  and  the  negro  hung. 

When  hair  is  found  clinging  to  a  weapon  it  may  become  a  factor. 
The  microscope  will  determine  what  kind  of  hair  it  is,  and  it  may  also,, 
according  to  Casper,  decide  whether  it  has  been  cut,  or  broken  by  a  blow. 
Wool  and  cotton  fibers  found  adhering  to  a  blood-stained  weapon  may 
have  the  appearance  of  hair,  but  the  magnifying-glass  proves  the  charac- 
ter and  shows  wherein  they  differ  from  human  or  animal  hair.  Taylor 
calls  attention  to  an  interesting  case  where  rabbit-fur  and  shellac  were 
found  on  a  rake,  which  had  evidently  got  on  the  rake  by  the  burning  of 
a  hat  in  which  this  fur  entered  as  one  of  the  constituents.  It  is  con- 
sidered, then,  that  the  clinging  of  hair  to  a  weapon  may  aid  in  proving  it 
the  one  used  in  the  assault ;  but  before  the  medical  witness  can  state  pos- 
itively the  hair  is  that  of  the  deceased,  he  must  make  comparisons  with 
other  hairs  taken  from  the  victim,  to  see  if  the  two  correspond ;  for  the 
hairs  of  different  persons  vary  in  size,  the  characteristics  of  the  markings 
alone  being  the  same. 

Bullets,  Shot,  and  other  Substances  in  Wounds. — Where  the 
homicide  has  been  by  gunshot  injury,  portions  of  the  dress  or  sometimes 
of  the  wadding  of  the  gun  may  be  found  in  the  wound.  Nowadays  it 
is  rather  rare  to  find  muzzle-loading  guns  in  winch  paper  or  other  sub- 
stances may  be  used  for  wads.  The  breech-loader  having  almost  uni- 
versally taken  the  place  of  the  muzzle-loading  fire-arm,  the  wads  for  the 
cartridges  are  of  so  little  cost  that  one  rarely  finds  anything  else  than  the 
machine-made  ones  used,  and  consequently  if  one  of  these  be  found  in  a 
wound,  it  merely  confirms  the  evidence  of  the  wound  itself  as  to  the 
character  of  the  gun.  It  may  be  found  entire,  or  enough  so  to  give  the 
caliber  of  the  weapon ;  but  direct  evidence  as  to  the  wad  having  been 
part  of  some  paper  or  letter  belonging  to  the  suspected  assassin  is  in 
these  days  rare  to  find. 

The  shot  taken  from  the  wound  may  have  some  bearing,  if  other 
cartridges  are  found  to  belong  to  the  prisoner  loaded  with  the  same  kind 
and  size  of  shot,  but  while  all  shot  that  can  be  found  in  the  wound  should 
be  kept,  the  chances  that  they  can  be  proved  to  have  belonged  to  the 
prisoner  is  remote.  The  Billings  trial  showed  the  importance  of  recover- 
ing by  patient  search  all  the  lead  possible  from  a  gunshot  wound  where 
bone  has  been  traversed  by  the  ball.  The  ball  recovered  is  also  of  value. 
If  it  can  be  measured,  either  by  calculating  the  lands  and  grooves  found 
upon  it  or  by  some  portion  which  still  maintains  its  periphery  undis- 
turbed, it  may  be  stated  as  positively  of  a  kind  able  to  be  fired  from  the 
weapon  suspected,  or  that  it  could  not  be  ;  and  this  fact  alone  may  free 
a  person  accused  of  crime.  In  a  brawl  in  Troy  some  few  years  ago, 
shortly  after  the  second  trial  of  Jesse  Billings,  a  man  was  shot.  More 
than  one  shot  was  fired,  and  by  different  persons.  One  arrested  for 
doing  the  wounding  was  freed,  by  the  medical  witnesses  who  had  held 
the  autopsy  proving  absolutely  that  the  ball  recovered  from  the  dead 
man  could  not  have  been  fired  from  the  pistol  known  to  have  been  in  the 
possession  of  the  prisoner  at  the  time  of  the  brawl,  and  which  was  taken 
from  him  on  his  arrest.     Had  the  doctors  not  saved  and  produced  the 


HOMICIDE  AXD    WOUNDS.  277 

ball,  the  man  would  probably  have  stood  a  fair  chance  of  being  convicted 
of  homicide ;  for  the  testimony  presented  pointed  strongly  to  him  as  the 
one  giving  the  fatal  shot.  In  the  case  of  Woods  shot  by  Briggs,  the  ball 
was  recovered  entire.  It  was  not  upset,  as  it  had  encountered  nothing 
but  soft  parts,  and  it  was  the  same  caliber  and  the  lands  and  grooves 
were  of  the  same  number  and  size  as  those  in  the  pistol  used  by  Briggs. 
This  was  further  proof  of  the  story  of  the  prisoner,  he  relating  he  shot 
Woods  with  a  certain  weapon. 

Dirt,  grass,  hay,  and  similar  substances  may  be  found  in  wounds,  and 
should  all  be  carefully  preserved,  as  they  may  aid  in  tracing  a  crime  to 
the  person  guilty  of  it. 

Position  of  Weapon,  Clothes,  or  Body. —  Where  death  is  homicidal, 
suicidal,  or  accidental,  the  position  of  the  weapon  to  the  body  has  a  bear- 
ing on  the  decision  of  the  examiner  in  determining  to  which  category 
the  death  belongs.  If  a  weapon  is  found  near  to  a  body  it  may  argue 
strongly  for  suicide ;  but  suicides  have  been  known  to  endeavor  to  simu- 
late homicide,  and  throw  the  weapon  some  distance  to  lend  color  to  this 
view,  and  in  the  same  way  criminals  have  placed  weapons  by  their  vic- 
tims in  order  to  cover  the  crime.  The  manner  in  which  the  wound  is 
made,  and  the  way  the  weapon  is  found  with  reference  to  the  body,  taken 
together,  are  strong  points  on  which  to  reason.  In  the  Budge  case  the 
razor  with  which  the  woman  was  claimed  to  have  cut  her  throat  was 
found  lying  under  the  right  arm  and  was  partly  closed.  The  arm  itself 
was  bent  across  the  chest.  There  was  hardly  any  blood  upou  the  razor. 
Taking  into  consideration  the  character  of  the  wound  in  this  woman's 
neck,  it  is  more  than  questionable  if  she  could  have,  after  its  infliction, 
moved  her  arm  to  where  it  was  seen,  having  first  half  shut  the  razor  and 
put  it  on  the  bedclothes  beside  her.  To  do  this  is  to  assume  that  death 
was  not  instantaneous  from  such  a  terrible  wound,  and  that  consciousness 
and  power  of  movement  existed  after  both  carotids,  both  jugulars,  both 
pneumogastrics,  trachea,  and  oesophagus  had  been  completely  severed. 
When  a  knife  or  razor  is  found  shut  after  a'  mortal  wound,  it  is  a  suspi- 
cious circumstance,  for  one  having  determined  on  suicide  and  inflicted 
a  fatal  injury  does  not  care  much  what  becomes  of  the  weapon.  Again, 
where  the  wound  is  instantly  fatal  and  made  under  the  pressure  of  ex- 
citement most  suicides  experience  when  taking  their  lives,  the  weapon 
is  very  apt  to  be  found  grasped  firmly  in  the  hand.  This,  of  itself,  would 
be  almost  certain  proof  of  suicide,  for  cadaveric  spasm  will  not  take  place 
except  at  the  moment  of  death,  and  a  murderer  does  not  stay  by  his 
prey  and  hold  the  weapon  in  the  dead  man's  hand  until  it  is  fastened 
there  by  the  rigor  mortis.  In  the  case  of  the  woman  who  cut  her  throat 
iu  an  outhouse,  before  quoted,  the  knife  was  found  in  a  large  clot  of 
blood,  and  under  the  body.  It  had  evidently  fallen  from  the  hand,  and 
she  shortly  followed  it  to  the  floor. 

The  position  the  clothes  of  the  deceased  or  the  bed-coverings  are 
found  in  should  be  noticed.  In  the  Budge  case  the  night-dress  was  open 
in  front,  the  sheets  and  coverings  neatly  folded  down  upon  the  bed.  and 
everything  about  the  bed  arranged  as  if  the  person  were  merely  asleep. 
It  would  appear  impossible  to  have  this  condition  prevail  if  the  wound 
had  been  self-inflicted ;  the  mere  moving  of  the  arm  up  and  exerting  the 
strength  necessary  to  do  the  cutting  would  in  all  probability  disturb  the 
neatly  smoothed  sheet  lying  folded  over  the  chest. 


278  A   SYSTEM   OF  LEGAL  MEDICINE. 

In  1879  a  man  named  Thompson  kept  a  small  photograph  shop  in 
West  Troy,  N.  Y.  The  place  consisted  of  one  room  downstairs  about 
fifteen  by  twelve,  and  upstairs  a  dark  room  was  made  of  a  closet  in  the 
back,  and  a  sort  of  workshop  alongside,  taking  off  abont  five  feet,  while 
the  remainder  was  used  as  the  operating-room.  A  narrow  staircase 
ran  up  by  the  left-hand  wall  as  yon  entered  from  the  street,  only  wide 
enough  for  one  person  to  go  np  at  a  time.  This  stairway,  in  the  second 
story,  opened  directly  into  the  room  where  the  cameras  stood.  The 
place  was  entered  by  a  rather  narrow  door,  which  opened  on  the  level  of 
the  sidewalk.  This  door  was  glazed  in  its  upper  part ;  a  curtain  or 
shade,  with  the  man's  name  and  occupation  printed  on  it,  covered  this 
upper  half.  A  window  to  the  right  of  the  door  as  one  entered,  also 
shaded.  Standing  at  this  door,  to  the  right,  high  up  in  the  wall,  was  a 
half  window  opening  on  to  an  alley.  It  had  no  fastening.  Underneath 
it  was  an  old  sofa.  A  stove  nearly  in  the  middle  of  the  room,  a  table, 
some  chairs,  and  various  photographs  on  the  walls,  with  the  carpet,  com- 
pleted the  furnishing.  The  stairs  were  uncarpeted.  The  hand-rail  was 
narrow  and  round,  ending  in  a  round-topped  newel-post.  The  distance 
from  the  bottom  step  to  front  wall  was  about  three  feet.  On  the  side 
wall  of  the  staircase  three  or  four  large-sized  photographs  were  hung  in 
gilt  frames. 

Thompson  lived  by  himself  in  this  place,  sleeping  on  a  sofa  in  the 
room  he  used  as  his  gallery.  He  took  his  meals  out,  and  at  the  time  of 
his  death  had  no  one  working  for  him.  His  habits  were  not  good.  One 
Sunday  he  was  missed  at  his  boarding-place.  He  had  been  there  the 
evening  before,  but  had  gone  to  his  shop  about  nine  in  the  evening.  It 
being  winter,  made  it  dark  at  that  hour.  Not  being  seen  either  Sunday 
morning  or  noon,  inquiries  were  made.  He  had  been  seen  going  into 
the  place  the  evening  before,  but  no  one  saw  him  come  out.  Some  went 
and  looked  at  the  shop,  but  the  curtains  were  down,  and  nothing  could 
be  seen.  As  excitement  grew  more  peeping  at  the  windows  was  tried, 
and  one  person  said  he  could  see  through  a  tear  in  the  door-curtain  a 
man's  legs  lying  on  the  floor.  This  being  confirmed  by  others,  the  door 
was  forced.  Thompson's  dead  body,  evidently  dead  for  some  hours,  lay 
on  its  back  at  the  foot  of  the  stairs.  Moving  the  body,  after  carefully 
noting  its  position,  the  condition  of  clothes,  and  surroundings,  a  lacerated 
and  contused  wound,  forming  two  sides  of  an  acute  angle,  each  side  being 
about  an  inch  long,  was  found  on  the  left  side  of  the  head  near  the 
parietal  eminence.  This  wound  was  made  from  its  apex  downward. 
The  head  when  first  seen  touched  the  base-board.  The  feet  interfered  a 
little  with  the  opening  of  the  door.  To  his  right  side,  standing  on  edge, 
was  one  of  the  photographs  in  oval  frames  which  hung  on  the  stair  wall. 
Its  glass  was  not  broken,  and  its  string,  a  heavy  red  cord,  was  also  in- 
tact. The  nail  from  which  it  had  hung  was  bent  downward,  following 
nearly  the  angle  of  the  stairs.  An  ordinary  kerosene  lamp  was  on  the 
floor  at  his  left  and  near  the  newel-post.  The  chimney  was  found  on 
the  stairway,  lying  unbroken  upon  the  fourth  step.  There  were  no 
marks  of  blood  anywhere,  except  on  the  floor  where  the  wound  of  the 
scalp  rested.  The  clothing  was  neat,  the  legs  straight  out  alongside  each 
other,  and  the  trousers  were  pulled  down  over  the  boots ! 

Was  this  a  case  of  murder  or  accidental  death  ?  Suicide  was  out  of 
the  question.     The  man  was  sober  when  last  seen,  so  it  was  presumed  he 


HOMICIDE  AND    WOUNDS.  279 

was  so  when  he  died.  The  autopsy  showed  the  wound  on  the  head  cor- 
responded to  a  depressed  triangular  fracture  of  the  same  shape  and 
dimensions,  and  death  was  due  to  the  blow  and  compression.  No  other 
cause  for  death  was  anywhere  apparent.  Rumor  had  it  that  Thompson 
had  been  on  bad  terms  with  the  man  who  last  worked  for  him,  and  that 
this  man  had  threatened  vengeance.  The  coroner's  jury  could  not  find 
sufficient  evidence  on  which  a  warrant  could  be  issued,  and  so  gave  the 
verdict  of  death  from  compression  due  to  a  fracture  received  in  some 
manner  unknown. 

Minute  inspection  of  the  photographer's  shop  failed  to  show  any  signs 
of  a  struggle.  On  the  wall  of  the  stairway,  underneath  where  the  picture 
had  been  torn  off,  were  some  marks,  which  examination  proved  to  be 
made  by  boot-blacking.  They  were  made  from  above  down,  trending  in 
the  same  plane  as  the  stairs.  A  hammer,  the  hammer  head  square  with 
cut-off  corners,  was  found  upstairs.  This  could  have  made  the  wound, 
but  there  was  no  blood  or  hair  on  it,  and  if  it  had  been  used  it  was  put 
back  on  the  bench  in  the  small  workroom.  There  was  no  mark  on  the 
newel-post,  stairs,  stair-rail,  base-board,  or  floor  which  would  indicate  that 
the  head  had  been  wounded  by  striking  against  them.  And  the  body  lay 
out  straight  on  its  back,  one  hand  across  the  chest,  the  other  by  its  side, 
the  clothes  not  disarranged,  and  the  trousers  pulled  down  on  the  boots. 
If  this  was  a  fall,  and  consequently  accidental  death,  how  the  bocly  could 
fall  from  about  half-way  up  the  stairs,  as  it  must  have  to  make  the  boot- 
marks  on  the  wall  or  to  pull  down  the  picture,  strike  the  newel-post  on 
the  left  side  of  the  head — for  that  was  the  most  likely  object  about 
which  could  possibly  make  such  a  wound — and  then  turn  over  and  as- 
sume the  position  this  body  was  in,  is  hardly  possible  to  imagine.  The 
more  probable  theory  of  homicide  is  easier  of  explanation.  The  man. 
going  upsfeairs,  sees  an  enemy  above,  coming  toward  him.  He  has  no 
weapon,  and  seizes  the  first  thing  he  can  lay  hand  to,  the  picture,  turns 
with  it  in  his  hand  to  reach  the  floor  below,  and  receives  the  blow ;  falls 
head  foremost,  feet  striking  the  wall.  The  assailant  follows,  and  to  clear 
his  own  way  throws  the  legs  over.  This  turns  the  body  on  its  back,  and 
to  make  it  appear  as  if  accidental,  he  straightens  the  legs  by  pulling  on 
the  trousers.  Escape  was  easy  out  of  the  half  window  into  the  alley. 
and  from  there  to  the  street.  This  could  be  conjectured  to  be  somewhat 
the  manner  of  the  death  ;  but  so  much  would  have  to  be  mere  conjecture 
that  an  almost  equally  plausible  theory  could  be  as  well  constructed  on 
the  question  of  accidental  death.  The  case  is  one  of  interest,  and  will 
always  remain  one  of  doubt.  It  shows,  however,  how  every  point  must 
be  taken  into  account,  and  how  the  logical  bearing  of  one  upon  the  other 
must  be  carefully  studied  before  a  medical  witness  can  pronounce  whether 
death  was  from  homicide,  suicide,  or  due  to  accident. 

When  More  than  One  Wound  is  Present. — The  medical  witness 
may  be  called  on  to  say,  where  several  wounds  have  been  found  on  a 
body,  which  was  the  first  inflicted.  Lawyers,  apparently,  seem  to  believe 
that  a  doctor  should  be  able  to  state  with  positive  and  unqualified  speci- 
fication any  question  that  may  enter  their  heads  to  ask  about  an  injury. 
a  disease,  or  the  permanent  "effects  of  either.  Unfortunately  for  this, 
man  is  not  machine-made,  and  what  will  in  one  person  cause  death  im- 
mediately will  in  another  allow  of  more  or  less  action  before  loss  of  either 
mental  or  muscular  activity.      Therefore  it  is  that  a  medical  witness 


280  ^   SYSTEM  OF  LEGAL  MEDICINE. 

oftentimes  appears  at  great  disadvantage.  He  must,  however,  expect 
the  question,  and  prepare  himself,  as  well  as  may  be  possible,  to  answer. 
When  several  wounds  are  present,  if  a  case  of  homicide,  or  no  evidence 
of  struggle  is  attendant,  the  mortal  wound  was  probably  the  one  first 
inflicted ;  for  if  the  others  are  such  as  would  not  be  mortal  or  incapaci- 
tate the  assailed  from  an  effort  for  life,  it  is  a  fair  assumption  that  some 
defense  would  have  been  made  and  evidence  of  this  be  found.  If  the 
wounds  are  made  b}r  two  or  more  attacking  at  the  same  time,  no  definite 
answer  can  be  gi«ven  as  to  which  would  be  the  first,  or,  if  more  than  one 
be  mortal,  which  caused  the  death.  The  examiner  studies  each  wound 
on  its  merits,  and  by  the  character  of  the  injury  arrives  at  a  probable 
conclusion  of  the  ones  made  before  and  those  made  after  death.  Further 
than  this  he  cannot  go,  unless  other  evidence  than  that  of  the  wounds 
themselves  can  be  presented  which  will  decide  the  question.  Where 
wounds  are  incompatible  with  one  cause  for  all,  the  examiner  can  state 
with  positiveness  the  ones  produced  by  one  kind  of  injury  and  those 
produced  by  another.  This  may  be  most  important  evidence,  for  the 
death  may  be  due  to  a  fall,  and  the  cause  of  the  fall  a  blow  which  showed 
laceration  or  other  symptoms,  and  the  two  injuries  so  placed  that  both 
could  not  be  produced  by  the  fall  or  by  the  blow. 

Suicides  often  make  more  than  one  wound,  or  may  make  an  incised 
wound  and  then  use  a  pistol,  or  jump  into  water  or  from  a  height.  They 
may  do  all  these,  and  both  cut  and  gunshot  would  have  been  mortal  if  a 
little  patience  to  see  the  effect  of  their  work  had  been  exercised.  The 
finding  of  a  body  with  its  throat  cut  and  with  a  pistol-shot  in  the  brain 
would  be  apt  to  raise  the  cry  of  murder,  but  calm  study  of  the  matter 
would  prove  both  injuries  compatible  with  self-destruction,  although  both 
were  mortal.  The  case  of  Weston  is  one  where  three  mortal  wounds 
were  present,  if  not  a  fourth.  Two  bullets  in  the  brain,  which  had  tra- 
versed it  from  before  backward,  one  through  the  heart,  and  the  throat 
extensively  cut,  gives  a  case  where  the  question  of  which  wound  was 
made  first  is  not  possible  of  answer.  The  surgeon  thought,  from  the 
amount  of  blood  effused  in  the  chest,  that  the  heart  wound  was  made  while 
the  man  was  living ;  but  it  may  have  instantly  preceded  the  bullet  in  the 
brain  and  before  pulsation  had  ceased,  and  then  the  amount  of  blood 
would  have  been  equal  to  that  found.  The  amount  of  blood  found  on 
the  clothing  and  on  bushes  and  grass  around  where  the  body  lay  was 
not  enough  to  say  the  throat  was  cut  during  life  ;  but  as  between  the  two 
mortal  wounds  in  head  and  heart,  it  would  be  impossible  to  do  more  than 
to  give  an  opinion  of  priority  based  on  conjecture. 

Criminals  sometimes  make  wounds  upon  themselves  as  evidence  of 
attack,  and  that  their  action  was,  therefore,  in  self-defense.  The  manner 
in  which  the  wounds  are  stated  to  have  been  received,  when  compared 
with  the  reading  of  the  cut  itself,  do  not  always  agree,  and  suspicion  is 
created  as  to  the  truthfulness  of  the  prisoner's  statement.  The  marks 
of  the  cutting  through  the  clothing  will  have  important  bearing  in  de- 
ciding how  such  wounds  have  been  received,  for  few  care  to  boldly  cut 
direct  through  all  that  may  interpose  betweeu  knife  and  skin,  but  rather 
prefer  to  see  what  and  how  deep  they  are  cutting  and  then  make  the 
necessary  incisions  in  the  clothes  afterward.  As  few  know,  there  are 
points  of  difference  in  the  beginning  or  ending  of  a  cut,  or  that  to  an  ex- 
perienced eye  every  wound  tells  a  story ;  the  cutting  on  the  person  may 


HOMICIDE  AND    WOUNDS.  281 

~be  made  in  one  direction,  and  the  required  rents  in  the  clothes  in  the 
opposite.  In  June,  1874,  1  examined  a  man  named  Bruin  in  the  Wash- 
ington County  jail  at  Sandy  Hill,  by  direction  of  the  district  attorney. 
Bruin  was  an  old  man  over  fifty  years  of  age,  but  of  an  extremely  bad 
temper.  He  was  under  arrest  for  attacking  with  a  pitchfork  a  man  who 
worked  for  him  and  inflicting  a  stab-wound  in  the  face,  seriously  wound- 
ing one  eye.  The  prisoner  claimed  it  was  done  in  self-defense,  saying 
the  man  had  attacked  him  with  a  large-bladed  jack-knife  and  cut  him  in 
the  abdomen.  Examination  showed  a  freshly  healed  wound,  it  appear- 
ing from  the  cicatrix  as  if  two  incisions  had  been  made  close  to  each 
other,  of  one  half-inch  in  length,  running  perpendicularly  and  situated 
six  inches  above  the  antero-superior  spinous  process  of  the  ilium,  and 
five  inches  from  the  umbilicus,  its  upper  end  being  at  lower  border  of 
the  cartilage  of  the  ribs.  The  cicatrix  showed  the  wound  to  have  been 
made  from  a  cut  directed  upward,  and  that  it  did  not  penetrate,  merely 
entering  through  the  true  skin.  Examination  of  the  shirt,  waistcoat,  and 
trousers  which  the  prisoner  had  on,  and  which  he  said  he  had  worn  when 
assaulted,  discovered  rents  or  cuts  in  each ;  but  in  the  shirt  there  was  a 
tear  five  to  six  inches  long ;  in  the  waistcoat  a  rent,  also  several  inches 
long,  about  on  a  line  with  the  wound,  but  extending  both  above  and 
below  it ;  while  the  cut  in  the  trousers  was  so  made  that  when  they  were 
drawn  up  upon  the  body  as  far  as  the  make  of  the  garment  would  allow, 
the  upper  edge  of  the  rent  did  not  come  opposite  the  wound.  The  shirt 
appeared  more  torn  than  cut ;  the  waistcoat  was  cut  from  without  in  and 
from  below  up,  as  if  held  out  from  the  body  and  the  knife  passed  through, 
and  then  sawed  up  and  down  as  far  as  thought  necessary ;  while  the  cut 
in  the  trousers  was  made  by  thrusting  the  knife  from  within  and  cutting 
down.  The  linings  of  these  two  garments  told  the  direction  of  the  cut, 
while  the  fibers  of  the  cloth  showed  in  which  direction  the  knife  had 
gone  through  them.  As  the  prisoner  claimed  all  cuts  in  his  clothing  as 
well  as  that  on  his  abdomen  had  been  made  when  he  was  struck  by  his 
man's  knife,  there  was  no  hesitancy  in  reporting  to  the  district  attorney 
that  the  injury  was  self-inflicted. 

In  a  recent  trial  in  Albany  for  murder,  a  strong  point  for  the  defense 
was  made  of  the  fact  that  the  prisoner  had  shot  himself  immediately 
after  the  murder,  and  had  intended  to  kill  himself.  The  case  was  wife- 
murder.  A  young  man  named  Shattuck  shot  his  wife  and  then  fired  the 
pistol  at  himself,  making  a  dangerous  wound  in  the  right  temple ;  but 
the  weapon  was  so  held  the  ball  plowed  the  muscles,  merely  grazing  the 
bone.  On  the  ground  of  insanity  a  verdict  of  murder  in  the  second  de- 
gree was  rendered,  and  the  prisoner  escaped  the  electric  chair.  From 
all  the  evidence  of  the  crime,  it  was  fairly  considered  his  shooting 
himself  was  accidental,  although  the  appearance  of  the  scar  was  well 
used  by  the  defense.  Had  the  case  happened  differently,  this  wound 
would  have  been  excellent  evidence  of  injury  by  another,  for  the 
pistol  was  not  near  enough  for  the  discharge  to  cause  burning  by  the 
flash. 

Suicide. — To  say  that  all  who  take  their  own  lives  are  laboring  under 
a  temporary  aberration  of  mind  is,  in  many  cases,  to  rely  merely  on  the 
fact  of  self-destruction  for  evidence  of  mental  unsoundness.  That  mania 
is  undoubtedly  a  frequent  cause  of  suicide  nobody  would  deny,  and  with 
that  class  of  cases  we  have  little  to  do,  insanity  being  treated  of  elsewhere. 


282  A   SYSTEM  OF  LEGAL  MEDICINE. 

It  may  be  said  that  where  insanity  plays  a  part  the  methods  used  are  at 
times  so  peculiar  as  to  lead  not  only  to  positive  proof  of  self-slaughter, 
but  to  the  presence  of  mental  disease.  A  rational  being  who  decides  on 
suicide  does  it  generally  in  the  easiest  and  quickest  way  he  can.  A 
plunge  in  the  water,  and  all  is  over.  Determination  to  succeed  is  often 
manifested.  A  case  occurred  of  a  patient  who  had  been  in  my  wards 
when  I  served  in  the  Brooklyn  City  Hospital  in  1870.  The  man  had 
been  operated  on  for  partial  removal  of  the  lower  jaw.  Unfortunately, 
the  surgeon  attempted  to  save  the  rami,  the  disease  being  only  in  the 
anterior  portion  of  the  body  of  the  bone  ;  but  the  pterygoid  muscles  drew 
the  rami  inward,  causing  the  remaining  parts  of  the  body  to  press  upon 
the  tongue.  This  being  unbearable,  a  second  operation  was  decided 
upon,  but  the  patient  thought  he  had  had  enough.  Obtaining  leave  of 
absence,  he  did  not  return,  and  the  reason  for  this  was  explained  when 
his  body  was  found  in  Gowanus  Bay,  near  the  city,  when  the  tide  went 
out,  with  the  pockets  of  his  coat  filled  with  stones.  This  man  was  not 
crazy.  He  simply  determined  to  die,  and  took  precautions  to  prevent 
any  effort  on  his  part  floating  his  body  after  he  once  threw  himself  into 
the  water.  And  then  his  method  insured  his  body  being  found,  for  he 
was  securely  anchored  in  the  mud. 

As  has  been  seen  from  the  foregoing,  homicide  may  be  made  to  appear 
like  suicide  to  hide  crime.  It  is  rare  that  suicides  so  plan  their  exit  as 
to  show  a  desire  to  have  their  death  appear  to  be  murder.  An  interest- 
ing case  of  this  character  is  reported  by  Dr.  J.  B.  Lewis  in  his  book  of 
"  Stratagems  and  Conspiracies  to  Defraud  Life  Insurance  Companies." 
Captain  Colvocoresses,  a  retired  officer  of  the  United  States  Navy,  was 
found  in  a  dying  condition  in  a  by-street  in  Bridgeport,  Conn.,  at  a  late 
hour  of  the  night  of  June  3,  1872.  The  captain,  although  possessed  of 
small  means,  obtained  insurance  upon  his  life  for  $195,000.  He  was 
ostensibly  on  his  way  to  New  York  from  his  home  in  Litchfield  when 
his  death  took  place  in  Bridgeport.  He  had  been  to  the  boat,  secured  a 
room,  left  in  it  his  traveling-bag,  but  as  the  boat  did  not  leave  until 
eleven  o'clock  at  night  he  left  it  to  go  to  a  hotel  and  get  some  supper. 
When  going  off  the  boat  he  was  seen  to  carry  a  small  black  bag  and  his 
cane.  This  latter  was  a  bamboo  sword-cane.  After  getting  something 
to  eat  at  a  restaurant,  he  idled  away  his  time  until  half -past  ten,  when 
he  left  a  drug-store,  where  he  had  made  some  small  purchases  of  paper 
and  envelopes,  and  being  directed  how  to  find  the  boat,  he  apparently 
started  to  reach  it.  Just  as  the  boat  was  putting  out  the  report  of  a 
pistol  was  heard,  and  a  policeman,  of  whom  the  captain  had  earlier  in 
the  evening  asked  some  questions,  hearing  the  shot,  ran  to  the  place  from 
where  the  sound  seemingly  came.  Lying  on  the  sidewalk,  and  in  a 
dying  condition,  was  Captain  Colvocoresses.  A  large  gunshot  wound 
was  in  the  left  breast,  his  left  hand  pressed  against  it,  and  he  was  on  his 
back.  The  discharge  had  set  fire  to  his  shirt,  and  the  light  from  it  guided 
the  policeman.  In  a  diagonal  direction  across  the  street,  in  the  gutter, 
was  an  old-fashioned  percussion-lock  horse-pistol.  This  weapon  had  evi- 
dently just  been  discharged.  The  sword-cane  was  about  two  yards  from 
the  captain's  feet,  and  toward  the  gutter.  The  cane  was  broken,  and  tin' 
blade  in  it  bent.  From  examination  it  had  the  appearance  of  having 
been  broken  by  being  struck  or  snapped  over  a  fence.  The  bullet  had 
gone  completely  through  the  body. 


HOMICIDE  AND    WOUNDS.  283 

First  one  thing  and  then  another  was  brought  to  light.  A  pill-box, 
having  percussion-caps  which  fitted  the  pistol,  was  discovered.  A  boy, 
seeing  a  bit  of  rag  sticking  out  from  under  a  gutter  plank,  carelessly 
pulled  it  out,  and  with  it  an  old  powder-horn.  Tiring  of  his  plaything, 
he  threw  it  where  it  was  afterward  found.  The  black  bag  earned  off 
the  boat  by  the  captain  was  found  on  another  wharf,  partly  hidden  under 
a  railroad-tie.  One  end  was  slit  open,  and  nothing  was  in  it  but  a  blank 
check-book  and  some  few  grains  of  powder,  which,  on  comparison  with 
the  grains  in  the  powder-horn,  were  shown  to  be  similar.  Peculiar  in- 
dentations were  noticed  in  the  bag,  and  trying  the  pistol,  these  were  seen 
to  correspond  to  the  point  where  the  hammer  would  rest  if  the  pistol 
was  put  into  the  bag.  The  captain's  coat  and  waistcoat  were  unbuttoned 
and  lay  open  when  he  was  found  on  the  sidewalk.  It  was  proved  that  he 
habitually  wore  his  coat  buttoned  up,  and  while  it  was  supposed  that  the 
opened  clothing  was  a  sign  of  violence  on  the  part  of  footpads,  the  but- 
tons were  not  torn  off  either  garment. 

The  evidence  of  the  wound  was  that  of  close  fire.  The  discharge 
must  have  been  fairly  near,  or  the  shirt  would  not  have  been  set  in  a 
blaze.  And  the  carefully  cut  satchel,  the  peculiar  weapon — one  which 
was  traced  as  having  been  owned  by  the  deceased — the  peculiar  manner 
in  which  the  sword-cane  was  broken,  the  evident  care  with  which  the 
percussion-caps  and  powder-horn  had  been  hidden,  the  repeated  questions 
by  the  captain  in  the  early  evening  of  the  way  to  the  boat,  although  he 
was  well  acquainted  with  the  town,  the  motive  for  death,  that  his  family 
would  be  left  in  affluent  circumstances,  the  peculiar  manner  of  his  bid- 
ding good-by  to  the  family  when  leaving  home  that  morning — all  brought 
the  positive  conclusion  that  this  was  a  case  of  suicide  and  not  of  homicide 

Dr.  Lewis,  in  his  report,  says  the  pistol  being  found  thirty  feet  away 
was  accounted  for  by  the  recoil  of  the  weapon,  the  pistol  springing  back 
from  the  chest  after  it  was  fired.  I  am  inclined  to  differ  from  this  view, 
and  would  rather  think  it  an  act  of  volition.  All  the  evidence  points  to 
so  carefully  conceived  a  plan  that  some  arrangement  must  have  been 
thought  of  by  which  the  weapon  would  be  found  a  distance  from  the 
body.  Therefore,  I  do  not  think  it  incompatible  with  the  wounding  that 
the  captain  could  throw  the  weapon.  The  recoil  may  have  helped  in  this, 
the  arm  giving  the  sudden  jerk  predetermined  on,  and  both  forces  com- 
bined carrying  the  pistol  thirty  feet.  The  case  of  Woods  shows  coordi- 
nate muscular  ability  after  a  terrible  wound,  and  in  this  case  but  much 
less  was  attempted.  And  the  captain  was  not  dead  when  found,  although 
life  lasted  but  a  few  minutes  after.     (Also  see  article  Life  Insurance.) 

A  young  man  some  five  years  ago  attempted  his  life  by  shooting. 
The  weapon,  a  pistol,  fortunately  for  him,  Avas  faulty  in  action,  and  while 
the  shot  was  well  aimed  and  intended,  it  did  no  material  harm.  The 
wound  was  in  the  right  temple,  just  in  front  of  the  hair  line.  When  I 
saw  the  patient,  about  an  hour  after  the  shooting,  he  was  lying  on  his 
bed,  his  head  done  up  in  a  wet  cloth,  and  he  thought  himself  wounded 
unto  death.  As  this  was  what  he  wanted  when  he  fired  the  shot,  he  was 
perfectly  resigned,  and  did  not  wish  anything  done  to  interfere  with  an 
edifying  end.  But  being  persuaded  to  allow  an  examination  of  the 
wound,  as  soon  as  he  was  assured  it  was  but  a  trifle  and  there  was  abso- 
lutely no  danger,  his  tune  changed,  and  he  was  as  anxious  to  live  as  a 
few  minutes  before  he  had  been  to  die.     The  wound  was  a  ragged,  lacer- 


284  A   SYSTEM  OF  LEGAL  MEDICINE. 

ated  one,  and  but  for  the  powder-marks,  not  such  as  would  at  first  sight 
appear  to  have  been  made  by  a  pistol  ball.  But  part  of  the  ball  was 
there  in  plain  sight  in  the  wound,  and  lying  flattened  against  the  bone. 
Taking  this  out,  it  was  seen  to  be  only  half  a  ball,  so  the  pistol  was  pro- 
duced and  the  cause  of  his  escape  from  death  was  easily  explained.  The 
cylinder  did  not  revolve  properly,  so  but  half  of  the  chamber  was  pre- 
sented to  the  barrel  when  the  trigger  was  pulled.  The  ball  cut  itself  in 
two,  one  part  going  out  of  the  muzzle  with  just  sufficient  force  to  cut  the 
skin,  the  other  half  squeezing  sideways  between  cylinder  and  barrel,  and 
being  found  on  the  floor. 

When  the  suicide  is  by  cutting,  blood  is  generally  found  on  the  hand 
using  the  knife ;  and  if  cadaveric  spasm  keeps  the  weapon  in  the  hand, 
the  blood  is  on  the  back  and  between  the  fingers.  It  is  hardly  within 
the  range  of  the  possible  that  a  person  can  cut  his  throat,  severing  the 
carotid,  and  not  have  blood  over  hand  and  arm.  To  find  otherwise 
would  be  to  raise  strong  suspicions  of  homicide.  If  the  death  is  by  stab- 
bing, then  no  blood  would  be  expected  other  than  what  might  flow  from 
the  wound  on  the  surrounding  parts.  The  hands,  however,  would  prob- 
ably be  free  from  stains,  and  if  the  suicide  threw  away  the  weapon  the 
appearances  of  homicide  would  be  very  real.  Other  facts  would  have  to 
be  relied  on  to  decide  the  question,  for  the  evidence  of  the  wound  would 
only  show  that  it  could  have  been  produced  by  the  dead  as  easily  as  by 
another. 

It  often  happens  that  a  person  trying  to  commit  suicide  fails  by  rea- 
son of  pointing  the  weapon  improperly.  A  young  man,  whose  "  course 
of  true  love  "  did  not  run  as  smoothly  as  he  thought  it  should,  and  con- 
sidering life  was  no  longer  worth  living,  fired  a  shot  at  his  head  from  a 
small  pistol,  which  he  hoped  would  end  his  troubles.  The  intention  was 
evidently  to  fire  a  bidlet  into  the  right  ear.  Instead,  the  ball  was  fired  a 
little  to  the  front  and  just  underneath  the  zygoma,  and  as  the  direction, 
given  by  the  manner  the  pistol  was  held,  was  upward  and  forward,  the 
ball  passed  into  the  zygomatic  fossa,  entered  and  crossed  the  right  orbit, 
lodging  against  the  nose  at  the  inner  canthus.  It  did  not  enter  the  brain 
cavity,  and  although  a  painful  wound,  was  not  dangeroiis.  The  result 
was  to  cure  the  young  man  of  the  desire  for  self-destruction,  and  to  allow 
him  for  the  future  to  observe  matters  with  a  "single  eye,"  for  the  sight 
of  the  right  was  destroyed  by  the  bullet.  I  removed  the  ball  without 
difficulty,  and  the  case  made  a  good  recovery. 

The  determination  between  suicide  and  accidental  wounding  is  at 
times  difficult,  and,  it  may  be  said,  sometimes  impossible ;  for  so  many 
accidental  deaths  occur  when  persons  are  examining  or  cleaning  fire-arms 
that  it  is  beyond  mortal  power  to  say  whether  the  death  was  by  mishap 
or  design.  The  medical  witness  can  only  state  the  evidences  presented 
by  the  wounds  and  weapon,  and  must  use  caution  in  giving  positive 
opinions  as  to  how  the  death  came  about.  Such  peculiar  accidents  do 
take  place  that  the  range  of  possibilities  for  them  is  infinite,  and  at  times 
the  most  improbable  happens.  Taylor  relates  a  case  of  where  a  man's 
gnu  went  off  accidentally,  the  recoil  throwing  the  gun  backward,  and  as 
it  fell  the  second  barrel  was  fired,  the  charge  entering  its  owner's  thigh. 
This  case  is  sufficiently  unique  to  call  attention  and  emphasize  the  care 
that  must  be  exercised  in  the  examination  of  wounds  and  the  expression 
of  opinion  as  to  how  they  were  caused. 


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HOMICIDE  AND    WOUNDS.  28V 

Burns  and  Scalds. — While  it  is  not  common  to  consider  injuries 
arising  from  the  application  of  external  heat  to  the  body  as  wounds, 
under  the  definition  of  wounds  before  given,  and  for  the  purposes  of  a 
clearness  of  description  before  a  jury,  the  lesions  caused  by  burns  and 
scalds  will  be  considered  in  the  same  light  as  incised,  contused,  gunshot, 
■or  other  injuries — viz.,  as  wounds.  Burns  are  considered  as  those  wounds 
made  by  fire,  heated  metals,  solids  or  fluids ;  and  scalds,  as  the  result  of 
hot  fluid,  like  water,  tea,  etc.,  and  steam.  Boiling  oil  makes  a  burn  as 
does  boiling  sugar,  while  they  may  also  give  scalding,  if  but  a  small 
amount  of  the  liquid  be  thrown  upon  the  body,  not  sufficient  in  quantity 
to  cause  a  true  burn. 

The  danger  from  either  kind  of  wounding  is  due  to  the  extent  of  sur- 
face involved  or  the  severity  as  to  the  destruction  of  tissue.  A  scald  or 
burn  which  covers  a  large  extent  of  surface,  even  though  it  involve  the 
cuticle  alone,  is  very  dangerous  to  life,  for  the  shock  is  so  severe  that  the 
patient  may  not  rally,  and  death  be  due  to  it.  In  such  a  case  as  this 
pain  is  excruciating,  and  aids  the  shock  by  its  exhausting  effect.  It  is 
well  to  remember  that  such  an  injury  has,  especially  in  children,  a  stupe- 
fying action,  and  the  patient  usually  dies  in  a  comatose  condition.  The 
administration  of  narcotics  may  become  a  question  of  investigation,  as 
the  death  may  be  attributed  to  their  improper  use.  While  pain  is  a 
symptom  where  the  burns  are  slight,  it  decreases  in  amount  as  the  severity 
or  depth  of  the  burn  and  destruction  of  tissue  increases.  Where  the 
skin  is  killed  by  the  action  of  whatever  causes  the  burn,  there  is  no  sen- 
sation in  it  itself,  and  it  rapidly  sloughs.  It  at  first  contracts,  and  then, 
if  the  patient  lives,  inflammation  begins,  and  the  dead  skin  separates. 
The  seat  of  the  injury  has  also  a  marked  influence  on  its  risk,  burns  of 
the  abdomen  being  more  dangerous  than  those  of  the  thigh,  the  wound- 
ing being  equal,  and  burns  of  the  hands  more  dangerous  than  those  of 
the  feet.  Death  may  be  due  to  shock  alone,  uncombined  with  the  effects 
of  the  burning,  in  which  case  no  internal  evidence  would  be  found  on 
post-mortem  examination ;  or  it  may  be  due  to  secondary  inflammations, 
as  pneumonia,  pleurisy,  or  of  the  intestines.  Perforating  ulcers  of  stom- 
ach and  intestines  also  result  from  wounds  of  this  character,  and  the 
prognosis  is  not  to  be  lightly  given  when  a  fair  amount  of  injury  Las 
been  done,  as  death  may  take  place  when  everything  is  apparently  pro- 
ceeding toward  recovery.  The  patient  may  sink  under  the  exhaustion 
caused  by  the  pain  and  shock,  the  collapse  coming  on  suddenly.  Where 
death  is  immediate  from  a  general  burning,  it  may  be  long  before  any 
great  pain  is  suffered,  for  the  shock  may  kill,  or  suffocation  from  smoke 
take  place.  In  the  latter  case,  the  body  being  recovered  in  such  state 
that  an  autopsy  can  be  held,  the  usual  appearances  of  death  from  asphyx- 
iation will  be  present,  while  it  is  common  to  find  where  death  has  been 
from  the  shock  of  the  intense  heat  or  of  the  burns,  the  heart  empty,  the 
blood  of  a  red  color,  and  the  organs  generally  congested. 

As  burning  may  be  resorted  to  as  a  cover  for  crime,  the  medical  ex- 
aminer has  to  be  prepared  to  state  whether  the  wounds  found  were  made 
before  or  after  death.  It  is  agreed  by  all  the  authorities  on  this  subject 
that  certain  marks  are  fairly  indicative  of  burns  before  death  ;  but  the 
question  is  on  the  same  plane  as  other  injuries,  for  the  burns  made  at 
the  time  of  death  or  immediately  after  present  the  same  appearance,  so 
that  a  decision  can  only  be  positive  in  a  relative  sense.     Where  certain 


288  4   SYSTEM   OF  LEGAL  MEDICINE. 

signs  are  present,  such  as  the  slough  beginning  to  separate,  there  is  no 
hesitation  in  saying  the  wound  was  made  during  life,  for  nature  had  to 
have  time  to  form  pus  and  commence  the  operation  of  throwing  off  the 
dead  tissue.  And  the  same  may  be  said  of  lighter  burns  or  scalds ;  for 
if  we  find  evidence  of  the  blister,  which  undoubtedly  was  caused,  having 
been  broken  or  cut  away,  and  some  pus-corpuscles  lying  on  the  healing 
surface,  we  know  that  life  had  gone  on  for  twenty-four  or  more  hours  at 
the  very  least.  The  question,  for  the  medical  witness,  is  not  of  easj' 
solution  like  the  above.  It  is  whether  death  took  place  either  at  the  time 
the  burn  was  inflicted  or  after  it,  and  if  after,  how  long  a  time  probably 
elapsed  between  the  two. 

Blisters. — Blisters  or  vesicles  are  made  by  the  amplication  of  heat  to 
the  surface  of  the  skin,  usually  by  boiling  water,  direct  flame  barely 
touching,  or  steam-jets ;  for  where  the  injury  is  produced  by  heated  metal 
or  molten  metals,  or  longer  continued  applications  of  flame,  the  skin  is 
more  deeply  involved,  and  an  eschar  results.  The  vesicle  in  the  cuticle 
at  first  turns  white  from  the  heat,  and  then  rises  from  the  surface.  It 
is  seen  to  contain  serum,  and  the  surface  of  the  skin  under  it  is  intensely 
red.  If  pricked  and  the  serum  allowed  to  escape,  it  will  wrinkle  down 
upon  the  inflamed  skin  and  remain  there,  if  not  rudely  disturbed,  acting 
as  a  dressing  until  the  healing  process  has  formed  a  new  cuticle,  when 
it  comes  away  in  dry  scales ;  or  it  may  again  fill  from  more  exudation. 
If  torn  off,  the  skin  shows  red  even  after  death,  in  this  differing  from  the 
removal  of  the  cuticle  by  abrasion,  the  skin  in  this  latter  case  drying  a 
yellow  or  brown.  The  capillary  congestion  accounts  for  the  red  color, 
and  this  may  and  does  become  a  red-brown  color  some  time  after  death, 
but  sufficiently  different  even  then  to  be  distinguished  from  the  plaques 
resulting  from  abrasions.  Experiments  made  by  Sir  R.  Christison, 
Dr.  Taylor,  and  others,  show  that  vesications  can  be  made  on  the  dead  body, 
but  unless  on  dropsical  subjects,  air  instead  of  serum  is  found  in  the 
blister.  Bloody  serum  will  be  present  if  the  blister  is  made  directly  after 
death,  that  is,  within  a  few  minutes.  As  with  contusions,  so  with  blis- 
ters :  more  heat  is  required  to  cause  one  in  the  dead  than  in  the  living, 
as  more  forceful  blows  were  found  to  be  required  to  produce  an  ecehy- 
mosis  in  the  dead  which  resembled  one  made  in  the  living  body.  The 
serum  effused  into  a  living  blister  coagulates  when  heated  or  on  the  ad- 
dition of  nitric  acid  ;  but  that  in  a  vesication  produced  on  the  dead,  even 
if  life  has  but  departed  within  a  few  minutes,  is  more  watery,  and  is 
merely  rendered  opaline  by  the  use  of  the  above-named  agents. 

Boiling  water  poured  on  the  dead  will  not  produce  a  blister.  It  shriv- 
els the  cuticle,  but  does  not  produce  effusion  of  serum.  Some  fifteen 
years  ago  I  was  called  to  perform  an  autopsy  on  the  body  of  a  boy  who 
had  died  at  the  Elmira  Reformatory.  The  statement  received  from  the 
prison  was  that  he  had  committed  suicide  by  hanging  in  his  cell;  that  he 
was  discovered  before  life  was  extinct,  cut  down,  and  every  effort  made 
at  resuscitation,  but  in  vain.  At  various  points  on  the  body,  especially 
the  prominent  joints,  such  as  elbows,  knees,  and  other  exposed  portions, 
were  reddish  brown  spots,  varying  in  size  and  extent.  Careful  examina- 
tion showed  these  had  been  made  by  heat.  There  were  no  blisters,  how- 
ever,  but  the  color  of  the  spots  was  such  as  to  lead  to  the  conclusion  that 
they  were  slight  scalds  made  while  life  was  present.  Further  inquiry  from 
those  conversant  with  what  was  done  at  the  reformatory  when  the  boy 


HOMICIDE  AND    WOUNDS.  289 

was  found  hanging,  disclosed  the  fact  that  one  method  used  for  resusci- 
tation had  been  emersion  in  a  hot  bath.  In  the  excitement  attendant 
upon  the  matter,  the  water  had  been  made  too  hot,  being  boiling,  or 
nearly  so,  and  as  the  boy  was  plunged  in,  this  being  discovered,  he  was 
immediately  taken  out.  The  points  slightly  vesicated  were  in  contact 
with  the  metal  lining  of  the  tub,  which  had  become  very  hot  from  the 
water.  As  the  autopsy  disclosed  evidences  of  strangulation  and  death 
from  that  cause,  the  explanation  of  the  scalded  spots  was  probably  cor- 
rect. Vesication  does  not  always  immediately  follow  the  injury.  It  may 
appear  in  a  few  minutes,  and  it  may  not  appear  for  hours ;  therefore,  a 
patient  may  die  from  the  shock  or  exhaustion  before  blisters  appear,  and 
after  death  they  may  come  on  and  contain  serum,  the  capillary  conges- 
tion having  taken  place  during  life.  The  appearance  of  the  skin  under 
such  a  vesicle  will  be  a  guide  as  to  the  period  the  burn  was  received. 

More  serious  burns,  those  when  an  eschar  is  produced  from  red-hot 
solids,  molten  metals,  or  flames,  show  more  marks  than  vesication.  The 
part  burned — that  is,  the  skin — turns  white.  Around  the  spot  is  a  sharp 
red  line,  and  generally  redness  of  the  skin  beyond  that  again,  which 
gradually  fades  into  the  normal  color.  This  inflammatory  blush,  if 
pressed  on,  disappears  under  the  pressure,  returning  again  as  soon  as  the 
pressure  is  removed.  The  deeper  red  hue,  resembling  the  line  of  demar- 
kation  around  a  slough,  will  not  yield  to  pressure,  and  remains  present 
after  death.  The  attending  blush,  however,  fades  entirely  when  death 
takes  place.  Wlide  this  red  line  is  a  mark  of  a  burn  during  life — for 
there  are  no  satisfactory  experiments  recorded  that  show  it  can  be  pro- 
duced on  the  dead,  it  being  caused  by  deep  injection  of  the  true  skin — 
its  absence  is  not  proof  that  the  burn  was  made  after  death,  for  it  is 
not  always  present  in  such  wounds  produced  in  the  living.  Its  pres- 
ence, then,  is  fairly  reliable  proof  that  the  burn  was  made  while  vitality 
existed. 

Bodies  may  be  so  destroyed  by  fire  as  to  preclude  any  autopsy,  or  any 
judgment  being  pronounced  as  to  the  cause  of  death.  All  appearances 
in  one  so  cremated  are  to  be  observed,  especially  those  relating  to  sex. 
If  the  body  has  been  rescued  before  more  than  partial  destruction  has 
taken  place,  the  autopsy  may  reveal  much  or  little,  for  if  death  is  from 
shock,  with  the  exception  of  the  conditions  before  noted  nothing  will  be 
seen.  If,  however,  death  has  been  produced  by  other  means,  and  the  fire 
has  been  caused  to  hide  the  crime,  the  examination  of  the  remains  will 
in  all  probability  reveal  the  facts.  Burns  which  are  severe  in  character 
may  cause  fissures  in  the  skin,  which  have  the  appearance  of  incised 
wounds.  The  reason  for  the  fissure  is  the  destruction  of  the  elasticity  of 
the  skin  and  its  being  desiccated  by  the  heat.  While  the  skin  gives  way, 
the  cellular  and  fatty  tissue  below,  being  intimately  connected  with  it, 
may  also  part,  so  that  the  apparent  cut  may  show  the  muscular  tissue. 
Examination  of  the  tissue,  however,  will  demonstrate  the  difference  from 
wounding  by  the  knife,  for  the  edge^s  are  more  uneven,  the  fissure  may 
extend  in  one  direction  and  then  go  off  at  a  tangent,  and  the  condition 
of  the  deeper  tissue  will  also  aid  in  the  decision. 

Corrosive  Liquids. — A  medical  witness  may  be  asked  to  state  whether 
a  given  wounding  was  by  the  application  of  heat  or  some  corrosive  fluid. 
While  both  are  called  burns,  the  latter  are  not  properly  so.  Usually,  Tin- 
color  of  the  wound  is  a  guide  to  the  cause,  those  made  by  sulphuric  acid 


290  ^   SYSTEM  OF  LEGAL  MEDICINE. 

being  brown,  while  nitric  and  muriatic  acid  give  yellow  stains.  As  these 
injuries  are  generally  made  with  malicious  intent  on  the  part  of  another, 
the  most  common  seat  is  the  face  and  hands.  There  is  no  blistering,  and 
the  eschar  is  colored,  and  without  either  the  red  line  or  red  blush.  The 
skin  touched  is  killed  and  sloughs  away,  healing  taking  place  by  granu- 
lation. Generally  these  wounds  are  not  dangerous  to  life,  but  the  at- 
tendant inflammation  may  become  so.  It  is  not  found  that  ulceration 
of  the  intestines  follows  these  injuries  as  it  does  burns  from  hot  sub- 
stances, and  consequently,  while  disfigurement  follows  them,  they  are  not 
so  serious  in  prognosis. 

Fractures  and  Dislocations. — With  these  classes  of  injury  all  sur- 
geons are  familiar,  but  all  those  who  have  to  do  with  legal  cases  in  which 
such  injuries  come  are  not  equally  well  informed  with  the  medical  man. 
And  both  classes  are  met  with  from  criminal  violence,  either  as  the  direct 
result  of  the  violence,  or  as  an  indirect  one,  for  the  force  which  causes  a 
fracture  may  exert  itself  in  different  ways.  A  fracture  is  the  break  of  a 
bone,  and  divided  into  classes,  according  to  its  character  or  its  cause.  A 
simple  break  is  where  the  bone  is  at  some  point  of  its  course  divided  into 
two  fragments,  and  it  may  be  caused  by  a  blow  or  pressure  exerted  op- 
posite the  place  of  the  break,  or  it  may  be  from  the  force  being  trans- 
mitted to  this  particular  bone  and  expending  its  energy  there  in  break- 
ing it.  In  the  first  case,  it  would  be  called  a  direct  fracture,  in  the  second, 
an  indirect.  As  an  example,  the  arm-bone  may  be  broken,  at  any  point 
between  the  shoulder  and  the  elbow,  by  a  blow  from  a  club  :  this  would 
be  a  direct  fracture.  A  man  might  fall  and  land  on  his  feet,  sustaining 
a  fracture  of  the  neck  of  the  thigh-bone :  this  would  be  an  indirect  fract- 
ure. If  the  bone  is  broken  in  more  than  two  pieces,  it  is  called  a  com- 
minuted fracture,  and  this  does  not  mean,  as  the  name  "  comminuted ,r 
would  seem  to  imply,  that  the  bone  is  crushed  into  small  pieces,  but  that 
it  is  divided  into  three  or  more  fragments,  broken  in  more  than  one 
place.  The  break  may  be  said  to  be  compound  when  the  soft  parts  lead- 
ing to  the  seat  of  fracture  are  lacerated  or  cut,  and  the  wound  leads  from 
the  outer  air  to  the  break.  This  laceration  may  be  either  done  from 
without  in,  by  the  force  making  the  fracture,  or  from  within  out,  the 
force  driving  one  or  more  of  the  fragments  through  the  skin.  If  the 
laceration  or  cutting  of  the  soft  parts  does  not  reach  to  the  break  itself, 
or  a  dislocation  of  one  end  of  the  broken  bone  from  its  joint-socket  is 
present  with  the  fracture,  then  the  injury  is  called  complicated,  by  the 
additional  wounding  or  by  the  dislocation.  And  this  complicating  of  a 
fracture  may  be  done  in  more  ways,  for  one  end  of  a  fragment  may 
wound  a  nerve  or  blood-vessel,  thus  adding  to  the  primary  injury  the 
complications  of  the  secondary  ones.  A  fall  on  the  knee  maj^  produce 
another  kind  of  fracture,  comminuted,  it  is  true,  but  taking  its  name 
more  from  its  peculiar  radiating  line  of  cleavage ;  for  the  fall  being  re- 
ceived on  the  knee-pan,  that  bone  may  be  broken  in  star-shaped  formr 
and  give  us  what  is  called  a  stellated  fracture.  This  may  also  be  found 
elsewhere,  for  a  fracture  from  t*he  blow  of  a  hammer  or  other  like 
weapon,  or  from  a  bullet,  may  cause  a  stellated  fracture  of  the  skull. 
The  force  which  causes  the  break  may  drive  one  part  of  the  bone  broken 
into  another  and  hold  it  fast.  This,  while  an  indirect  fracture,  is  known 
by  the  name  of  an  impacted  one.  And  lastly,  fracture  may  be  in  the 
line  of  the  bone's  axis,  longitudinal  splits,  either  clipping  loose  a  project- 


HOMICIDE  AND    WOUNDS.  291 

ing  part  of  the  bone,  or  splintering  the  shaft  itself.  These  are  generally 
the  result  of  gunshot  injuries,  and  when  so  are  also  called  compound,  as 
the  wound  of  the  bone  opens  by  means  of  the  wound  of  the  soft  parts 
to  the  outer  air. 

Fractures  take  place  in  some  persons  much  more  readily  than  in 
others.  In  an  old  person  the  bones  are  more  earthy  and  break  easier 
than  in  the  adult,  and  the  force  being  equal,  the  young  breaks  easier 
than  the  adult,  because  in  the  latter  the  bones  are  at  their  strongest 
period.  In  the  child  or  young  person  the  bone  may  bend,  partially 
breaking  on  the  periphery  of  the  arc,  giving  what  is  called  by  writers 
"the  green-stick  fracture."  And  in  the  young  the  epiphyses  do  not 
unite  to  the  diaphyses  until  certain  ages  have  been  passed,  all  the  epiph- 
yses not  becoming  bone  until  about  the  twenty-fifth  year ;  consequently, 
there  may  be  a  separation  of  one  of  these  ununited  epiphyses,  which  to 
all  intents  and  purposes  is  a  fracture  or  break.  Certain  diseases  or  con- 
ditions of  the  system,  resulting  from  disease  or  medication,  predispose 
to  fracture :  mollifies  ossium,  cancer,  syphilis,  rickets,  gout,  scurvy,  mer- 
curialization,  and  any  disease  dependant  upon  cachexia3.  These  facts 
are  to  be  borne  in  mind,  for  the  wounding  may  be  increased  in  severity 
by  their  presence,  and  3ret  the  responsibility  of  the  assailant  be  not,  and 
the  assault  not  be  aggravated. 

Fractures  may  be  spontaneous,  and  caused  by  the  action  of  the  mus- 
cles attached  to  the  bones  so  breaking.  Commonly,  those  bones  pecul- 
iarly exposed  to  the  violence  of  suddenly  contracted  muscles  are  the 
ones  broken  in  this  way,  but  the  long  bones,  such  as  the  bones  of  the 
arm  and  thigh,  have  been  fractured  in  this  manner.  If  the  patient 
suffers  from  fragile  bones,  breaks  may  take  place  by  turning  over  in 
bed.  Breaks  thus  made  are  the  simplest  kind  of  fracture,  the  bone 
merely  parting,  and  not  causing  laceration  of  the  soft  parts.  Where  the 
fracture  is  from  any  violence  or  force,  either  directly  or  indirectly  exerted, 
the  fragments  lacerate  the  soft  parts  surrounding  the  break  according  to 
the  degree  of  force  experienced.  This  wounding  is  a  guide  to  the  de- 
cision of  the  time  it  took  place,  for  if  much  bleeding  follow  the  tearing 
the  probabilities  are  that  the  break  was  during  life.  The  muscles  may  be 
torn  as  much  after  death  as  before  it  by  the  fragments,  but  unless  a  vein 
be  cut  across,  less  hemorrhage  will  take  place  in  the  dead  than  in  the 
living.  A  fracture  made  at  the  moment  of  death,  or  immediately  after 
it,  could  not  be  told  from  one  made  at  a  corresponding  time  before  death  ; 
but  if  the  body  has  been  dead  a  short  while,  say  from  ten  minutes  to 
half  an  hour,  the  appearances  around  the  broken  ends  of  the  bone  will 
show  life  to  have  been  extinct  when  the  wounding  took  place.  If  the 
fracture  be  of  some  hours'  or  days'  standing  before  death  takes  place, 
then  the  examiner  can  give  a  positive  opinion,  for,  as  in  wounds  of  the 
sitt't  parts  by  other  instruments,  Nature  is  getting  ready  to  repair  the 
injury  she  has  received,  and  the  signs  of  this  work  are  apparent. 

As  to  the  Cause  of  Fracture. — The  medical  witness  may  be  asked 
how  a  certain  fracture  was  produced,  whether  by  a  blow  <>r  by  a  fall. 
The  defense  usually  claims  that  the  attack  of  their  client  did  not  cause  the 
break,  but  it  was  the  result  of  a  fall.  The  first  thing  is,  was  a  weapon 
used?  If  so,  what  kind?  Of  course  the  answer  is  easy  if  the  wounding 
was  by  means  of  powder  and  shot,  for  then  we  have  the  wound  of  en- 
trance to  reply  to  the  question  of  time  of  occurrence.     If  extensive  con- 


292  A   SYSTEM   OF  LEGAL  MEDICINE. 

tused  or  lacerated  wounds,  and  it  may  be  incised  ones,  are  present,  with 
the  fracture  directly  in  the  track  of  the  force  making-  the  wounding,  we 
have  but  to  find  the  weapon,  club,  stone,  pistol-butt,  gun,  hatchet  or  ax, 
and  the  whole  story  is  ready  for  recital.  Leaving  aside  weapons  which 
divide  the  skin,  we  consider  ones  making  contused  wounds.  Here  the 
extent  of  the  contusion  on  the  soft  part  is  not  only  indicative  of  the 
weapon,  but  also  of  the  amount  of  force  used.  Taking  the  bruise  of  the 
muscles  into  consideration,  the  extent  and  depth  of  this  bruising  would 
show  that  a  fall  could  not  have  produced  the  wounding,  for  undoubtedly 
as  the  break  was  caused  at  the  same  time  as  the  contusions,  it  being  a 
fracture  from  direct  violence  and  in  line  of  the  external  injur}-,  the  im- 
possibility of  a  man  falling  so  as  to  cause  just  so  much  violence  in 
one  spot,  without  corresponding  injuries  which  would  be  naturally  and 
necessarily  received  by  the  same  fall  and  at  the  same  time,  the  breaking 
by  direct  violence,  and  that  from  a  weapon,  would  be  clearly  shown. 
This  presupposes  careful  examination  of  the  place  where  the  assault  is 
stated  to  have  taken  place,  as  well  as  of  the  wounded  limb  itself.  If  the 
wounded  man  is  suffering  from  fragile  bones  or  from  any  cause  which 
renders  the  resistance  to  force  less  strong  than  normal  in  the  bones 
breaking,  it  is  no  aggravation  of  the  assault,  for  the  force  used  was  prob- 
ably such  as  would  in  no  way  break  a  bone  in  an  ordinary  man ;  and  as 
no  intent  to  do  such  severe  injury  is  shown,  the  responsibility  for  the 
break  would  lay  with  the  assailed.  If  he  did  not  have  a  condition  which 
rendered  his  bones  brittle,  he  would  not  have  had  them  broken,  for  the 
force  used  was  not  sufficient  to  break  a  like  bone  normal  in  its  condition. 

Fractures  of  ribs  may  be  made  by  blows  on  the  sides,  by  compres- 
sion, as  by  a  person  jumping  on  another.  The  fracture,  like  those  in 
the  long  bones,  is  either  at  the  point  where  the  force  impinges,  in  which 
case  depression  of  the  fragments  may  follow  and  the  lung  be  wounded, 
or  by  the  transmittal  of  the  force  around  the  rib  until  it  extends  itself  at 
the  angle.  In  this  case  the  fracture  is  outward,  and  no  danger  of  wound- 
ing the  pleura  need  be  feared.  When  the  injury  is  by  compression,  more 
than  one  rib  may  be  found  broken,  and  at  different  points.  Unless  the 
pressure  is  sharp  and  sudden,  the  angles  of  the  ribs  suffer  the  most. 
Quick,  direct  pressure,  so  strong  that  the  natural  spring  of  the  rib  is 
overcome,  will  be  apt  to  make  a  break  at  the  point  of  application.  In 
1882  a  man  was  tried  for  the  supposed  murder  of  a  boy  who  worked  for 
him.  The  case  was  tried  in  Schoharie,  N.  Y.,  and  the  people  presented 
the  following :  That  on  a  Sunday  afternoon  the  farmer,  finding  his  sheep 
had  strayed  from  the  paddock,  the  bars  of  which  had  been  left  down, 
told  this  boy  to  go  and  bring  them  back.  The  house  stood  by  the  road- 
side. Across  the  road  was  a  pasture  leading  down  an  incline  to  some 
brush  and  small  woods,  in  which  ran  a  little  stream,  and  also  contained 
more  or  less  swamp.  The  sheep  having  gone  in  that  direction,  the  last 
seen  of  the  boy  was  his  entering  the  woods  He  never  returned,  and 
some  inquiry  was  made,  but  the  conclusion  reached  was  that  he  had  run 
away,  for  the  short  cut  to  the  village  lay  through  these  woods  and  across 
the  fields  beyond.  The  boy  was  about  thirteen  years  old,  lame  in  the 
left  leg,  that  limb  being  shorter  than  the  right,  of  light  hair,  dressed  in 
brown  overall  trousers,  a  shirt,  and  an  old  jacket,  It  was  late  in  Septem- 
ber, and  frost  was  felt  at  night. 

The  following  spring  a  man,  following  the  by-path  to  the  village,  was 


HOMICIDE  AND    WOUNDS.  293 

somewhat  startled  to  see  a  small  human  skull  grinning  at  him  from  be- 
tween two  bars  which  on  a  line-fence  crossed  the  brook.  Remembering 
the  disappearance  of  the  boy  the  autumn  before,  he  gave  the  alarm,  and 
search  revealed  the  following:  Further  up  the  stream,  which  from  the 
melting  snows  had  quite  a  volume,  on  one  bank  was  found  some  scalp 
with  hair  adherent,  and  part  of  the  skin  of  the  back  of  the  neck.  This 
was  shriveled  and  dry,  showing  the  appearance  of  having  been  alternately 
wet  and  dried  until  it  had  been  left  where  it  was  found  by  the  waters 
going  down.  In  different  places  were  found  bones,  and  as  excitement 
grew  and  different  persons  engaged  in  the  search,  many  bones  were 
found  scattered  over  quite  a  territory,  and  belonging  to  different  animals. 
The  whole  of  the  boy's  skeleton  was  not  found,  but  enough  was  to  make 
out  height  and  age,  and  that  the  left  femur  was  shorter  than  the  right. 
Nearly  all  the  left  ribs  were  recovered,  and  some  of  the  opposite  side. 
The  lower  jaw  was  not  found,  nor  were  any  bones  of  the  hand,  while 
only  a  few  vertebrae  and  foot-bones  were  among  the  remains.  The  long 
bones  all  gave  evidence  of  having  been  chewed  by  some  animal,  and  the 
ends  of  both  ulna?,  the  head  of  one  radius,  and  both  ends  of  one  fibula 
were  thus  eaten  off. 

The  medical  witnesses  for  the  people  and  defense  agreed  as  to  what 
were  human  bones,  the  age  and  size  of  the  skeleton,  but  differed  as  to 
the  two  main  facts — one,  the  probable  cause  of  death,  the  other  whether 
the  body  had  been  buried.  On  this  latter  question  turned  the  guilt  or 
innocence  of  the  prisoner,  for  if  the  boy  had  been  placed  in  a  grave, 
murder  had  been  done.  The  expert  for  the  people  thought  death  was 
due  to  a  blow  over  the  left  chest,  which  could  have  been  made  by  a  hoe 
or  some  such  instrument,  and  marked  three  ribs  of  that  side,  the  third, 
fourth,  and  fifth,  as  being  the  ones  struck,  and  showing  this  by  a  slight 
line  of  fracture,  not  complete,  but  still  apparent,  which  went  across  each. 
The  doctor  also  thought  the  body  had  been  buried,  and  dug  from  its 
shallow  grave  by  foxes  or  dogs.  I  could  not  agree  with  this  theory,  and 
ehiefly  because  if  these  lines  of  fractures  on  these  three  ribs  were  made 
by  a  blow  from  a  hoe,  howr  came  similar  lines  on  all  the  other  ribs  found, 
ribs  belonging  to  both  sides  of  the  body  ?  Nor  did  I  agree  with  the 
theory  of  burial,  for  evidence'  of  great  unanimity  on  the  part  of  the  dogs 
and  foxes  which  dug  up  the  body  must  have  been  present  to  scatter  the 
bones  in  the  way  they  were  found,  and  to  chewr  only  certain  ones.  The 
ribs  had  much  more  the  appearance  of  having  been  frozen  in  ice,  for 
when  carefully  scanned  the  lines  of  fracture  were  such  as  would  be  made 
by  some  general  pressure  in  a  straight  line,  the  body  on  its  back.  The 
jury  took  the  same  view,  for  they  rendered  a  verdict  of  acquittal  within 
ten  minutes  after  retiring. 

Fractures  of  the  bones  of  the  skull  differ  from  those  of  the  long  bones 
in  that  there  is  generally  more  than  one  line  of  break.  And  commonly 
these  fractures  are  from  direct  violence,  either  by  falls,  blows,  or  bullets. 
It  has  already  been  seen  what  effect  a  ball  has  upon  the  head  and  upon 
bone  itself.  When  the  break  is  by  a  blow,  unless  a  soft  weapon  or  a 
large  one  has  been  used — large  in  the  sense  that  its  striking-surface  does 
not  hit  one  bine  of  scalp — the  fracture  is  not  usually  compound.  The 
soft  parts  may  be  contused  to  a  considerable  extent,  the  bone  broken 
beneath  them,  and  still  the  skin  be  not  lacerated.  The  line  of  fracture 
in  such  ease  may  be  single,  following  the  course  the  force  of  the  blow 


294  -4   SYSTEM  OF  LEGAL  MEDICINE. 

would  take  around  the  skull,  or  it  may  be  multiple,  one  line  going 
around,  the  other  passing  inward  through  the  base.  Whether  such  an 
injury  is  from  a  fall  or  blow  will  be  known  by  the  presence  of  the  con- 
tusion, and  the  seat  of  this  will  lead  to  the  statement  to  which  class  of 
cause  the  wound  is  to  be  attributed.  If  the  contusion  is  either  in  front 
or  behind,  it  is  as  easily  made  by  a  fall  as  by  a  blow,  bat  on  the  side  the 
probability  is  in  favor  of  a  blow,  it  being  more  difficult  to  receive  such 
injuries  on  the  side  of  the  head  from  a  fall,  the  shoulder  being  apt  to  in- 
terfere. Still  it  is  by  no  means  impossible,  and  therefore  the  medical 
witness  must  be  guided  in  his  opinion  by  attendant  evidences,  such  as 
the  character  of  the  contusion,  the  place  where  the  alleged  fall  is  said  to 
have  taken  place,  what  object  the  head  could  have  struck,  and  any  other 
circumstance  that  bears  upon  the  case. 

Fractures  of  the  base  may  happen  from  a  fall  on  the  feet,  the  force 
being  transmitted  upward  so  rapidly  that  the  base  is  broken  by  contact 
with  the  condyles.  In  such  an  accident  it  will  not  be  difficult  to  show 
no  homicidal  assault  was  made  upon  the  head.  Fractures  of  the  head 
made  by  hammers,  hatchets,  and  other  like  weapons  are  characterized  by 
the  article  producing  the  wound.  A  sharp-pointed  tool,  like  a  pick  or 
the  pointed  end  of  a  fireman's  ax,  will  make  a  depressed  fracture,  often- 
times driving  before  it  a  piece  of  bone,  with  hardly  any  lines  of  fracture 
in  the  rest  of  the  skull.  The  size  of  the  hole  and  shape,  for  it  is  nearly 
if  not  quite  square,  is  a  guide  to  the  manner  of  its  production.  The  cut 
made  by  a  hatchet  or  ax  is  likewise  indicative,  for  while  extensive  lines 
of  fracture  may  be  present,  the  cleavage  made  by  the  cutting  part  is  dis- 
tinct, and  shows  the  kind  of  instrument  used. 

Dislocations. — Dislocations  of  the  long  bones  are  rarely  fatal.  They 
show  less  disturbance  of  the  soft  parts  at  the  point  of  luxation  than  that 
made  by  the  ends  of  broken  bone,  for  the  smooth  articular  surface  is  not 
disarranged,  and  the  bone  tears  its  way  through  the  capsular  ligament 
and  then  usually  stops.  There  is  not,  therefore,  as  much  effusion  of 
blood  as  in  fractures,  and  the  injury  is  not  so  severe.  If,  however,  the 
luxation  is  of  a  vertebra,  then  the  injury  is  dangerous  and  may  be  in- 
stantly fatal,  according  to  the  amount  of  pressure  exerted  upon  the 
spinal  cord.  These  injuries  are  more  common  in  the  cervical  region  than 
elsewhere  in  the  column,  and  if  the  luxation  is  sufficient  to  cause  press- 
ure on  the  cord,  are  attended  by  paralysis,  if  not  death.  They  are  ac- 
cidental rather  than  homicidal,  for  even  if  caused  during  an  assault,  the 
assailant  is  not  usually  of  the  class  that  knows  such  an  injury  could  be 
produced  by  certain  bendings,  and  if  he  creates  it,  it  is  more  by  accident 
than  design. 

Position  of  the  Body  when  Wound  was  received. — The  medical 
witness  may  be  asked  to  determine  the  position  the  body  was  in  when 
the  wounds  found  were  received.  In  many  cases  it  can  be  readily  under- 
stood the  wound  would  give  no  positive  evidence  of  how  the  assailed 
stood  or  what  position  he  assumed  when  struck.  A  contused  or  lacerated 
wound  of  the  head  could  be  made  on  the  person  standing,  sitting,  or 
lying  down.  Again,  the  wound  could  only  be  given  with  the  body  in  some 
position  which  would  allow  of  the  full  force  of  the  blow  being  delivered 
where  its  effect  is  found.  Stab  and  gunshot  wounds  are  more  apt  to 
give  evidence  of  the  body's  position  than  other  injuries,  for  here  the 
direction  of  the  wound  gives  some  clue  to  the  position  of  both  assailed 


HOMICIDE  AND    WOUNDS.  295 

and  assailant.  In  the  case  of  Woods,  the  evidence  of  the  course  of  the 
bail  showed  he  received  the  wound  in  two  ways,  either  semi-inclined,  as 
claimed,  or  erect,  the  shot  coming  from  above.  It  was  impossible  for 
the  bullet  to  have  been  fired  at  right  angles  to  the  body,  for  it  could  not 
have  taken  the  course  it  did,  as  nothing  hit  by  the  ball  deflected  it,  the 
line  being  perfectly  straight  from  the  wound  of  entrance  to  the  spot 
where  the  ball  was  found.  In  1892,  in  Greene  County,  a  negro  named 
Bedell  was  shot  and  killed  by  a  man  named  Hess.  It  was  in  a  country 
hotel  bar-room.  Bedell,  who  was  a  powerful  man,  engaged  in  a  fight 
with  another  and  knocked  his  opponent  down,  rendering  Mm  insensible. 
He  was  then  going  to  attack  Hess,  who  was  behind  the  bar,  when  two 
others  seized  him,  one  on  either  side,  and  a  struggle  ensued.  Bedell 
broke  away  from  his  would-be  captors,  and  at  the  instant  he  freed  him- 
self Hess  fired.  Bedell  stopped,  turned  and  walked  to  a  billiard-table, 
about  twelve  feet  away,  leaned  against  it,  then  walked  to  a  chair  about 
twenty-five  feet  from  the  table,  into  which  he  sat.  While  sitting  there 
the  man  whom  he  had  just  knocked  down  recovered  his  senses,  and  made 
an  assault  upon  the  negro,  striking  him  over  the  head  with  a  pistol-butt. 
Men  interfered  to  prevent  further  fighting,  when  Bedell  got  up,  walked 
forward  about  eight  feet,  and  struck  his  assailant  a  strong  blow  in  the 
face.  Then  he  went  to  the  chair  and  lay  down  on  the  floor,  exhaustion 
coming  on.  The  whole  affray  only  took  five  minutes.  Bedell  went  into 
a  state  of  collapse.  I  am  indebted  to  Dr.  A.  Beach,  of  Coxsackie,  for  the 
description  of  the  wounding.  Dr.  Beach  states  that  the  ball,  which 
weighed  ninety  grains,  entered  by  an  oblique  wound  a  little  to  the  left  of 
the  median  line,  passing  over  the  cartilages  of  the  sixth  and  seventh  ribs, 
then  through  the  left  lobe  of  the  liver  into  the  stomach,  and  out  again 
nearer  the  pyloris,  through  the  transverse  colon,  six  times  through  the 
small  intestines,  and  lodged  in  the  right  psoas  muscle  near  to  the  prom- 
ontory of  the  sacrum.  Here,  as  in  the  case  of  Woods,  from  the  line  of 
the  bullet  the  man  could  not  have  been  in  the  erect  posture.  Nor  was 
he  lying  down.  The  track  made  shows  he  was  bending  forward,  prob- 
ably the  last  effort  he  made  in  breaking  away  from  the  two  holding  him, 
and  in  this  position  the  bullet  struck.  If  one  tries  the  position  it  will  be 
seen  that  the  ball  could  wound  just  the  viscera  that  were  found  injured, 
the  bending  of  the  bod}7  bringing  them  in  such  relations  that  the  bullet 
woiild  make  a  straight  course  from  its  entrance  to  its  resting-place.  In 
the  case  of  the  man  killed  at  Mechanicsville  in  1882,  the  wound  could 
have  been  received  either  standing,  sitting,  or  lying  down,  for  it  was  a 
blow  on  the  temple,  and  nothing  gave  evidence  from  the  wound  in  what 
position  the  body  was  when  it  was  inflicted.  Other  facts  that  could  be 
adduced  had  to  be  shown  to  prove  the  body  was  standing  when  it  was 
struck. 

Did  the  Person  move  after  being  Wounded  ? — It  may  be  of  impor- 
tance to  know  how  much  a  wounded  man,  one  "  wounded  unto  death," 
can  move  or  accomplish  after  he  has  received  the  injury.  The  medical 
witness  may  be  asked  the  question  if,  in  his  opinion,  it  was  possible  for 
any  voluntary  movements  to  take  place  after  the  receipt  of  a  given 
wound ;  and  the  question  is  not  always  one  where  a  positive  yes  or  no 
can  be  given  for  answer.  Men  differ  in  this  regard  as  much  as  they  do 
in  others,  some  falling  to  the  ground  from  a  comparatively  slight  wound, 
others  fighting  until  nature  is  exhausted  by  hemorrhage  or  other  cause. 


29G  ^   SYSTEM  OF  LEGAL  MEDICINE. 

Some  wounds  are,  of  course,  instantly  disabling,  no  matter  by  whom 
received.  A  rifle-ball  going  through  the  head  would,  by  the  force  of  the 
concussion  alone,  without  taking  into  account  the  injury  to  the  brain, 
render  the  patient  insensible.  A  heavy  blow  on  the  head  or  neck  from 
a  sand-bag  or  other  weapon  would  cause  insensibility,  or  instantaneous 
death  could  follow  stab- wounds  of  chest  or  abdomen,  as  well  as  gunshot 
injuries.  But  the  cases  cited  have  been  sufficient  to  show  that  mortal, 
and  what  would  ordinarily  be  considered  paralyzing,  wounds  may  be 
suffered  and  still  violent  exertion  follow.  "Woods,  with  blood  pouring 
out  of  the  wounded  right  auricle,  broke  an  iron  bolt  and  ran  nearly  a 
quarter  of  a  mile  before  falling.  Bedell  walked  about  and  began  again 
to  fight,  although  the  wound  he  had  received  cut  the  mesenteric  arteries, 
and  blood  and  the  contents  of  the  intestines  were  being  discharged  into 
the  peritoneal  cavity.  Here  are  two  wounds,  both  mortal,  and  yet  both 
borne  without  any  apparent  effect  for  some  few  minutes,  and  the  recip- 
ients doing  that  which  a  medical  witness,  not  knowing  the  evidence,  would 
have  felt  justified  in  saying  would  have  been  a  physical  impossibility  for 
either  to  perform. 

"When  serving  as  dresser  in  the  Montreal  General  Hospital  in  1867,  a 
fire  breaking  out,  a  panic  started  among  the  patients.  "When  the  fire 
was  over,  a  woman  who  had  a  fracture  of  both  bones  of  one  leg,  and  who 
had  been  dressed  in  the  old  fracture  box,  was  found  in  the  main  hall  two 
flights  of  stairs  down  from  the  ward.  How  she  got  there  she  could  not 
explain,  but  no  one  helped  her,  and  in  her  fright  she  walked  and  ran.  As 
soon  as  all  excitement  was  over  she  was  perfectly  helpless,  and  could  not 
move.  Instances  innumerable  might  be  cited  where  men  have  fought 
for  their  lives  after  receiving  wounds  which  were  mortal ;  but  it  is  only 
cumulative  evidence,  and  enough  has  been  said  to  show  the  need  of  cau- 
tion on  the  part  of  the  medical  witness  in  stating  that  the  deceased  could 
not  have  moved  after  the  receipt  of  his  wound.  It  is  but  another  illustra- 
tion of  how  every  circumstance  bearing  upon  the  death  must  be  carefully 
sought  for,  and  considered  by  the  medical  examiner  before  he  passes  an 
opinion. 

And  even  wounds  involving  the  brain  are  not  always  preventive  of 
motion.  The  celebrated  case,  quoted  in  physiologies,  of  a  man  who  had 
a  blasting-iron  three  feet  long  blown  through  the  anterior  portion  of  his 
head,  and  who  got  up  and  walked  to  a  cart,  rode  from  the  quarry  to  his 
home,  walked  upstairs  and  did  not  become  insensible  until  he  was  in  bed, 
is  known  to  all.  Had  this  man  been  found  dead  with  such  a  wound,  it 
would  have  been  said  he  never  moved  from  the  spot  where  he  received 
the  injury,  for  such  a  wound  would  render  him  insensible,  if  it  was  not 
immediately  fatal.  A  hasty  expression  of  opinion  as  to  the  power  of 
one  seriously  wounded  to  move,  might  cause  an  innocent  person  to  be 
accused  of  the  crime  of  murder. 

Wounds  affecting  Special  Parts  of  the  Body. — The  character  and 
evidences  of  wounds  in  general  have  been  now  studied.  It  remains  to 
see  how  injuries  affect  different  parts  of  the  body,  and  to  look  somewhat 
more  closely  into  the  question  of  how  dangerous  wounds  in  regions  may 
be,  and  what  influence  they  exert  in  causing  death. 

Of  the  Head. — Incised  wounds  of  the  scalp  are  not  usually  dangerous. 
If  properly  treated  they  heal  readily,  and  the  patient  suffers  but  little 
inconvenience.     A  contused  and  lacerated  wound  of  the  scalp  is  a  differ- 


HOMICIDE  AND    WOUNDS.  297 

ent  affair.  These  are  dangerous,  for  the  liability  to  inflammation  and 
erysipelas  is  great.  A  patient  who  walked  into  the  Brooklyn  City  Hos- 
pital during  my  service  as  resident  surgeon  died  from  inflammation  of 
the  meninges  of  the  brain,  resulting  from  suppuration  of  a  large,  lacer- 
ated wound  of  the  scalp.  The  man  had  fallen  about  twenty  feet  out  of 
a  cherry-tree,  tearing  the  scalp  on  the  left  side  of  his  head  so  it  hung 
down  over  the  ear.  The  wound  was  carefully  cleansed  with  disinfect- 
ants, the  parts  brought  together  by  suture  pins,  the  patient  sitting  on  a 
chair  and  talking  all  the  time  his  head  was  being  dressed.  Inflammation 
with  suppuration  followed,  the  periosteum  was  denuded,  matters  went 
on  from  bad  to  worse,  until  death  ended  the  case.  Here,  apparently, 
was  a  simple  wound,  and  one  not  likely  to  cause  any  danger  to  life,  but 
it  was  a  lacerated  and  contused  one,  and  despite  all  that  was  done  for  the 
patient,  a  fatal  issue  followed. 

Another  danger  from  a  contused  wound  of  the  head  is  the  amount  of 
injury  done  to  the  brain,  and  this  cannot  be  at  first  definitely  decided, 
for  a  slight  injury  will  be  followed  by  inflammation  of  the  brain  or  its 
membrane  and  cause  death,  while  one  much  more  severe,  even  where  a 
depressed  fracture  is  present,  may  be  fully  recovered  from,  and  no  bad 
result  be  noticed  as  a  sequel.  A  physician  cannot  prognosticate  from 
the  appearance  of  the  wound,  and  therefore  must  call  time  to  his  aid  be- 
fore giving  the  dictum  that  the  patient  is  out  of  danger.  It  is  perfectly 
proper  for  a  medical  man,  after  the  usual  time  for  brain  symptoms  to 
appear  has  passed,  and  the  wound  is  free  from  erysipelatous  inflamma- 
tion or  undue  suppuration,  to  pronounce  the  man  out  of  danger,  espe- 
cially if  pulse  and  temperature  are  normal.  But  the  effects  of  the  con- 
tusion may  not  yet  be  dissipated.  The  injury  to  the  brain  may  go  on  to 
the  formation  of  an  abscess  with  no  symptom  until  a  sudden  explosion, 
and  the  patient  rapidly  dies  from  the  abscess,  due  to  the  original  wound- 
ing. That  the  physician  has  pronounced  the  patient  out  of  danger  from 
the  assault,  and  in  a  few  days  the  man  suddenly  dies  from  brain  lesion 
due  to  the  blow,  is  no  reflection  on  the  skill  of  the  doctor,  as  all  symptoms 
of  regaining  health  were  present,  and  none  of  special  brain  injury. 

A  severe  blow  to  the  head  gives  concussion.  The  degree  of  this  is 
according  to  the  force  of  the  blow  and  the  individual  struck,  but  it  may 
ordinarily  be  considered  that  a  violent  blow  is  followed  by  some  amount 
of  concussion,  effusion  of  blood,  or  both.  The  blow  may  be  so  severe 
that  the  recipient  falls  and  dies  at  once  from  concussion  alone.  The 
autopsy  would  show  no  cause  of  death,  and  there  might  be  nothing  more 
than  a  small  contused  wound  of  the  scalp  to  indicate  that  violence  has 
been  done.  Concussion  confes  on  immediately,  and  may  vary  in  inten- 
sity from  a  slight  dazing  to  insensibility,  followed  by  vomiting,  or  a 
state  of  coma  lasting  for  some  days,  until  death  takes  place.  If  the  con- 
cussion does  not  of  itself  prove  fatal,  it  may  be  followed  by  brain  lesions 
in  the  same  way  as  contusions.  Like  the  others,  the  secondary  injuries 
are  but  sequels  of  the  primary  one,  and  responsibility  for  the  original 
wound  is  also  responsibility  for  the  effects.  The  condition  of  concussion 
may  be  mistaken  for  intoxication,  and  the  medical  witness  mav  have  to 
decide  between  the  two.  This  is  not  always  easy  to  do,  especially  if  a 
history  of  the  case  cannot  be  obtained.  The  fact  that  there  is  a  smell  of 
alcohol  about  the  breath  is  no  proof,  for  a  person  may  have  taken  spirits 
and  received  a  concussion  afterward.     Where  concussion  is  slight,  the 


298  ^   SYSTEM  OF  LEGAL  MEDICINE. 

patient  may  walk  as  if  intoxicated,  talk  unintelligibly,  act  in  an  aimless 
manner,  and  be  totally  unconscious  of  what  he  is  doing,  simulating 
•drunkenness  so  closely  that  an  ordinary  observer  would  unhesitatingly 
pronounce  him  intoxicated ;  and  yet  all  is  due  to  the  effect  of  the  blow. 
If  a  man  dies  while  in  an  extreme  state  of  intoxication,  the  brain  does 
not  show  more  than  it  does  after  severe  concussion,  no  rupture  of  vessels 
having  taken  place.  Contusions  may  be  found  on  the  head  in  both 
cases,  alcohol  may  be  found  in  the  stomach  in  both,  the  brain  is  equally 
congested,  and  so  are  the  other  post-mortem  appearances  similar.  The 
medical  examiner  can  only,  the  body  living,  await  further  developments 
in  the  case ;  the  body  dead,  gather  all  evidence  possible  from  circum- 
stances. It  is  necessary  to  treat  all  such  cases  with  the  utmost  caution, 
and  to  carefully  note  all  facts  that  may  develop.  Cases  are  constantly 
reported  where  persons  have  been  arrested  for  being  drunk  and  dis- 
orderly, put  in  a  cell,  and  found  dead  next  morning,  the  autopsj-  showing 
fracture  of  the  skidl  with  effusion  of  blood  as  the  cause  of  death,  and 
proving  the  prisoner  not  to  have  been  drunk  at  all. 

Extravasation  of  Blood  from  a  Blow. — A  blow  on  the  head  may 
cause  extravasation  or  effusion  of  blood,  which,  from  its  pressure,  be- 
comes the  cause  of  death.  As  said  elsewhere,  contusions  of  the  head 
may  result  equally  from  blows  or  falls,  and  as  the  contusion  precedes  the 
concussion,  the  latter  and  its  effects  may  be  ascribed  to  a  fall  as  well  as 
to  a  blow.  Supposing  a  1)1oav  is  struck  which  knocks  the  person  receiv- 
ing it  down.  Tins  blow,  while  severe,  may  not  be  strong  enough  to  give 
more  than  a  slight  contusion.  But  in  the  falling  the  head  receives  a 
violent  concussion,  and  the  man  dies.  While  the  concussion  is  not 
directly  from  the  blow,  it  is  a  result  of  the  blow,  for  the  fall  would  not  have 
taken  place  if  it  had  not  been  struck,  and  the  concussion,  therefore,  would 
not  have  been  suffered.  To  the  medical  witness  it  makes  no  difference 
whether  the  concussion  results  from  a  blow  or  a  fall;  he  has  but  to  de- 
scribe the  condition  he  finds,  and  state  to  the  best  of  his  knowledge  how 
the  lesions  causing  death  were  received. 

When  the  effusion  is  due  to  the  injury  it  is  most  commonly  from 
rupture  of  a  meningeal  artery.  This  may  be  ruptured  by  the  force  of 
the  blow  even  without  fracture  of  the  skull,  and  where  a  clot  from  a 
meningeal  artery  is  found,  causing  pressure  on  the  brain  or  its  base,  it 
is  more  apt  to  have  violence  for  its  cause  than  disease,  therefore  atten- 
tion is  called  to  other  matters  in  the  case,  and  a  hasty  opinion  that  death 
was  due  to  an  apoplexy  prevented.  The  blow  causing  the  effusion  may 
make  so  little  contusion  as  to  escape  notice ;  or  if  on  division  of  the 
scalp  some  ecchymosis  is  apparent,  it  might  be  assumed  that  this  was  due 
to  a  fall  and  followed  the  effusion,  instead  of  preceding  and  causing  it. 
Spontaneous  rupture  of  these  arteries  from  disease  is  rare,  and  this  fact 
being  known,  the  medical  examiner,  finding  such  a  cause  of  death,  has 
his  suspicions  aroused,  and  should  make  inquiries  to  show  what  led 
to  the  artery  breaking.  The  blood,  when  the  effusion  is  from  one  of  the 
meningeals,  is  between  the  inner  table  and  the  dura  mater.  If  the  effu- 
sion is  large,  death  may  be  rapid ;  but  the  brain  will  stand  a  great  deal 
of  pressure  at  all  other  points  than  the  base,  where  the  medulla  may  be 
impinged  upon,  and  the  effusion  may  be  not  sufficient  in  amount  or  it 
may  be  spread  over  the  whole  side  of  a  brain,  and  in  this  way  not  give 
the  amount  of  compression  necessary  to  cause  trouble;  or,  in  fact,  it 


HOMICIDE  AND    WOUNDS.  299 

may  not  make  its  presence  known  at  all.  In  the  Mechanicsville  case  the 
■clot  found  was  from  the  right  meningeal  artery,  and  was  as  large  as  the 
hand.  It  showed  not  only  its  origin  and  cause,  but  also  that  it  was  a 
fresh  clot,  death  supervening  before  any  changes  could  occur  in  it. 

A  person  receiving  a  severe  injury  to  the  head  may  recover  its  first 
effects  and  be  apparently  on  the  high-road  to  his  original  health,  when 
he  suddenly  becomes  worse,  goes  into  a  state  of  coma,  and  dies.  The 
autopsy  may  show  clots  more  or  less  extensive  in  the  cavity  of  the  ven- 
tricles, or  over  the  brain  surface  and  dipping  into  the  sulci.  The  condi- 
tion here  arises  from  the  contusion,  some  vessels  being  ruptured,  and  the 
blood  slowly  escaping.  The  clot  will  show  that  it  is  not  of  late  origin  by 
being  partially  organized  and  of  different  colors,  and  its  time  of  begin- 
ning can  be  drawn  to  or  near  to  the  time  the  contusion  was  received. 

Is  the  Effusion  found  from  Violence  or  Disease? — Hemorrhage 
may  take  place  from  violence  in  almost  any  part  of  the  brain,  for  the  blow 
may  rupture  the  brain  or  it  may  cause  effusion  into  its  substance  into 
the  ventricles  or  about  the  base.  And  similar  bleedings  inay  have  dis- 
ease for  the  cause.  If  a  man  dies  after  a  fight  or  fall,  and  an  introcranial 
hemorrhage  be  found,  the  medical  witness  may  be  called  on  to  state 
which  cause,  the  blow  or  disease,  gave  the  effusion  of  blood.  Much  may 
depend  on  his  answer,  for  a  person  innocent  of  crime  may  be  placed  in  a 
serious  position  because  he  was  engaged  in  the  brawl  and  his  opponent 
died  after  it  was  over.  In  1880  two  policemen  in  Albany  were  summoned 
to  arrest  a  man  who  was  creating  a  breach  of  the  peace.  The  fellow 
was  drunk,  or  had  been,  and  was  ugly,  as  the  stupefying  effects  of  the 
liquor  were  passing  off.  His  age  was  a  little  over  thirty  years.  He  re- 
fused to  be  quiet  when  the  officers  appeared,  and  they  started  to  take  him 
to  the  station-house,  about  three  quarters  of  a  mile  distant.  The  man 
fought,  and  the  patience  of  the  officers  becoming  exhausted,  one  of  them 
used  his  club,  hitting  his  prisoner  over  the  right  temple.  He  was  only 
hit  once  or  twice,  the  skin  was  not  cut,  and  no  fracture  was  caused.  The 
prisoner  continued  his  struggles  all  the  way  to  the  station-house,  but  was 
not  struck  again.  After  his  name  was  put  upon  the  blotter,  he  fought 
the  officers  to  the  cells,  and  until  he  was  pushed  in  one  and  the  door 
locked.  Then  he  continued  to  swear  and  abuse  them  as  long  as  they 
were  in  hearing.  The  arrest  was  late  in  the  afternoon.  The  watchman 
saw  and  spoke  to  the  prisoner  in  the  evening,  getting  curses  for  a  reply. 
He  saw  him  again  before  midnight,  when  he  stated  that  the  man  was 
asleep  and  snoring.     In  the  morning  the  prisoner  was  dead. 

An  autopsy  was  held  by  the  coroner's  physician,  and  he  stated  that 
he  found  the  contusion  with  a  clot  under  the  muscle ;  no  fracture  of  the 
skull,  no  break  of  the  skin.  On  opening  the  skull  nothing  was  found 
external  to  the  brain,  but  on  section  a  clot,  evidently  from  the  branch  of 
the  right  anterior  cerebral,  was  buried  in  the  right  lobe.  The  rest  of  the 
autopsy  did  not  show  very  much,  according  to  the  doctor's  report,  and 
he  gave  as  a  cause  of  death  the  hemorrhage  in  the  brain.  When  asked 
what  caused  the  hemorrhage,  he  stated  that,  in  his  opinion,  it  was  the  blows 
the  deceased  had  received.  This  led  to  the  arrest  of  the  two  officers,  and 
the  presentment  of  this  case  to  the  grand  jury.  The  defense  had  the 
body  exhumed,  and  further  examination  made.  The  statements  of  the 
coroner's  physician  were  substantiated  as  far  as  tin1  contusion  and  there 
being  no  fracture  of  the  skull,  but  from  that  on  I  differed  in  the  opinion 


300  A   SYSTEM.    OF  LEGAL  MEDICINE. 

that  the  man  was  healthy.  Both  kidneys  and  liver  were  fatty.  Speci- 
mens of  the  aorta,  vertebral,  basilar,  and  cerebral  arteries  were  taken  and 
put  under  the  microscope.  All  proved  the  presence  of  fatty  degenera- 
tion. The  condition  of  the  contused  part  was  carefully  examined.  As 
considerable  decomposition  had  taken  place,  it  being*  the  summer,  the 
evidence  from  the  contusion  was  not  so  conclusive  as  it  was  on  the 
first  examination,  so  questions  were  asked  the  doctor  who  held  the  first 
autopsy,  concerning  this  and  other  points.  Upon  the  statements  made 
by  him  and  upon  the  microscopical  appearances,  I  gave  the  opinion  the 
rupture  was  due  to  disease,  and  was  not  caused  by  the  blow. 

If  this  case  is  scanned,  the  reasons  leading  to  this  decision  will  be 
apparent.  While  apoplexy  is  not  usual  in  persons  under  forty,  intemper- 
ance and  violent  habits  predispose  to  it,  and  consequently  in  such  sub- 
jects the  age  has  less  to  do  with  the  effusion  than  the  intemperate  habits. 
The  microscopical  examination  showed  the  arteries  of  the  brain  in  an 
enfeebled  state,  by  reason  of  fatty  degeneration.  This  was  undoubtedly 
due  to  the  intemperance  of  the  man ;  and  as  neither  the  examination  I 
made  nor  the  statements  of  the  coroner's  physician  as  to  the  evidence  of 
the  contusion  showed  it  had  been  a  severe  one,  one  that  would  do  injury 
to  an  ordinary  man,  the  fair  inference  was  that  the  rupture  was  not  due 
to  the  blow,  but  to  the  congestion  caused  by  his  intoxication  and  bad 
temper  and  his  struggles  with  the  officers,  a  congestion  too  prolonged 
and  too  much  increased  by  the  constant  struggling  to  be  borne  with  im- 
punity by  the  weakened  vessels.  The  grand  jury  did  not  indict,  and  the 
policemen  were  released.  Here,  it  appears  to  me,  all  the  evidence  points 
to  rupture  from  disease.  The  blow  was  comparatively  slight,  the  vessels 
were  diseased,  the  man  was  a  drunkard,  was  violent  and  excited,  the  cere- 
bral vessels  were  highly  congested  from  the  time  of  his  arrest  until  put 
in  a  cell,  and  the  point  of  the  rupture  was  in  the  brain  substance.  Had 
a  rupture  in  that  situation  been  the  result  of  a  contusion,  the  contusion 
ought  to  have  been  a  more  violent  one  than  was  shown  to  have  been  re- 
ceived. In  deciding  on  these  cases  as  to  what  produced  the  effusion, 
whether  the  violence  or  the  disease,  it  must  be  taken  into  account  whether 
the  injury  done  is  one  that  would  cause  a  wound  sufficient  to  harm  one 
in  ordinary  health  and  who  did  not  suffer  from  the  effects  of  alcoholism. 
While  the  general  rule  may  be  followed  that  where  the  injury  done  would 
not  give  danger  to  a  healthy  man,  the  rupture  is  from  disease,  it  should 
be  borne  in  mind  that  ruptures  sometimes  follow  quite  slight  contusions, 
and  that  cases  are  on  record  to  substantiate  this  condition.  It  again 
conies  back  to  the  same  story,  viz.,  that  the  medical  examiner  must  take 
into  consideration  all  circumstances  attendant  upon  the  case  before  giv- 
ing his  opinion. 

Wounds  to  the  Spine. — Concussions  of  the  spinal  cord  caused  by 
blows  or  falls  are  more  likely  to  be  cases  where  a  medical  witness's  ser- 
vices are  needed  in  civil  suits,  and  not  such  injuries  as  are  subjects  of 
criminal  charges.  It  is,  however,  a  legitimate  condition  for  study,  as  in- 
juries may  be  received  to  the  cord  which  are  either  fatal  or  permanent, 
and  be  the  residt  of  criminal  assault.  Many  cases  of  sudden  death  from 
injury,  in  which  no  appearances  post-mortem  are  found  to  account  for 
the  death,  might  be  found  due  to  some  injury  to  the  spinal  cord  if  it  was 
taken  out  and  examined. 

We  have  found  that  the  brain  may  suffer  secondarily  from  a  blow  upon 


HOMICIDE  AXI)    WOUNDS.  301 

the  head,  inflammation,  softening,  abscess,  and  death  resulting.  The 
spinal  cord  is  of  itself  a  nerve  center,  and  in  construction  is  analogous 
to  the  brain.  What,  therefore,  will  cause  injury  in  one  will  in  the  other, 
and  we  may  have  varying  degrees  of  injury  from  contusions  to  the  spine 
or  indirect  falls  or  blows,  which  will  cause  concussion  and  temporary 
disablement  to  follow,  to  traumatic  meningitis  or  traumatic  myelitis  and 
death.  The  lesser  of  these  injuries  are  often  made  subjects  of  suits  for 
damages,  and  many  times  the  plaintiff  is  partially  paralyzed  in  one  or 
both  limbs  with  interference  with  the  functions  of  the  bladder  and 
bowels,  recovering  with  wonderful  rapidity  when  a  favorable  verdict  has 
been  obtained.  But  all  are  not  frauds,  and  genuine  injury  is  suffered 
from  a  concussion  of  the  spinal  cord.  In  1879,  a  man  who  was  a 
brakeman  on  a  freight-train  fell  from  the  top  of  his  car  by  the  break- 
ing of  a  brake-head.  He  was  picked  up  insensible,  and  when  conscious- 
ness returned  he  was  found  paralyzed  in  the  lower  limbs.  The  catheter 
had  to  be  used,  and  bloody  urine  was  voided  for  some  days.  He  re- 
covered the  control  of  the  bladder,  the  pain  he  had  suffered  disappeared, 
sensation  and  temperature  were  somewhat  impaired  in  the  lower  limbs, 
but  elsewhere  were  normal,  and  he  got  so  he  could  walk  on  crutches. 
He  sued  for  the  injury  and  recovered,  his  injuries  being  considered  per- 
manent by  the  medical  witnesses.  His  suit  came  to  trial  three  or  four 
years  after  the  accident,  and  it  was  then  I  first  saw  the  man.  He  had 
been  treated  in  Albany,  New  York,  and  Hartford,  being  in  hospital  in 
all  these  places,  but  his  legs  only  recovered  enough  power  to  swing  back 
and  forth,  and,  aided  by  the  crutches,  carry  him  along  at  a  rapid  walk. 
He  could  not  raise  the  feet  high  enough  to  step  upstairs,  nor  could  he 
stand  without  his  crutches. 

I  saw  the  man  daily,  for  two  years  or  more,  at  his  post  of  gate-keeper 
on  the  New  Capitol.  He  was  fat  and  healthy,  in  every  way  perfectly 
well,  excepting  the  want  of  power  in  the  lower  limbs.  Losing  his  posi- 
tion in  1884,  I  lost  sight  of  him,  and  did  not  see  him  again  until  1891, 
when  he  came  to  my  office  on  some  errand,  and  told  me  he  was  going 
out  shooting.  His  condition  was  the  same  as  in  76  or  78,  when  I  first 
examined  him.  He  still  had  to  use  his  crutches,  for  his  legs  would  not 
hold  him  up  without  them ;  otherwise  he  was  perfectly  well,  and  with 
their  aid  he  could  walk  far  and  fast.  There  was  no  symptom  of  fracture 
or  dislocation  of  the  vertebra?,  and  whether  any  existed  of  course  could 
not  be  told.  The  case  was  undoubtedly  a  concussion  of  the  cord  with 
probably  some  hemorrhage  in  or  about  it,  and  the  recovery  was  only 
partial. 

From  this  to  severer  injuries  inflicted  with  weapons  or  by  falls, 
where  more  direct  violence  is  done  to  the  spinal  column  itself,  is  but  a 
step,  and  the  wounding  to  the  cord  may  be  so  severe  as  to  cause  mortal 
injury,  either  within  a  few  days  or  later,  inflammation  supervening,  and 
complete  paralysis  interfering  with  respiration,  bringing  on  death.  The 
injuries  may  be  by  criminal  violence  or  be  accidental.  The  fact  that 
they  may  occur  is  to  be  borne  in  mind,  for  the  death  may  be  an  obscure 
one,  no  appearances  to  account  for  it  being  found  on  the  post-mortem 
examination  until  the  vertebral  canal  is  explored,  when  the  condition  of 
the  cord  or  its  membrane  wfll  show  why  life  ceased. 

Where  dislocation  of  a  vertebra  takes  place  the  pressure  on  the  cord 
may  be  so  severe  as  to  cause  death  at  once,  or  it  may  only  cause  paralysis, 


302  A   SYSTEM  OF  LEGAL   MEDICINE. 

which,  under  treatment,  may  improve  for  a  time  and  then  suddenly  grow- 
worse,  the  patient  sinking-  into  coma,  and  death  shortly  following.  This 
may  be  from  inflammatory  products  causing  increase  of  pressure,  or  from 
the  formation  of  pas.  This  same  condition  may  follow  injuries  from  fract- 
ure of  the  arches  or  bodies  of  the  vertebra?,  even  if  after  the  fracture  the 
fragments  spring  back  into  place,  for  the  pressure  would  be  so  severe  at 
the  time  of  the  primary  displacement  that  the  contusion  sustained  by  the 
meninges  or  the  cord  would  lead  to  effusion  of  blood  from  rupture  of  the 
vessels  of  the  meninges,  hemorrhage  within  the  substance  of  the  cord,  or 
subsequent  inflammation  of  either.  The  cause  of  the  fracture  may  either 
be  direct  or  indirect — blows,  falls,  crushes,  or  gunshot  injuries  all  giving 
this  result.  In  18G7  a  case  was  brought  into  the  Montreal  General  Hos- 
pital, in  which  I  then  served  as  dresser.  The  man  was  driving  a  load  of 
hay  under  an  arch,  and  was  kneeling  on  the  load.  His  head  was  bent, 
but  not  enough,  and  in  some  way  not  known  he  was  caught  by  the  arch  ; 
the  horses  kept  on,  and  he  was  found  insensible  on  the  top  of  the  load 
when  the  passage  was  finished.  Being  brought  to  the  hospital,  the  diag- 
nosis of  an  impacted  fracture  of  some  of  the  dorsal  vertebra?  was  made. 
The  man  suffered  some  slight  paralysis,  from  which  he  recovered,  but 
when  he  was  well  and  ready  for  discharge  he  had  lost  over  an  inch  in 
height.  I  do  not  pretend  to  account  for  how  the  cord  escaped  severe 
injury,  but  merely  state  the  case  to  illustrate  the  fact  that  severe  fractures 
may  take  place  in  the  back  and  recovery  follow. 

Fractures  of  the  spine  or  severe  injuries  to  the  cord  are  more  com- 
mon from  gunshot  wounds  than  from  other  classes  of  injuries.  Here, 
the  bones  not  being  broken,  we  may  also  have  the  direct  cause  of  a  fatal 
concussion,  for  the  bullet  may  render  such  a  blow  to  the  vertebrae  into 
which  it  drives,  or  to  the  intervertebral  substance,  if  it  lodges  between 
two  of  the  bones,  as  to  cause  hemorrhage  within  the  cord.  In  the  case 
of  the  man  shot  in  the  neck  at  Fonda,  elsewhere  described,  the  ball  im- 
pinged upon  an  intervertebral  disk  and  the  man  died  of  paralysis  of  the 
right  side.  What  caused  this,  whether  a  clot  or  a  piece  of  the  left  lacer- 
ated vertebral  artery  went  up.  to  the  brain  with  the  last  flow  of  blood  in 
that  vessel  and,  lodging  in  some  of  the  vessels  of  the  right  hemisphere, 
caused  the  paralysis,  or  whether,  what  I  think  more  probable,  the  con- 
cussion gave  hemorrhage  in  the  cord  substance,  the  autopsy  was  not 
carried  sufficiently  far  to  decide.  It  was  certain,  however,  no  fracture 
had  been  produced,  and  yet  the  bullet  undoubtedly  caused  the  paralysis 
and  death. 

Death  may  not  always  follow  immediately  upon  fracture  or  penetra- 
tion of  the  spinal  canal  by  a  bullet,  although,  where  the  eord  is  injured 
by  the  missile,  movement  of  the  part  of  the  injured  man  below  the  point 
of  wounding  is  generally  impossible.  The  case  of  President  Garfield  is 
one  in  point,  and  I  quote  its  description  from  Ashurst's  International 
Encyclopedia  of  Surgery:  "The  aperture  by  which  it  [the  ball]  entered 
involved  the  intervertebral  cartilage  next  above  [the  first  lumbar  verte- 
bra], and  was  situated  just  below  and  anterior  to  the  intervertebral  fora- 
men, from  which  its  upper  margin  was  about  one  fourth  of  an  inch  dis- 
tant. Passing  obliquely  to  the  left  and  forward  to  the  upper  part  of  the 
body  of  the  first  lumbar  vertebra,  the  bullet  emerged  by  an  aperture, 
the  center  of  which  was  about  half  an  inch  to  the  left  of  the  median  line, 
and  which  also  involved  the  intervertebral  cartilage  next  above.     The 


HOMICIDE  AND    WOUNDS.  303 

cancellated  tissue  of  the  body  of  the  first  was  much  comminuted,  and  the 
fragments  were  very  much  displaced.  Several  deep  fissures  extended 
from  the  track  of  the  bullet  upward  into  the  lower  part  of  the  body  of 
the  twelfth  dorsal  vertebra.  Others  extended  downward  through  the 
first  lumbar  vertebra  into  the  intervertebral  cartilage  between  it  and  the 
second  lumbar  vertebra.  Both  this  cartilage  and  the  next  above  were 
partly  destroyed  by  ulceration.  A  number  of  minute  fragments  from 
the  fractured  lumbar  vertebrae  were  driven  into  the  adjacent  soft  spots. 
On  sawing  through  the  vertebra?  from  behind,  a  little  to  the  right  of  the 
median  line,  it  was  found  that  the  spinal  cord  was  not  involved  by  the 
track  of  the  missile.  The  spinal  cord  and  other  contents  of  the  spinal 
canal  presented  no  abnormal  appearance.  The  fractured  spongy  tissue 
of  the  vertebra?  was  suppurating.  The  missile  was  lodged  behind  the 
pancreas.  Secondary  hemorrhage  from  the  splenic  artery  had  super- 
vened, causing  death  seventy-eight  days  after  the  infliction  of  the  wound." 

And  when  the  bullet  cuts  the  cord  death  is  not  immediate,  but  may 
"be  deferred  for  some  weeks.  Immediately  all  power  of  motion  is  lost  if 
the  cord  is  divided  below  the  point  of  injury,  and  the  injury,  causing 
paralysis,  proves  fatal  from  varying  causes.  The  digestion  may  be  So 
impaired  that  death  is  due  to  this,  or  asphyxia  from  interference  with 
the  muscles  of  respiration ;  or  exhaustion  from  bed-sores  and  loss  of 
functions  may  be  the  immediate  cause  of  death.  The  bullet,  where  it 
has  cut  through  the  body  of  a  vertebra,  wall  be  more  or  less  upset.  It 
may  still  be  measured,  for  part  will  probably  retain  the  circumference, 
and  so  allow  of  determination  whether  it  could  have  been  fired  from  the 
weapon  with  which  the  assault  is  alleged  to  have  been  committed ;  and 
the  same  remarks  as  were  made  when  speaking  of  the  Billings  case,  con- 
cerning the  care  with  which  the  bullet  should  be  examined,  are  equally 
applicable  where  a  wound  of  the  spinal  column  is  made  by  a  ball. 

Facial  Wounds. — Usually  wounds  of  the  face  give  deformity,  and 
this  may  become  a  question  the  medical  expert  has  to  pass  upon ;  for  if 
an  assault  is  claimed  and  the  wound  healed,  the  question  of  whether 
such  a  wound  as  is  said  to  have  been  received  would  leave  the  mark  in 
evidence  will  be  asked  of  the  physician.  And  the  results  of  apparently 
trivial  wounds  are  matters  to  be  carefully  considered.  The  injury  re- 
ceived over  the  orbit  may  be  but  a  small  lacerated  and  contused  wound, 
but  the  supraorbital  nerve  may  be  involved  in  the  bruising,  and  traumatic 
neuralgia  develop,  converting  a  simple  wound  into  one  of  serious  nature. 
The  eye  itself  is  protected  by  being  placed  in  a  deep  socket,  which  is 
surrounded  by  a  strong  ring  of  bone,  and  when  a  blow  is  struck  upon 
the  eye  the  ball  is  pressed  by  the  muscles  of  the  lids  as  far  back  into  the 
orbit  as  possible,  nature  taking  this  mode  of  protecting  the  organ  from 
injury.  A  penetrating  wound  of  the  orbit,  however,  may  be  a  fatal  one, 
for  while  the  external  bone  forming  the  cavity  is  strong  and  thick,  the 
plates  lining  it  are  thin  and  easily  pierced.  The  roof  of  the  orbit,  the 
<  wrbital  plate  of  the  frontal  bone,  is  so  thin  as  to  be  translucent,  and  any 
instrument  which  can  penetrate  the  soft  parts  can  also  force  this  plate. 
In  this  way  injury  to  the  membranes  of  the  brain,  or  to  the  brain  sub- 
stance, may  be  received,  and  while  not  always  proving  fatal  at  once,  is 
liable  to  give  from  inflammation  not  only  cause  for  alarm,  but  be  the 
cause  of  death.  And  even  if  the  orbital  plate  be  not  pierced,  the  inflam- 
mation and  suppuration  of  the  tissues  around  the  eyeball  may  follow 


304  A   SYSTEM   OF  LEGAL   MEDICINE. 

into  the  brain  along  the  course  of  the  optic  nerve.  All  wounds,  there- 
fore, involving  the  orbit  are  serious  ones,  and  if  the  wound  is  deep,  dan- 
gerous. 

Wounds  of  the  nose,  if  it  is  fractured  and  the  arch  is  broken,  result  in 
deformity.  When  the  fracture  does  not  destroy  the  integrity  of  the  arch, 
there  may  be  no  deformity,  and  no  opinion  could  be  given  as  to  the  blow 
or  character  of  the  injury.  In  the  case  referred  to  of  the  gentleman 
injured  when  riding  to  hounds,  the  nose  was  broken  by  the  hat  being 
forcibly  driven  down  upon  it.  Crepitus  could  distinctly  be  felt  after  the 
injury,  but  as  the  septum  was  not  crushed  no  deformity  resulted.  Pen- 
etrating wounds  of  the  nasal  cavities  may  lead  to  serious  results,  for  the 
upper  passage  leading  to  the  ethmoidal  and  sphenoidal  cells  may  partici- 
pate in  the  inflammation  and  suppuration,  and  as  the  ethmoid  is  of 
paper-like  bone,  the  spread  to  the  cranial  meninges  is  not  difficult.  The 
instrument  making  the  wound  may  go  into  the  brain  and  wound  it  pri- 
marily, causing  either  sufficient  hemorrhage  to  give  compression,  or  sup- 
purative inflammation. 

Incised  or  lacerated  wounds  involving  other  portions  of  the  face,  aside 
from  the  deformity  they  leave,  are  not  more  dangerous  than  wounds  in 
other  parts  of  the  body,  and  they  may  vary  in  extent  as  far  as  the  size  of 
the  face  will  permit.  One  involving  the  cheek  and  cutting  across  Steno's 
duct,  while  not  more  dangerous,  is  more  serious,  the  difficulty  in  prevent- 
ing a  fistula  resulting  complicating  the  wound. 

Gunshot  wounds  in  the  face,  if  not  fatal  by  penetration  into  the  brain,, 
are  usually  followed  by  great  deformity,  especially  if  the  ball  has  torn 
through  bone.  They  are  dangerous  wounds,  if  of  any  extent,  but  not 
necessarily  fatal,  although  other  results  than  the  deformity  are  to  be  ex- 
pected. The  concussion  may  be  so  severe  as  to  impair  the  brain,  and  the 
patient  never  recover  the  former  condition  of  that  organ.  Or  by  reason 
of  loss  of  bone,  mastication  be  interfered  with,  bringing  with  it  disar- 
rangement of  the  digestion  and  its  attendant  evils.  The  sight  of  one 
eye  may  be  lost  and  the  other  injured ;  the  special  senses  may  be  affected,, 
the  sense  of  smell  being  killed,  and  hearing  in  one  or  both  ears  destroyed 
by  injury  to  the  Eustachian  tubes  or  obliteration  of  the  external  meatus 
by  cicatricial  tissue.  The  speech  may  be  changed  by  loss  of  bone  or 
wounds  of  the  tongue,  so  as  to  make  intelligible  conversation  almost  an 
impossibility ;  the  lower  jaw  may  be  anchylosed  on  one  or  both  sides,  in- 
terfering with  mastication  ;  deglutition  may  also  suffer  from  the  loss  by 
suppuration  following  these  wounds ;  and  these  facts  must  all  be  taken 
into  account  in  giving  an  opinion  as  to  the  severity  of  an  injury  of  this 
nature  and  the  permanency  of  the  effects. 

Wounds  of  the  Neck. — Commonly  these  are  incised,  and  more  fre- 
quently suicidal  than  homicidal.  In  suicidal  wounds  the  cut  is  generally 
slanting,  from  left  to  right  and  from  above  down.  They  are  not  invari- 
ably fatal,  for  persons  cutting  their  throats  are  apt  to  carry  the  knife  too 
high,  and  thus  strike  the  hyoid  bone  instead  of  severing  the  "jugular," 
the  point  aimed  for.  Unless  the  suicide  is  determined,  a  missed  fatal 
cut  may  not  be  followed  up,  the  pain  of  the  first  effort  deterring  from  a 
second,  and  bringing  the  actor  to  a  sense  of  what  he  is  doing,  and  at 
the  same  time  to  a  desire  for  life.  The  difference  between  wounds  self- 
inflicted  and  those  for  the  purpose  of  homicide  has  been  already  dwelt 
upon.     The  murderer  cuts  to  kill,  and  is  more  apt  to  use  greater  force 


HOMICIDE  AND    WOUNDS.  305 

than  lie  who  seeks  his  own  life,  and  the  wound  will  give  evidence  of  this 
fact.  Then  also  the  cut  is  as  often  from  right  to  left  as  vice  versd,  and 
proof  being  adduced  to  show  the  deceased  was  right-handed,  wovdd  give 
suspicion  of  murder  rather  than  suicide. 

Stab-wounds  depend,  of  course,  upon  what  the  weapon  divides  as  it  is 
driven  in.  If  the  blow  misses  its  mark  by  the  assailed  turning  or  from 
whatever  cause,  a  slight  wound  may  result,  the  knife  only  passing  through 
muscular  tissue  without  severing  any  vessels,  trachea  or  oesophagus. 
These  wounds  are  almost  always  homicidal,  and  from  their  position,  on 
right  or  left  side,  struck  probably  from  behind  or  in  front.  The  evidence 
of  the  wound  will  lead  the  medical  examiner  to  the  conclusion  of  the  as- 
sailant's position.  They  are  dangerous  wounds,  and  if  dividing  the  large 
vessels,  almost  immediately  fatal.  When  the  weapon  is  driven  with 
sufficient  force  and  by  chance  takes  the  proper  direction,  the  spinal  cord 
may  be  severed,  the  blade  passing  between  two  vertebrae.  In  such  case 
the  assailed  drops  at  once,  for  if  not  instantly  killed,  he  is  instantly  par- 
alyzed below  the  section. 

When  the  wound  is  from  a  bullet  it  is  generally  fatal,  especially  if  the 
shot  is  from  the  front,  as  in  this  position  there  is  more  chance  of  its  cut- 
ting vital  parts.  If,  however,  the  ball  passes  only  through  the  muscle, 
say,  for  example,  the  sterno-cleido-mastoid,  the  wound  is  not  a  dangerous 
one ;  but  if  it  approaches  nearer  the  median  line,  the  danger  increases 
the  closer  to  the  center  it  comes.  If  the  patient  survive  the  shot,  per- 
manent injury  may  result,  for  where  it  is  in  the  lower  part  of  the  neck 
some  of  the  cervical  plexus  of  nerves  may  be  cut  through,  and  more  or 
less  paralysis  of  the  upper  extremity  of  that  side  follow ;  for,  as  stated 
before,  a  bullet  kills  the  tissues  it  plows  through,  disintegrating  them  by 
the  force  with  which  it  is  driven,  and  a  nerve  severed  by  a  ball  does  not 
heal  again  as  one  divided  by  a  knife.  By  injury  to  the  windpipe  or  gul- 
let deglutition  and  respiration  may  be  permanently  impaired,  and  these 
probable  results  must  be  taken  into  account  in  deciding  upon  the  danger 
of  the  wound  and  the  extent  of  the  injury. 

Wounds  of  the  Chest. — Superficial  wounds  of  this  region  require 
but  little  if  any  attention,  for  unless  the  wound  penetrates  the  cavity  the 
danger  is  small.  Hence,  contusions  are,  however,  more  serious,  for  from 
them  fracture  of  the  ribs  or  sternum  may  take  place,  or  rupture  of  inter- 
nal organs.  When  speaking  of  fractures,  the  break  of  a  rib  from  direct 
violence  was  stated  to  occur  opposite  the  point  of  the  contusion,  and  here 
the  danger  is  that  the  fragments  are  apt  to  be  driven  in  by  the  force 
used,  perforating  the  pleura,  if  not  the  lung  itself.  In  such  a  case  em- 
physema may  follow,  or  inflammation  of  the  tissue  injured.  On  Christ- 
mas, 1871,  there  was  brought  into  the  surgical  wards  of  the  Brooklyn 
City  Hospital,  of  which  I  then  had  charge,  a  young  man  who  was  found 
by  the  police  insensible  and  injured.  Examination  showed  a  long  list  of 
wounds,  and  among  others  fractures  of  two  ribs  of  the  left  side.  The 
general  injuries  comprised  lacerated  wound  over  left  eye,  punctured 
wound  behind  left  ear  and  on  left  cheek,  fracture  of  left  clavicle,  scapula, 
and  ribs,  dislocation  of  right  clavicle  from  the  acromion,  dislocation  of 
the  cartilages  of  left  ribs  from  sternum,  frozen  hands  and  frozen  feet. 
The  evidence  of  the  injuries  showed  the  man,  while  lying  on  his  right 
side,  had  probably  been  jumped  upon,  for  all  the  direction  of  force  was 
from  left  to  right.     The  fractured  ribs  had  punctured  the  lungs  and  em- 


306  J   SYSTEM  OF  LEGAL  MEDICINE. 

physema  began,  but  did  not  spread  further  than  over  the  left  breast,  and  a 
little  on  left  side  of  the  neck,  for  traumatic  pneumonia  developing,  the  in- 
flammation shut  up  the  puncture  through  which  air  was  escaping.  De- 
spite these  serious  injuries  and  the  operations  on  hands  and  feet  that  had 
to  be  performed  to  remove  the  frozen  fingers  and  toes,  the  man  made  a 
good  recovery.  The  heart  as  well  as  the  lungs  may  be  injured  by  a 
broken  rib,  and  when  so,  a  fatal  result  is  to  be  expected. 

When  the  wound  is  to  the  lungs,  the  first  element  of  danger  is  from 
bleeding.  The  force  of  the  blow,  while  it  may  not  fracture  a  rib,  may 
rupture  a  lung,  and  death  from  hemorrhage  follow.  And  such  an  injury 
may  also  be  due  to  a  fall  or  to  a  crush,  where  great  weight  may  pass 
over  the  body,  such  as  a  carriage-wheel.  If  the  wound  is  from  a  weapon, 
a  knife,  for  instance,  the  injury  to  the  lung  may  be  comparatively  slight,, 
and  yet  death  ensue ;  for  these  wounds  bleed  more  than  their  extent  ap- 
pears to  warrant,  and  how  much  blood  is  being  lost  cannot  be  determined,. 
the  blood  running  into  the  pleural  cavity  rather  than  out  of  the  external 
wound.  If  the  stab  divides  one  of  the  larger  vessels,  then  the  patient 
generally  sinks  rapidly ;  for,  as  shown  in  the  autopsy  on  the  body  of 
Woods,  the  blood  may  fill  the  entire  side  of  the  chest  cavity,  compressing 
the  lung  to  its  smallest  circumference.  If  air  can  escape  from  the  wound, 
the  diagnosis  of  the  deeper  wounding  involving  the  lung  is  made  by  bub- 
bles being  mixed  with  the  blood ;  the  blood  is  frothy. 

While  wounds  to  the  parietes  are  generally  of  little  danger,  gunshot 
injuries  may  leave  such  conditions  as  cause  a  positive  crippling  of  the 
patient,  especially  where  the  missile  tears  more  substance  than  a  simple 
bullet  would.  The  sequelas  may  be  a  contracted  condition  of  the  chest 
walls,  impairment  of  respiratory  movements,  pleuritic  inflammations  with 
adhesive  exudations,  and  cough  and  pain  follow,  to  shorten  the  days  of 
the  sufferer.  If  the  ball  or  shot  penetrate  the  chest  cavity,  the  fatality 
is  much  greater,  and  generally  the  person  shot  survives  but  a  short  time 
after  receiving  the  wound.  The  Surgical  History  of  the  War  of  the 
Rebellion  gives,  however,  instances  in  which  wounds  of  this  character 
were  recovered  from,  where  ordinarily  it  would  be  considered  the  inju- 
ries were  fatal.  Private  Charles  P.  Betts  was  struck  by  a  three-ounce 
grape-shot  at  the  battle  of  Fredericksburg.  The  sternum  was  commi- 
nuted at  the  bend  of  the  third  rib,  and  the  costal  pleura  torn  through. 
The  arch  of  the  aorta  and  its  pulsations  could  be  plainly  seen  through 
the  wound.  The  man  recovered,  but  in  1872  reported  the  wound  was 
not  perfectly  healed,  the  left  lung  weak,  and  that  he  suffered  somewhat 
from  dyspnoea. 

In  1864  Private  Steele  was  wounded  by  a  round  ball  which  entered 
upper  part  of  sternum  and  lodged  under  left  scapula.  He  recovered,  but 
with  permanent  interference  with  motion  of  the  arm  and  with  hemor- 
rhage of  the  lungs.     This  condition  was  reported  in  1869. 

A  remarkable  case  was  that  of  Lieutenant-Colonel  Lewis,  who  was 
wounded  at  Port  Hudson  in  1863,  by  an  iron  grape-shot  weighing  half 
a  pound  and  being  an  inch  and  a  half  in  diameter.  The  shot  entered 
just  above  the  right  clavicle,  fractured  that  bone,  passed  downward 
through  apex  of  lung,  passed  out  of  chest  about  third  dorsal  vertebra, 
breaking  the  ribs,  and  lodged  under  the  skin  on  the  left  side  of  the  spine 
near  the  fifth  dorsal  vertebra,  from  whence  it  was  removed.  This  man 
recovered,  but  the  wound  was  not  healed  for  a  year,  and  several  pieces 


HOMICIDE  AND    WOUNDS. 


307 


of  bone  had  to  be  removed.  Air  could  be  blown  out  of  both  wounds  of 
entrance  and  exit  until  they  closed.  In  1865  he  was  reported  by  the 
pension  examiner  as  having  his  right  arm  very  weak,  some  cough  at 
times,  and  a  good  deal  of  tenderness  on  right  side  of  chest. 

These  cases  could  be  multiplied  many  times,  but  they  are  sufficient  to 
call  the  medical  examiner's  attention  to  the  fact  that  while  such  wounds 
are  highly  dangerous,  they  are  not  necessarily  fatal,  and  it  further  again 
emphasizes  the  fact  that  care  must  be  exercised  before  pronouncing  in- 
juries necessarily  ones  from  which  death  must  result. 

Wounds  of  the  Heart. — Blows  or  severe  contusions  may  rupture  the 
heart  the  same  as  rupture  may  occur  in  the  lungs.  The  death  is  caused 
by  two  factors :  one,  the  bleeding ;  and  the  second  and  more  potent,  the 
hydrostatic  pressure  of  the  blood,  preventing  the  movements  of  the  heart, 
for  the  rupture  does  not  involve  the  cardiac  sac,  and  it  being  inelastic, 
the  blood  exerts  so  much 
pressure  the  heart  cannot 
work.  Pressure  from  ve- 
hicles or  weights  on  the 
chest  may  cause  rupture, 
and  it  may  also  come  from 
natural  causes  or  disease. 
Severe  pressure  is  there- 
fore to  be  carefully  looked 
after,  for  while  no  appar- 
ent injury  is  to  be  seen  ex- 
ternally, we  may  have  a  le- 
sion which  will  cause  death 
as  a  result  of  the  sustained 
force.  Like  every  other 
class  of  wounds,  exceptions 
are  found,  and  these  serve 
but  to  enforce  the  meaning 
of  the  proverb,  "What's  one 
man's  meat  is  another  man's 
poison."  I  remember  a  case 
which  was  brought  into  the 
yard  of  the  old  New  York 
Hospital  in  1869,  when  it 
was  on  Broadway.  I  was 
serving  as  a  substitute  on 
the  surgical  division,  and 
happening  to  be  alone,  was 
called  to  see  a  patient  just 
brought  in  by  the  police. 
Going  down  to  the  yard,  I  found  a  man  lying  in  a  push-cart,  insen- 
sible, very  pale,  and  evidently  suffering  from  shock.  Asking  the  acci- 
dent, the  officer  stated  that  the  man  had  been  pushing  his  cart  along 
Broadwav  when  he  was  knocked  down  by  an  omnibus  and  run  over. 
The  mark  of  the  wheel  was  plainly  to  be  seen  on  the  patient's  clothes, 
and  the  track  extended  from  the  right  hip  to  the  left  shoulder,  passing 
directly  over  the  heart.  No  fracture  could  be  found.  I  went  to  report 
the  case  to  the  sujjerintendent  and  get  the  order  for  his  admission. 


Fig.  72.— 1,  Right  ventricle;  2,  left  ventricle;  3.  right 
auricle;  4,  left  auricle;  5,  pulmonary  artery:  li,  right 
pulmonary  artery;  7,  left  pulmonary  artery;  8,  liga- 
ments of  the  ductus  arteriosus;  9,  arch  of  aorta;  UK 
superior  vena  cava;  11,  arteria  innominata:  1:.'.  right 
subclavian  vein;  13.  right  common  carotid  artery  and 
vein;  14,  left  vena  innominata;  15,  left  carotid  vein  and 
artery;  16,  left  subclavian  vein  and  artery;  17,  trachea 
and  windpipe;  18,  right  bronchus;  10,  left  bronchus:  20, 
pulmonary  veins ;  21,  superior  lobe  of  the  right  lung ;  22, 
middle  lobe ;  23,  inferior  lobe :  24,  superior  lobe  of  the  left 
lung;  25,  inferior  lobe.     (After  Taylor.) 


308  A   SYSTEM  OF  LEGAL   MEDICINE. 

When  I  left,  the  man  was  still  insensible.  When  I  returned,  after  an 
absence  of  abont  six  to  ten  minutes,  I  heard  a  shout  of  laughter  in  the 
yard,  and  there  was  the  man  on  his  feet  and  using-  language  more  forcible 
than  polite,  at  being  detained  until  "  some  fool  doctor"  would  let  him  go, 
and  he  not  hurt.  He  went,  pushing  his  cart  before  him,  nor  did  he  thank 
the  policeman  who  had  palled  him  out  from  his  dangerous  position,  or 
the  "fool  doctor"  who  tried  to  make  a  patient  of  him. 

When  the  wounding  is  by  stabbing,  it  is  usually  instantly  fatal.  The 
shock  and  the  hemorrhage  both  bring  about  the  result.  But  the  stab 
may  be  by  a  small-pointed  instrument,  or  the  point  of  the  knife  may 
wound  the  muscular  tissue  of  the  heart  without  penetrating  the  cavities. 
In  such  case  death  may  be  deferred  for  some  days,  and  be  due  to  inflam- 
mation caused  by  the  wound.  A  small  puncture  may  bleed  but  little,  and 
only  as  the  contraction  of  the  heart  allows  the  muscular  fibers  to  come 
into  the  position  in  which  they  were  at  the  moment  the  stab  was  received. 
This  bleeding  may  continue  for  some  time  and  death  follow. 

Gunshot  wounds  of  the  heart  are  almost  always  instantly  fatal.  It  is 
not  the  invariable  rule,  for,  as  shown  by  the  Woods  case,  the  injured  man 
may  use  violent  muscular  action  even  when  a  bullet  of  large  size  has 
gone  through  the  heart,  and  live  three  days.  The  wound  in  this  case 
was  through  the  right  auricle.  If  the  ventricles,  one  or  both,  are  pene- 
trated, it  would  be  more  probable  to  cause  death  sooner  than  where  an 
auricle  was  injured ;  but  the  fact  is  established  by  more  than  one  case 
that  a  bullet  may  wound  the  heart  and  the  person  live  for  some  time, 
varying  from  hours  to  days. 

Wounds  of  the  Diaphragm. — When  these  are  from  gunshot  or  stabs, 
the  organs  lying  either  above  or  below  are  more  or  less  involved,  and 
death  is  due  to  the  injuries  beyond  the  diaphragm,  its  wound  being  com- 
paratively unimportant.  When,  however,  the  wounding  is  a  rupture  of 
the  muscle  caused  by  contusions  or  falls,  the  condition  is  altered.  Here 
the  danger  is  from  the  complications  that  are  apt  to  take  place,  for  the 
torn  muscle  itself  bleeds  but  little,  and  with  as  perfect  rest  as  can  be 
given  would  heal  readily.  The  danger  comes  from  what  is  known  as 
phrenic  hernia,  as  the  passage  through  the  opening  made  by  the  rupture 
of  some  portion  of  the  abdominal  contents  is  termed,  and  as  the  wound 
heals  strangulation  may  supervene  and  be  the  cause  of  the  death,  even 
though  over  a  year  has  elapsed  since  the  receipt  of  the  injury  which 
caused  the  rupture.  The  history  of  the  case  would  have  to  be  carefully 
gone  into  by  the  medical  examiner  before  he  could  give  an  opinion  that 
the  hernia  was  due  to  the  injury  under  investigation. 

Wounds  to  Abdominal  Walls. — Blows  struck  on  the  abdomen  do 
not  usually  show  ecchymosis.  While  the  yielding  character  of  the  ab- 
dominal walls  allows  of  their  escaping  a  good  deal  from  the  effects  of  a 
blow,  the  injury,  nevertheless,  may  be  most  serious,  for  this  very  yielding 
allows  the  force  of  the  blow  to  be  expended  on  the  deeper  tissues  or 
the  contents  of  the  abdominal  cavity.  The  blow  may  be  followed  by 
peritonitis  or  by  rupture  of  liver,  spleen,  stomach,  or  intestines ;  or  it 
may  be  instantly  fatal  by  shock,  the  concussion  being  to  the  solar  plexus. 
In  this  case  no  trace  post-mortem  would  be  found,  and  the  blow  even 
could  be  a  light  one.  Professor  T.  11.  Thomas,  of  New  York,  used  to 
relate  a  case  where,  in  coming  out  of  the  theater,  some  young  men  were 
indulging  in  rather  boisterous  play,  and  one  bending  another  quickly 


HOMICIDE  AND    WOUNDS. 


309 


over  his  arm,  tapped  him  a  sharp  blow  with  the  disengaged  hand  on  the 
stretched  abdomen.  The  blow  alighted  over  the  solar  plexus,  and,  to  the 
horror  of  him  striking,  his  friend  Avas  immediately  killed.  In  a  fight,  a 
blow  may  be  seen  struck  and  the  recipient  fall  dead.  If  the  medical  ex- 
aminer finds  nothing  on  holding  the  autopsy  to  cause  the  sudden  death, 
he  can  testify  that  a  shock  to  the  solar  plexus  will  cause  death,  and  the 
post-mortem  examination  give  no  evidence  to  support  or  disprove  the 
statement.  The  absolute  absence,  however,  of  any  other  reason  or  injury 
to  other  organs  will  add  weight  to  his  testimony,  evidence  of  the  blow 
being  present. 

Wounds  to  the  Liver. — The  liver,  by  its  position  and  structure,  is 
peculiarly  liable  to  suffer  rupture  from  violence  done  to  the  abdomen. 
Or,   like   all   the    other  or- 


gans 


Fig.  73.— The  liver:  1,  right  lobe;  2,  left  lobe:  3, 
lobus  caudatus;  4,  lobus  Spigelii;  5,  lobus  caudatus: 
6,  longitudinal  fissure;  7,  pons  hepatis;  8,  fissure  of 
the  duct:  9,  inferior  vena  cava:  10,  gall-bladder;  11, 
transverse  fissure.     (After  Taylor.) 


it  may  be  injured 
by  a  fall.  The  contusion 
causing  the  rupture  may  not 
give  external  evidence  of  its 
infliction,  and  the  patient 
after  receiving  the  blow  is 
able  to  walk  and  may  com- 
plain of  only  pain  and  weak- 
ness. This  condition  is,  how- 
ever, only  found  when  the 
rupture  does  not  involve  the 
large  vessels,  for  if  the  vena 
cava  is  also  torn,  death  is  al- 
most immediate.  The  rupt- 
ure of  the  liver  itself  does 
not  bleed  rapidly,  death  fol- 
lowing the  injury  in  from 

one  to  two  days,  or  it  may  be  earlier.  Cases  are  reported  where  the 
patient  has  lived  longer,  but  the  general  rule  is  that  death  takes  place 
within  about  forty-eight  hours. 

The  liver  may  be  involved  in  other  wounds,  such  as  a  stab  either  from 
above  or  below.  If  death  is  from  the  wound  to  the  liver,  and  its  large 
blood-vessels  are  not  involved  in  the  cutting,  it  follows  much  the  same 
course  as  in  rupture. 

In  the  case  of  Mr.  Hadley,  the  stab  did  not  involve  the  liver,  but  the 
sharp  end  of  the  cartilage  of  the  rib,  becoming  depressed  and  eroded  by 
the  action  of  the  suppuration,  caused  the  lesion  of  the  liver,  and  the  in- 
flammation was  only  prevented  from  infecting  the  peritoneal  cavity  by 
the  adhesions  which'  had  formed  between  the  liver  and  parietes. 

It  has  been  seen  in  two  cases  quoted  that  gunshot  wounds  of  the  liver 
apparently  had  but  small  effect  upon  the  wounded,  and  in  neither  case 
was  the  evidence  post-mortem  that  death  was  due  to  the  hepatic  injuries. 
In  both  cases  the  wound  was  by  pistol-ball,  and  in  the  case  of  Hess  the 
man  did  not  live  long  enough  for  any  inflammation  to  start  in  the  liver 
as  the  result  of  the  bullet's  passage.  In  the  case  of  Woods,  while  he  lived 
three  days  after  the  shooting,  the  hepatic  wound  showed  merely  the  red 
line  of  the  ball's  track,  and  union  was  taking  place.  There  was  no  evi- 
dence of  bleeding  having  followed  the  bullet.  Naturally,  if  a  lacerating 
gunshot  wound,  such  as  would  be  made  by  a   shotgun,  was  inflicted  in 


310  A   SYSTEM  OF  LEGAL  MEDICINE. 

the  liver,  it  would  be  fatal,  and  probably  immediately  so ;  but  here  the 
shock  would  be  much  greater  than  from  a  single  ball,  and  this  might 
have  to  do  with  the  death  before  the  wounding  of  the  liver  would  have 
time  to  exert  much  influence.  Again,  such  a  wound  would  cause  much 
greater  hemorrhage  than  a  pistol-bullet,  and  death  might  be  due  to  this. 

The  spleen  may  be  considered  in  the  same  way  the  liver  has  been,  as 
affected  by  the  same  class  of  injuries,  and  causing  death  in  the  same 
manner.  Both  glands  are  so  near  alike  in  general  character  as  regards 
injuries,  that  the  description  of  wounds  to  one  is  equally  applicable  to 
wounds  of  the  other. 

Wounds  to  Kidneys. — Concussion  may  rupture  these  organs  either 
to  such  an  extent  as  to  cause  a  fatal  result,  or  slighter  injuries  ensue, 
from  which  recovery  takes  place.  In  1889  a  horse-car  driver  was  vio- 
lently tin-own  from  his  car  by  collision  with  a  railroad  engine.  He  was 
dazed  by  the  fall,  but  after  coming  to  his  senses  got  on  to  another  horse- 
car,  went  to  his  doctor's,  walking  a  block  after  leaving  the  car,  then  went 
back  in  the  same  way  to  near  the  place  where  the  accident  occurred,  and 
again  leaving  the  car,  walked  to  his  home,  about  three  blocks  distant,  and 
went  to  bed.  He  was  assisted  by  two  men  when  walking.  That  night 
and  for  three  days  afterward  he  passed  bloody  urine.  After  that  time 
the  blood  gradually  disappeared  until  it  was  entirely  gone,  about  a  week 
or  ten  days  after  the  injury.  There  was  undoubted  rupture  of  a  kidney 
in  this  case,  for  there  was  no  injury  to  the  bladder,  no  wounding  which 
would  cause  bleeding,  and  in  no  other  way  could  the  blood  in  the  urine 
be  accounted  for.  And  yet  even  with  this  ruptured  kidney  the  man 
walked  some  distance.  Cases  are  reported  where  persons  suffering  from 
ruptures  which  eventually  caused  death  walked  after  the  receipt  of  the 
injury,  and  gave  at  first  no  symptoms  of  such  serious  wounding. 

Wounds  of  the  Stomach  and  Intestines. — These  organs  may  be 
ruptured  from  external  violence  in  the  same  way  as  the  foregoing, 
although  ruptures  from  disease,  from  ulcers  which  have  existed  some 
time,  are  more  common.  The  injury  is  one  generally  quickly  fatal,  and 
is  characterized  by  shock  and  pain.  The  contents  of  the  viscera  escape 
into  the  peritoneal  cavity,  but  usually  there  is  little  hemorrhage  unless 
the  rupture  has  involved  a  vessel.  When  the  rupture  is  from  disease, 
the  microscope  would  aid  in  determining  the  fact,  as  it  would  show  on 
some  part  of  the  rent  the  presence  of  the  ulcer.  And  unless  the  body 
was  found  dead,  or  under  such  circumstances  as  to  cause  doubt  of  the 
manner  of  the  death,  the  history  of  the  case  would  answer  the  question 
of  criminal  interference. 

Stab-wounds  have  the  same  effect  as  ruptured  ones,  with  the  added 
injury  of  the  entering  wound  through  the  parietes.  Death  in  such  cases 
may  be  due  to  the  shock  and  escape  of  the  contents,  or  to  these  combined 
with  bleeding.  Even  though  a  serious  rupture  may  be  present  in  the 
stomach,  the  patient  may  walk  some  distance  and  fatal  collapse  not  ensue 
for  some  hours.  This  is  also  true  of  ruptures  of  the  intestines.  I  am 
indebted  to  Dr.  W.  G.  MacDonald,  of  Albany,  for  the  following  case  :  In 
1893  a  man  of  thirty-six  years  of  age,  strong  and  well,  weighing  about 
one  hundred  and  forty  pounds,  a  junk-dealer  by  occupation,  engaged 
one  Sunday  morning  in  a  wrestling  bout  with  a  friend  who  was  a  heavier 
man  than  himself,  one  weighing  about  two  hundred  pounds.  They  used 
what  is  called  the  "back  hold,"  that  is,  each  put  his  arms  around  the 


HOMICIDE  AND    WOUNDS.  3H 

other,  the  hands  being  clasped  behind  the  adversary's  back,  and  then 
each  endeavored  to  throw  the  other  by  sudden  side  wrenches.  While 
struggling  and  tugging  the  lighter  of  the  two  said,  "  Let  go,  I  am  hurt." 
He  complained  of  pain  in  his  right  side,  and  sat  down  for  a  little  while 
on  a  bench  in  his  shop,  where  the  wrestling  took  place.  The  pain  did 
not  lessen  for  some  few  minutes.  Then,  feeling  a  little  easier,  he  started 
for  his  home,  walking  four  blocks  to  the  electric  cars,  in  which  he  rode 
about  half  a  mile,  and  then  walked  a  block  and  a  half  to  his  home.  The 
doctor  was  sent  for,  but  did  not  see  the  patient  until  six  o'clock  in  the 
evening,  some  three  or  four  hours  after  the  wrestling.  When  the  physi- 
cian arrived  the  man  was  sitting  up.  His  pulse  was  fifty-four  per  min- 
ute, but  no  rise  in  temperature.  Considering  he  had  to  deal  with  mus- 
cular strain,  the  doctor  ordered  morphine  and  hot-packs.  Betwreen  two 
and  three  o'clock  Monday  morning  the  patient  vomited,  but  no  alarm 
was  felt  by  the  family  until  near  seven  o'clock,  when  symptoms  of  col- 
lapse appeared.  The  doctor  was  summoned,  and  in  company  with  Dr. 
MacDonald,  who  had  been  called  for  consultation,  he  reached  the  house 
at  nine,  to  find  the  patient  was  dead. 

The  autopsy  showed  no  external  lesion  of  any  kind.  All  the  organs 
were  healthy,  and  no  signs  of  disease  were  found.  On  opening  the 
abdomen,  extravasation  of  fa?ces  stained  with  blood  was  found  in  the 
peritoneal  cavity.  No  clots  were  seen.  The  whole  peritoneum  was 
congested,  and  freshly  effused  lymph  was  present.  The  intestines  were 
matted  together.  The  effusion  was  like  that  of  hemorrhagic  peritonitis. 
Fifteen  inches  above  the  ileo-csecal  valve,  in  the  wall  of  the  ileum,  was  a 
rupture  five  eighths  of  an  inch  long  by  three  eighths  wide,  the  long 
diameter  being  transverse  to  the  gut.  About  one  and  a  half  inches  below 
the  rupture,  nearer  the  caput  coli,  was  an  ecchymosis  in  the  intestinal 
wall  the  size  of  a  twenty-five  cent  piece.  This  ecchymotic  effusion  was 
in  the  muscular  layer,  and  section  showed  it  to  be  a  fresh  bruise.  The 
intestines  were  very  full  of  faeces.  Careful  examination  of  the  rupture 
showed  no  sign  of  inflammatory  process  around  the  edge  of  the  rupture, 
and  nowhere  in  the  intestinal  track  was  there  any  point  where  an  ulcer 
was  beginning  or  had  been. 

The  position  of  the  rupture,  the  history  of  the  case,  aud  the  fact  that 
solitary  ulcers  of  the  small  intestines  do  not  occur,  shows  this  case  to 
have  been  a  rupture  from  exertion,  and,  it  may  be,  aided  by  strong  press- 
ure from  the  outside,  for  in  the  position  the  arms  of  the  two  men  were  in 
while  wrestling,  the  forearm  of  his  adversary  would  compress  the  abdom- 
inal parietes  just  about  opposite  the  position  of  this  rupture.  And  this 
outside  pressure  would  not  be  light,  but  at  the  same  time  it  would  not  be 
like  the  force  of  a  blow,  as  it  would  be  a  squeeze  or  hug.  Taking  into 
consideration  the  full  condition  of  the  intestines,  the  pressure  exerted 
from  within  by  the  diaphragm  and  from  without  by  the  arm  of  his  ad- 
versary, the  rupture  was  clearly  due  to  the  straining,  and  took  place  at 
the  moment  he  called  out,  "  Let  me  go,  I  am  hurt."  And  notwithstanding 
the  pain  and  the  shock  to  the  peritoneum  of  intestinal  contents  being  poured 
out  into  it,  the  man  walked  Ave  and  a  half  blocks,  rode  in  a  street-car 
half  a  mile,  sat  up  for  an  hour  or  more  before  the  doctor  saw  him,  and  gave 
no  symptom  of  being  mortally  hurt  until  two  hours  before  his  death. 

On  July  10, 1878,  with  suicidal  intent,  T.  B.,  a  prisoner  in  the  Albany 
County  Penitentiary,  inflicted  wounds  upon  himself  with  a  knife  he  had 


312  A   SYSTEM  OF  LEGAL  MEDICINE. 

made  out  of  the  steel  of  a  woman's  gaiter,  the  blade  being  three  eighths 
of  an  inch  wide,  two  long,  thick,  pointed,  and  well  ground.  The  case 
was  reported  by  Dr.  Samuel  B.  Ward,  of  Albany,  who  saw  the  patient 
with  the  penitentiary  physician,  Dr.  H.  R.  Haskins.  The  man  was  serv- 
ing a  thirty  years'  sentence  for  counterfeiting,  and  at  the  time  he  at- 
tempted self-destruction  was  undoubtedly  suffering  from  mental  aliena- 
tion. He  did  the  cutting  at  night  in  his  cell,  and  was  not  found  until 
the  morning.  The  doctor  was  sent  for,  and  found  the  man  exsanguinated, 
with  no  pulse  at  the  left  wrist  and  very  little  at  the  right.  B.  had  made 
an  attempt  to  sever  the  right  carotid,  had  cut  his  abdomen  and  the  left 
brachial  about  an  inch  above  the  elbow.  The  doctor  found  a  wound  one 
and  a  quarter  inches  long  over  the  left  brachial,  but  the  artery  was  not 
in  sight ;  a  wound  in  the  abdominal  parietes  which  extended  for  seven 
inches,  beginning  a  little  to  the  left  of  the  umbilicus  and  ending  at  the 
ensiform  cartilage,  through  which  protruded  the  stomach,  large  and  small 
intestines,  with  omentum,  gashed  in  several  places,  and  feeal  matter  was 
on  the  skin,  the  viscera  having  been  further  cut  after  protrusion.  The 
intestines  were  cold  and  dry,  somewhat  adherent,  and  had  fuzz  from  the 
blanket  which  lay  over  the  man  sticking  to  them.  Being  apparently 
moribund,  the  parts  were  merely  wiped  dry  with  the  handkerchief,  and 
after  an  hour  returned  to  the  abdominal  cavity,  immediate  efforts  at  re- 
duction being  prevented  by  severe  hiccough  and  pain.  The  wound  was 
closed  by  eight  stitches,  not  through  the  peritoneum,  and  broad  bands  of 
adhesive  plaster  were  passed  around  the  trunk.  The  wounds  in  the  neck 
and  arm,  bleeding  having  ceased,  were  brought  together  with  plaster 
only.  The  man  was  kept  under  the  influence  of  morphine,  and  after 
forty-eight  hours  was  removed  from  his  cell  to  the  prison  hospital.  For 
four  days  he  did  not  raise  his  head  or  move  hand  or  foot.  At  the  end  of 
that  time  the  stitches  were  removed,  the  wounds  having  nearly  healed  by 
first  intention,  about  an  inch  of  the  abdominal  wound  being  still  open 
at  top,  but  healed  at  the  bottom.  The  pulse  was  always  below  a  hun- 
dred, and  the  temperature  never  notably  increased.  Morphine  was  dis- 
continued on  the  eleventh  day,  and  the  bowels  moved  voluntarily  on  the 
fourteenth  day  after  the  wounding.  Dr.  Ward  states  that  by  the  27th  of 
the  month  a  firm  cylindrical  mass  could  be  felt  where  the  left  brachial 
was  wounded,  with  pulsation  in  the  artery  two  inches  above  and  also  at 
the  left  radial,  as  collateral  circulation  had  been  established.  The  .pris- 
oner was  returned  to  duty  November  1st. 

About  a  year  after  this  attempt  B.  made  another,  this  time  by  cutting 
his  throat.  Dr.  A.  Vander  Veer,  of  Albany,  saw  him,  in  consultation 
with  the  prison  physician,  Dr.  W.  H.  Murray,  and  reported  that  the  cutting- 
had  been  done  with  very  much  the  same  sort  of  knife  as  was  used  in  the 
first  instance.  This  time,  however,  two  knives  were  used,  one  in  each 
hand,  and  the  cutting  done  both  ways.  The  trachea  was  completely 
severed,  the  oesophagus  cut  into,  and  severe  hemorrhage  was  present 
from  both  superior  thyroids,  which  the  doctor  ligated.  The  wound  in 
the  oesophagus  was  closed  with  fine  silk  stitches,  that  of  the  trachea  with 
silver  wire,  the  external  wound  carefully  adapted,  and  good  drainage 
secured.  B.  again  recovered,  and  recovered  not  only  from  his  wounds, 
but  also  his  mental  balance.  He  was  pardoned  by  President  Cleveland 
in  1887,  and  at  that  time  was  in  excellent  health,  his  former  wounds 
giving  him  no  trouble  whatever. 


HOMICIDE  AND    WOUNDS. 


313 


This  ease  is  truly  remarkable,  and  shows  what  a  human  being  can 
stand  without  loss  of  life.  It  is,  however,  more  than  probable  that  it  is 
one  of  those  cases  where  "  the  exception  proves  the  rule,"  for  the  injuries 
inflicted  in  either  case  would  ninety-nine  times  out  of  a  hundred  be  fatal. 
Still,  it  is  just  such  cases  that  are  most  useful  to  the  medical  jurist,  for  he 
has  to  give  opinions  upon  not  only  how  wounds  cause  death,  but  whether 
they  are  the  only  and  absolute  cause ;  and  cases  like  the  above  impress 
caution  and  the  greatest  of  care  in  the  post-mortem  examination  to  see 
that  nothing  escapes  notice  which  could  in  any  way,  even  the  slightest, 
have  an  effect  upon  the  vital  forces. 

The  injuries  done  the  intestines  were  done  after  they  had  come  out 
of  the  body.  No  mention  is  made  of  their  extent,  or  whether  any  attempt 
was  made  to  close  their  wounds.  The  man  was  so  nearly  dead  and  the 
wounding  was  so  extensive  that  at  the 
time  he  was  seen  the  doctor  considered 
there  was  no  possible  chance  of  his  liv- 
ing, and  it  was  only  a  question  of  time 
when  he  woidd  die.  Precautions  were 
not  taken,  therefore,  as  to  cleansing  the 
intestines  :  these  were  merely  wiped  dry 
and  returned  to  the  cavity. 

To  compare  this  with  the  case  of  Dr. 
MacDonald's  is  to  call  attention  to  the 
great  distance  which  lies  between  the 
cause  of  death  in  one  man  and  the  vital- 
ity and  power  of  resistance  to  injuries  in 
another. 

Gunshot  wounds  of  the  intestines  are 
usually  fatal.  Where  the  wounding  in- 
volves the  abdominal  walls  alone  without 
puncture,  if  there  is  but  little  laceration 
no  marked  trouble  may  be  expected ;  but 
if  much  loss  of  substance  follow  the  in- 
jury, hernia  may  be  a  sequence,  the  cica- 
trix not  being  strong  enough  to  control 
the  viscera.  From  penetrating  wounds 
the  danger  is  hemorrhage,  with  escape  of 
the  intestinal  contents,  as  in  the  case  of 
Bedell,  shot  by  Hess.  If  the  large  blood- 
vessels are  cut  by  the  ball,  death  would 
be  rapid,  and  the  bullet  may  lodge  in  the 
spinal  column  in  such  way  as  to  cause  in- 
jury to  the  cord  and  paralysis  of  all  below 
the  point  of  its  contact.  Balls  have  lodged 
in  the  abdominal  cavity  and  the  x>atient 
recovered  without  any  bad  effects.  When 
the  bullet  passes  in  and  out,  traversing  the  large  intestine,  a  false  anus  nun- 
result.  Lieutenant  Borie,  of  the  navy,  was  severely  wounded  at  the  at- 
tack on  Fort  Fisher  during  the  War  of  the  Rebellion.  The  ball  traversed 
the  left  side  of  the  abdomen,  cutting  the  descending  colon.  For  three 
months  and  over  he  passed  the  faeces  through  the  wound.  Eventually 
recovering,  he  returned  to  duty.     In  December,  1867,  I  was  returning 


Fig.  74.— a,  Stomach;  ?>,  oesophagus; 
c,  cardiac  end  of  stomach ;  d.  pyloric 
end  of  stomach;  c,  pylorus;  /,  duode- 
num; o,  jejunum;  h,  ileum:  i,  vermi- 
form appendix;  /r,  caecum;  t,  m.  re,  as- 
cending, transverse,  and  descending 
colon;  o,  rectum.    (After  Taylor.) 


.314  A   SYSTEM  OF  LEGAL   MEDICINE. 

from  Rio  de  Janeiro,  and  on  the  same  ship  Lieutenant  Borie  took  passage, 
going  home  on  sick  leave.  He  had  been  attached  to  the  South  Atlantic 
squadron,  but  could  not  stand  the  effects  of  the  hot  weather,  it  seemingly 
affecting  his  old  wound,  causing  paroxysms  of  pain  which  rendered  him 
unfit  for  duty.  His  state-room  being  next  to  mine,  I  had  full  chance  to 
observe  his  condition,  and  noticed  how  he  suffered  whenever  the  heat  in- 
creased. As  soon  as  we  ran  into  cooler  latitudes  his  condition  improved. 
He  stated  that  this  had  happened  ever  since  his  recovery,  and  while  he 
felt  no  inconvenience  from  his  wound  when  in  cold  climates,  as  soon  as 
he  was  exposed  to  constant  and  high  temperatures  the  pains  came  on, 
rendering  him  weak  and  absolutely  unable  to  stand  or  walk. 

Shot  wounds  of  the  smaller  intestines  are  much  more  dangerous  than 
those  of  the  large,  and  the  injury  to  the  colon  is  less  dangerous  where  it 
is  to  the  descending  than  to  the  transverse  or  ascending  portions.  In 
the  Medical  and  Surgical  History  of  the  War  of  the  Rebellion  but 
five  cases  of  bullet  wounds  to  the  small  intestines  are  reported  as  having 
recovered,  and  these  are  given  with  caution  as  to  the  fact  that  the  intes- 
tines had  really  been  implicated  in  the  wounding.  The  medical  examiner 
can,  therefore,  in  making  his  statement  as  to  the  danger  to  life  of  a  pen- 
etrating gunshot  wound  of  the  abdominal  cavity,  gauge  somewhat  the 
amount  of  danger  by  the  probable  course  of  the  ball,  and  by  knowing 
also  the  character  of  the  weapon  which  fired  the  bullet. 

Wounds  of  the  Bladder. — This  viscus  may  be  injured  in  the  same 
way  as  others,  by  blows,  falls,  incised  or  gunshot  wounds.  When  the 
rupture  is  due  to  a  blow,  kick,  or  other  contusion,  it  is  usually  fatal  from 
peritonitis  following  the  escape  of  the  urine.  These  ruptures,  from 
whatever  cause,  are  most  dangerous  wounds,  and  the  prognosis  is  neces- 
sarily unfavorable.  If  the  extravasation  does  not  pass  into  the  peritoneal 
cavity,  the  chance  of  recovery  is  greater  than  in  the  contrary  case,  for 
the  abscess  consequent  upon  the  presence  of  the  urine  in  the  tissues  may 
be  relieved  by  surgical  interference.  Should  the  diagnosis  of  rupture 
be  made  and  of  effusion  of  urine  into  the  peritoneum,  early  laparotomy 
might  increase  the  chance  of  recovery  and  certainly  would  be  justified, 
for  that  the  rupture  would  close  spontaneously  or  that  peritonitis  would 
not  be  excited  by  the  escaping  urine  are  matters  too  conjectural  to  rely 
on,  and  surgical  aid  should  be  rendered,  even  though  it  carry  with  it  an 
element  of  danger  from  the  operation.  While  this  is  what  the  surgeon 
is  called  on  to  do,  it  may  materially  affect  the  case  in  court  should  the 
rupture  be  due  to  criminal  violence,  for  the  defense  would  justly  question 
whether  the  death  of  the  patient  was  not  due  to  the  operation  and  inflam- 
mation following  it,  rather  than  to  the  rupture  whose  production  was 
charged  to  the  prisoner.  The  surgeon,  of  course,  cannot  hesitate,  his 
duty  being  to  save  life  if  possible ;  and  the  operation  giving  a  chance 
greater  to  the  patient  than  the  almost  positive  condition  which  would 
follow  the  rupture,  he  should  give  the  patient  the  benefit  of  that  chance. 

Rupture  takes  place  when  the  bladder  is  more  or  less  distended  and 
when  it  is  the  result  of  blows  no  mark  of  injury  or  ecchymosis  may  be 
apparent.  This  is  for  the  same  reason  as  was  noted  where  other  viscera 
suffer  rupture  from  contusion,  the  yielding  parietes  allowing  the  force  to 
pass  on  inward.  Bullet  wounds  are  not  as  dangerous  as  incised  or  rupt- 
ured ones,  and  a  fatal  issue  may  not  follow  them  by  peritonitis  until  the 
wounds  in  the  walls  of  the  bladder  slough.     Out  of  one  hundred  and 


HOMICIDE  AND    WOUNDS.  315 

eighty-three  cases  reported  during  the  Civil  War,  eighty-seven  cases  of 
recovery  took  place,  and  no  cases  of  rupture  from  blows  or  violence  were 
reported  at  all.  While  the  pain  caused  by  all  wounds  of  the  bladder  is 
severe,  and  in  case  of  rupture  with  extravasation  of  urine  the  person  ex- 
periences a  sinking  feeling,  movements  are  not  incompatible  with  the 
injury,  and  the  wounded  man  may  walk  after  its  receipt.  This  fact  pre- 
vents the  defense  from  claiming  absolute  inability  of  motion  on  the  part 
of  the  assailed  as  a  proof  that  the  rupture  did  not  follow  the  assault. 

Wounds  of  the  Genitals. — In  homicidal  wounding  by  men,  the  gen- 
itals are  not  often  if  ever  attacked,  for  the  object  of  the  assailant  is  easier 
gained  by  assaulting  other  parts.  Accidental  wounding  from  bullets,  or 
even  criminal  wounding  where  the  aim  of  the  offender  is  poor,  may  take 
place.  Kicks  or  blows,  also,  are  reported  as  affecting  these  parts,  but 
the  generality  of  cases  are  in  women.  A  severe  blow  on  the  vulva  may 
cause  laceration  so  sharply  defined  as  to  appear  like  an  incised  wound, 
and  the  danger  is  from  hemorrhage,  the  parts  being  so  very  vascular. 
Unless  in  the  insane,  incised  wounds  of  the  genitals  are  indicative  of 
homicidal  intent,  for  accidental  cutting  is  most  rare,  and  the  fact  of  a 
clean  cut  being  found  in  the  labia  would  be  sufficient  to  arouse  suspicion 
of  an  assault.  Contusions  or  cuts  made  after  death  would  be  known  by 
the  fact  of  bleeding  not  having  followed  their  infliction,  for  the  autopsy 
would  show  the  effect  of  profuse  hemorrhage  of  other  organs,  and  this 
condition  would  not  be  present  if  the  laceration  was  made  after  death. 
A  year  or  two  since,  in  New  Hampshire,  a  man  named  Almy  killed  a 
girl  by  putting  the  muzzle  of  a  pistol  into  the  vagina  and  firing  a  shot. 
He  was  seen  to  commit  the  deed,  and  the  post-mortem  examination  con- 
firmed the  statement  of  the  witnesses.  He  was  convicted  and  executed. 
Here  was  a  wounding  of  the  genitals,  but  death  was  not  due  to  it,  for 
the  ball  penetrated  further  and  caused  immediate  death  by  wounding  the 
more  vital  organs. 

Wounds  may  take  place  in  this  region  by  falls,  but  the}r  are  compar- 
atively rare.  The  most  frequent  form  of  wound  the  medical  jurist  would 
meet  with  would  be  contusions  and  lacerations  from  kicks,  and  the  evi- 
dence presented  by  the  injury  would  decide  against  the  probability  of  a 
fall  being  the  author  of  it. 

The  uterus  may  also  be  wounded,  and  the  injury  prove  fatal.  The 
wounds  produced  by  those  performing  criminal  abortions  have  been 
fully  treated  in  another  portion  of  this  work,  and  will,  therefore,  not  be 
referred  to  further.  Blows  and  kicks  or  falls  on  the  gravid  uterus  may 
cause  rupture,  and  the  escape  of  the  foetus  into  the  abdominal  cavity. 
Death  here  would  probably  be  due  to  the  shock  and  hemorrhage,  the 
autopsy  revealing  the  condition.  External  marks  may  be  absent,  as  is 
general  in  all  this  character  of  injuries,  but  the  uterine  walls  may  show 
ecchymosis  in  the  same  way  the  intestine  did  in  the  case  reported  by  Dr. 
MacDonald. 

The  Relation  of  the  Medical  Witness  in  Matters  other  than 
Wounds. — It  is  contended  by  some  that  the  medical  man  employed  in  a 
legal  case  should  in  no  way  take  into  consideration  the  bearing  of  any 
facts  other  than  those  purely  pertaining  to  medical  questions.  I  cannot 
agree  to  this  view,  for  it  is  considered  much  would  be  lost  which  would 
be  of  great  value  to  the  proper  administration  of  justice,  if  it  was  en- 
forced.    The  doctor  is  more  than  a  mere  witness,  for  while  he  is  called 


31G         .  J    SYSTEM   OF  LEGAL    MEDICINE. 

as  an  expert  on  those  subjects  upon  which  he  is  supposed  to  have  special 
knowledge,  knowledge  not  possessed  by  laymen,  and  in  tins  is  an  expert, 
experience  shows  he  is  more,  for  he  is  virtually  the  medical  counsel.  And 
it  is  no  Improper  procedure  for  him  to  act  in  that  capacity,  for  while  he 
takes  no  part  in  the  actual  trial,  in  the  examining  and  cross-questioning 
of  the  witnesses,  and  further  has  nothing  to  do  with  saying  what  course 
shall  be  followed  in  the  management  of  the  case,  he  must,  in  the  very 
nature  of  things,  counsel  the  lawyers  how  certain  facts  are  the  leading 
ones  in  the  medical  phase  of  the  cast-,  and  why  they  are  so.  Before  being 
able  to  act  in  this  way.  one  in  which  there  is  not  only  no  impropriety 
but  also  in  which  his  absolute  impartiality  as  an  expert  is  not  called  in 
question,  he  must  prepare  himself  to  give  an  opinion  which,  to  his  mind. 
rovers  every  medical  feature,  and  to  do  this  he  must,  or  at  least  should, 
understand  all  the  circumstances  connected  with  the  crime,  that  the  bear- 
ing they  have  on  the  relations  of  the  autopsy  and  the  evidence  of  the 
wounds  may  be  fully  and  justly  weighed. 

I  have  made  it  a  ride  to  always  investigate,  personally,  if  it  is  pi  Bsi- 
ble.  the  place  where  the  crime  was  committed.  In  the  Mechanicsville 
se  this  led  to  finding  another  weapon  than  the  one  supposed,  for  the 
height  of  the  ceiling  prevented  sufficient  power  being  given  to  the  piece 
of  board  claimed  as  the  weapon,  the  assailed  standing  at  the  time  of  the 
attack.  In  the  "Woods  case  examination  of  the  house  resulted  in  finding 
a  bullet  in  a  window-sill,  which  further  confirmed  the  evidence  of  the 
wounds,  and  proved  the  prisoner's  statement  to  have  been  true.  While 
it  is  not  necessary  before  holding  the  autopsy  to  examine  the  res  gestas, 
after  full  and  caret' id  study  of  the  body  every  item  known  to  the  attorney 
is  of  importance,  and  becomes  more  or  less  an  aid  to  the  forming  of  a 
true  and  just  opinion  of  how  the  death  was  caused.  The  reason  of  the 
death  is  found  in  the  post-mortem,  generally  speaking,  or  no  cause  may 
be  revealed,  in  which  case  it  is  all  the  more  important  for  the  medical 
witness  to  hear  all  the  circumstances  known.  In  making  a  diagnosis  of 
a  case  in  private  practice,  the  doctor  asks  many  questions  which  appear 
to  those  hearing  not  only  unnecessary  but  at  times  even  impertiuent. 
The  family  history  is  gone  into  as  far  back  as  it  can  be  traced.  The 
condition  of  collateral  branches  is  asked  about.  The  history  of  the 
patient  himself  is  sought  from  the  time  he  was  in  petticoats  until  the 
present,  and  then  is  added  to  the  knowledge  thus  gained  of  hereditary 
influences  or  habits  of  life,  the  physical  examination  of  tie  patient  and 
the  further  inspection  of  the  excreta.  I  believe  it  is  jnst  as  obligatory 
upon  the  medical  witness  to  study  the  legal  case  he  is  called  to  act  in  as 
carefully  and  fully  before  he  gives  his  opinion  as  it  is  for  him  to  do  the 
same  in  the  pursuit  of  his  private  business. 

The  theory  of  the  defense  in  the  Hess  case  was  self-defense.  And 
the  evidence  of  the  autopsy  as  detailed  by  Dr.  Bea<-h  would  not  be  in- 
consistent with  the  theory  if  the  statements  further  made  were  exact, 
viz..  that  the  shot  was  fired  as  Bedell  broke  from  the  men  who  were  try- 
ing to  hold  him  :  for  the  line  of  the  bullet  as  it  traveled  from  the  wound 
of  entrance  to  the  psoas  muscle  was  such  as  would  be  made,  and  could 
probably  only  be  made,  the  relative  positions  of  both  the  assailant  and 
assailed  being  taken  into  consideration,  with  the  body  bent  forward. 
This  is  a  fact  for  the  medical  witness  to  call  attention  to.  for  his  special 
knowledge  of  the  relation  of  the  parts  wounded  in  the  normal  rx»sition 


HOMICIDE  AND    U'OUXDS.  317 

when  the  body  is  erect,  and  the  changes  assumed  by  them  when  other 
forces,  such  as  the  pressure  of  the  diaphragm  and  of  the  abdominal  mus- 
cles, are  exerted,  would  show  to  him  clearly  the  position  in  which  the 
man  was  when  he  was  wounded,  and  thus  the  district  attorney  could  be 
thoroughly  informed  of  the  entire  bearing  the  evidence  of  the  autopsy 
would  have  upon  the  case.  Without  the  aid  of  the  knowledge  of  the 
struggle,  the  medical  examiner  could  only  say  the  wound  undoubtedly 
was  received  when  the  body  was  stooping,  and  he  might  or  might  not 
add,  in  violent  muscular  action. 

The  medical  witness  must  of  course  be  prepared  to  adduce  the  method 
of  the  crime  from  the  evidence  of  the  body  alone,  but  while  this  could  be 
the  case  and  be  done  with  reasonable  certainty,  doubt  may  be  cleared  and 
conjecture  changed  into  fact  if  more  understanding  be  had  of  the  cir- 
cumstances surrounding  the  crime.  Woods  had  two  other  wounds  besides 
the  one  which  entered  the  chest  and  proved  fatal.  Both  of  these  wounds 
were  gunshot,  both  were  from  behind  forward,  but  whether  thev  were 
made  by  one  shot  or  two  was  at  the  time  of  the  autopsy  undecided.  The 
doctor  engaged  by  the  defense  was  present  at  the  post-mortem  examina- 
tion. Together  we  discussed  the  evidence  of  these  two  wounds,  and  de- 
cided that  they  could  have  been  made  by  one  ball  or  by  separate  shots,  for 
the  right  arm  by  being  drawn  backward,  the  forearm  being  flexed,  coidd 
be  brought  into  a  position  which  would  allow  of  a  probe  being  passed 
through  the  wound  in  the  arm  and  then  to  the  grazing  one  in  the  side. 
Examination  of  the  house  showed,  however,  this  bullet  in  the  window-sill. 
If  there  were  only  twTo  shots  fired,  this  could  not  have  been  the  bullet 
which  made  these  slight  wounds,  for  in  no  way  could  a  man  be  placed  for 
the  ball  to  act  on  both  arm  and  side  and  have  it  fired  from  the  part  of  the 
room  which  Briggs  stood  in.  If,  however,  it  had  made  the  wound  in  the 
arm,  then  it  could  be,  for  if  the  arm  was  wTounded  independently  of  the 
side,  this  shot  could  easily  have  made  that  particular  wound.  The  direc- 
tion of  the  bullet  as  given  by  its  position  in  the  window-sill  was  proof  of 
its  having  been  fired  from  where  Briggs  claimed  he  stood.  And  while 
the  two  lesser  wounds  could  have  been  made  by  one  ball,  if  it  so  happened 
that  the  arm  was  placed  in  a  certain  position,  it  was  not  a  position  the  arm 
would  naturally  assume  in  one  running,  while  if  the  ball  found  in  the 
window  did  this  wounding,  the  arm  would  be  in  precisely  the  extended 
position  natural  in  one  suddenly  startled  and  who  was  fleeing  for  his  life. 
Careful  inquiry  ascertained  the  fact  that  three  shots  had  been  fired.  The 
autopsy,  without  endeavoring  to  place  the  limb  in  any  particular  position. 
gave  the  evidence  that  three  shots  had  taken  effect.  Had  the  fact  of 
three  discharges  not  been  known,  the  medical  witnesses  might  have 
differed  on  how  the  wounds  of  arm  and  side  were  made,  and  the  medical 
testimony  been  weakened  by  just  so  much  in  the  minds  of  the  jury. 

In  the  Mallon  case,  examination  of  the  place  where  the  murder  was 
committed  showed  by  the  evidence  of  the  blood-stains  in  what  position 
the  body  was  when  the  shot  was  fired.  While  the  jury  did  not  convict, 
and  despite  all  evidence  turned  the  body  around  and  placed  it  in  such  a 
position  that  the  blood-stains  would  have  had  to  go  in  the  contrary 
direction  to  the  force  causing  them,  this  was  a  deliberate  act  on  its  part 
and  had  nothing  to  do  with  the  medical  evidence.  But  without  inspection 
and  a  knowledge  of  other  circumstances  in  the  possession  of  the  district 
attorney,  confusion  on  points  of  medical  testimony  would  again  have 


318  A   SYSTEM  OF  LEGAL  MEDICINE. 

arisen,  and,  judging  from  the  value  the  jury  attached  to  the  medical  evi- 
dence, might  have  succeeded  in  freeing  the  prisoner  altogether  instead 
of  giving  him  the  light  penalty  of  manslaughter  in  the  third  degree. 

In  the  case  of  Thompson,  examination  of  the  premises  did  not  clear 
up  the  mystery  of  the  death.  If  anything,  it  seemed  rather  to  lead  to 
the  suspicion  of  homicide  than  to  accidental  death,  for  the  absence  of  any 
point  where  such  a  wound  and  fracture  as  were  found  could  be  made  by 
Thompson  falling  backward  down  the  stairway  gave  color  to  the  more 
probable  cause  of  human  agency ;  but  sufficient  circnmstantial  proof  of 
an  incontestable  character  could  not  be  found  to  allow  the  physicians 
to  state  that  the  death  was  by  murder. 

For  the  medical  witness  to  know  all  the  facts,  as  far  as  may  be  possi- 
ble, is  not  to  bias  his  conclusions,  but  rather  to  help  his  arriving  at  just 
ones,  and  in  this  adding  to  the  value  of  his  testimony  as  well  as  to  the 
value  of  his  opinion  on  the  medical  bearings  of  the  case:  By  neglect  of 
this  part  of  the  work  his  testimony  may  not  be  thoroughly  understood 
by  court,  counsel,  or  jury,  and  it  adds  another  subject  for  counsel  to  try 
and  make  plain  what  should  require  no  such  effort. 

The  attention  of  the  medical  examiner  to  every  point  presented  by 
the  autopsy  should  be  constantly  borne  in  mind.  Murders  are  not  com- 
mitted as  a  general  rule  in  the  presence  of  witnesses,  and  many  devices 
are  sought  by  homicides  to  cover  their  crime  and  make  it  appear  the 
death  was  suicidal  or  accidental.  The  case  of  Mrs.  Budge  illustrates  this 
point  in  a  strong  manner.  Had  the  doctor  who  was  called  first  known 
anything  of  medical  jurisprudence,  the  chances  are  a  miscarriage  of  jus- 
tice would  have  been  prevented.  But  the  case  shows  he  took  no  pains 
to  even  hold  an  autopsy.  The  throat  was  cut,  a  razor  was  found :  plainly 
suicide.  As  to  the  evidence  of  the  wound,  the  condition  of  the  organs  of 
the  body,  the  question  of  disease  or  poison  being  present,  the  appearance 
of  blood-stains,  the  appearance  of  the  razor-blade,  the  position  of  the 
"body — in  short,  any  of  the  points  a  medical  examiner  should  have  con- 
stantly before  him  when  summoned  to  such  a  case,  he  never  stopped  to 
look  or  reason  about  one  of  them.  To  stuff  the  throat  with  cotton  to  try 
and  stop  the  bleeding,  which,  despite  these  efforts,  continued,  to  sew  up 
the  wound  and  never  ask  why  a  corpse  should  bleed  hours  after  death, 
was  all  lie  seemed  capable  of  doing.  In  the  case  of  the  man  killed  at 
Fonda  with  a  pistol-ball  in  the  neck,  the  doctor  failed  to  hold  a  complete 
autopsy,  being  satisfied  with  finding  a  cause  of  death.  And  this  neglect 
on  his  part  was  turned  to  the  advantage  of  the  prisoner  by  his  counsel, 
for  death  could  have  come  from  other  causes,  the  wound  not  necessarily 
being  a  mortal  one,  and  by  the  doctor's  remissness  no  proof  could  be 
shown  by  the  people  that  it  did  not.  The  autopsy  on  a  body,  where  the 
cause  of  death  is  the  subject  of  legal  inquiry,  is  not  a  proper  one  unless 
every  organ  has  been  examined,  every  mark  noted,  every  wound  carefully 
inquired  into,  every  morbid  condition  found  inspected  to  see  if  death 
could  have  been  produced  by  it;  and  the  report  made  of  the  autopsy 
should  show  the  cause  of  the  death,  and  the  only  cause  that  it  could  come 
from.  And  where  death  is  from  a  shock  which  would  leave  no  positive 
signs  on  the  dead  body,  the  completeness  and  carefulness  of  the  post- 
mortem examination  would  go  a  long  wray  to  showing  that  such  cause 
alone  could  be  held  responsible  for  the  death,  and  the  proof  of  how  that 
shock  was  brought  about  would  be  for  the  jury  to  consider.     If  no  other 


HOMICIDE  AND    WOUNDS.  319 

thought  actuates  the  doctor  to  thoroughly  perform  this  most  important 
work,  the  fact  that  a  man's  life  or  liberty  may  be  at  stake  should  impress 
him  with  the  responsibility  he  is  assuming  when  he  gives  his  opinion  on 
the  examination  of  the  corpus  delicti,  on  which  opinion  all  may  depend. 
The  evidence  of  wounds  is  most  subtle,  and  care  is  needed  that  no 
point  escapes  the  observer.  At  the  best,  the  medical  witness's  testimony 
may  be  but  the  most  probable  and  not  the  certainty ;  but  the  inspection 
he  has  made  will  enable  him  to  decide  upon  the  most  probable,  and  not 
a  number  of  possibilities.  The  autopsy  is  the  most  important  part  of 
the  examiner's  work,  for  from  its  reading  his  conclusion  is  first  formed, 
to  be  strengthened  by  the  attendant  circumstances.  The  evidence  of  a 
wound,  if  clear  and  positive,  is  the  strongest  circumstantial  evidence,  for 
it  points  to  the  manner  in  which  it  was  inflicted,  it  declares  for  the 
weapon,  it  shows  the  agency  of  another's  hand,  it  proves  the  death  was 
due  to  it,  and  tells  its  story  in  the  most  powerful  manner  an  inanimate 
object  can.  Without  careful  study  and  a  knowledge  of  the  effects  of 
wounds,  a  medical  witness  would  misread  the  evidence,  and  be  more  than 
apt  to  give  an  opinion  which  further  examination  would  show  to  be  based 
on  erroneous  conclusions. 


INORGANIC  POISONS. 

By  C.  E.  PELLEW,  E.M. 
INTRODUCTION. 

Definition  of  a  Poison. — Before  entering  upon  the  main  subject,  it 
is  proper  to  state  what  must  be  understood  by  the  term  "  poison."  As  a 
rule  this  name  is  given  to  different  substances  which,  when  taken  into 
the  healthy  human  body  in  quantities  not  unusually  large,  produce,  as  a 
general  result,  injurious  or  even  fatal  effects.  These  effects  are,  as  a 
rule,  due  to  the  chemical,  not  the  mechanical,  action  of  the  substance, 
although  it  is  not  uncommon  to  include  in  the  list  broken  glass,  which 
in  some  parts  of  the  world  is  not  infrequently  used  as  a  slow,  subtle, 
irritant  poison. 

It  must  be  remembered,  however,  that  almost  all  medicines  when 
taken  in  excess  will  give  poisonous  symptoms,  and,  in  like  manner,  many, 
if  not  most,  of  the  commonest  poisons  are  in  general  use,  in  small  quan- 
tities, as  medicines.  Accordingly,  the  classification  of  any  drug  as  a 
poison  depends,  after  all,  upon  whether  it  has  so  far  caused  a  sufficient 
number  of  dangerous  or  fatal  results. 

Again,  a  true  poison  will  be  active  against  the  normal  healthy  body. 
In  various  diseases,  perfectly  harmless  articles  of  diet  may  prove  dis- 
tinctly injurious  and  set  up  characteristic  symptoms ;  while  every  now 
and  then  perfectly  healthy  people  are  met  with  who  are  affected  by  doses 
of  common  drugs,  and  by  simple  kinds  of  food.  Thus  the  evil  effects 
of  sugar  in  diabetes,  and  of  alcohol  in  genito-urinary  diseases,  are  well 
known  even  to  the  laity ;  while  cases  of  idiosyncrasy  have  been  frequently 
described,  where  a  saucer  of  oatmeal  or  a  single  strawberry  have  produced 
poisonous  symptoms. 

The  effects  of  a  poison  will  vary  very  much  according  to  the  size  and 
condition  of  the  dose,  the  state  of  the  system,  the  method  of  administra- 
tion, and  many  other  conditions.  As  a  rule,  though  not  quite  invaria- 
bly, it  will  produce  injury  no  matter  how  it  is  introduced  into  the  body, 
whether  by  the  stomach,  lungs,  skin,  mucous  membranes,  wounds,  or  any 
other  way.  Occasionally,  however,  a  drug  is  met  with,  like  curari,  for 
instance,  which  is  comparatively  harmless  when  taken  in  the  stomach, 
though  exceedingly  powerful  when  directly  introduced  into  the  blood. 

The  effects  of  the  various  poisons  differ  greatly  among  one  another. 
Many  of  the  mineral  poisons  here  dealt  with  have  a  distinctly  irritating, 
if  not  corrosive,  effect  upon  the  tissues  with  which  they  are  brought  in 
contact.  As  good  examples  of  these  we  may  mention  the  fixed  alkalies 
and  the  mineral  acids. 

321 


322  A   SYSTEM  OF  LEGAL  MEDICLNE. 

In  most  cases,  however,  besides  the  local  effects  of  the  poison,  there 
are  other  specific  effects  produced  in  various  parts  of  the  system  by  the 
poison,  after  it  has  been  absorbed  into  the  circulation.  These  may  be 
inflammatory  changes  in  various  organs,  the  liver,  kidneys,  heart,  etc.,  as 
from  phosphorus ;  or  in  the  stomach  and  intestines,  as,  for  instance,  in 
ordinary  cases  of  arsenic  poisoning ;  or  a  distinct  paralysis,  partial  or 
complete,  of  the  great  centers  in  the  medulla,  as  in  poisoning  by  bro- 
mides, by  large  and  soluble  doses  of  arsenic,  by  ammonia  and  nitric  acid 
vapor,  and  the  like ;  or  a  slower  and  gradual  paralysis  of  the  peripheral 
nerves,  as  in  chronic  lead  and  arsenic  cases ;  or  some  direct  change  pro- 
duced in  the  blood,  as  by  potassic  chlorate  and  carbonic  oxide.  Besides 
these  there  may  be  marked  disturbances  of  the  brain  and  spinal  cordr 
principally  produced  by  the  alkaloids  and  kindred  principles. 

To  properly  classify  the  mineral  poisons  according  to  their  effects- 
would  be  a  difficult  and  complicated  task.  Hence,  in  the  following  pages 
they  are  taken  up,  one  after  the  other,  in  a  rough  and  simple  classifica- 
tion, somewhat  according  to  their  physical  and  chemical  properties.  The 
first  section  will  treat  of  the  alkalies ;  then  will  come  the  acids,  the  hal- 
ogens and  haloid  salts,  and  phosphorus.  Next  I  shall  discuss  the  metal- 
lic poisons,  beginning  with  antimony,  arsenic,  lead,  mercury,  and  cop- 
per. And  I  shall  close  my  treatise  with  a  few  words  on  the  metals  of 
less  importance. 

I.   THE  ALKALIES  AND  THEIR  SALTS. 

The  term  "  alkali "  is  applied  to  a  substance  possessing  certain  prop- 
erties. It  will  dissolve  in  water,  will  neutralize  acids,  will  turn  red 
litmus-paper  blue,  will  saponify  soaps,  will  have  a  "  soapy  "  taste,  and, 
when  strong,  will  corrode  many  organic  substances,  including  the  skin 
and  many  of  the  tissues. 

These  properties  are  possessed  by  the  hydrates,  carbonates,  and  phos- 
phates of  the  common  alkaline  metals,  sodium,  potassium,  and  ammo- 
nium, and  also  of  the  rarer  metals  lithium,  caBsium,  and  rubidium.  They 
are  possessed  by  the  hydrates  of  the  alkaline-earthy  metals,  calcium,  mag- 
nesium, barium,  and  strontium,  but  only  to  a  slight  extent. 

The  most  powerful  of  these  compounds  are  the  caustic  or  hydrated 
alkalies,  i.e.,  the  hydrates  of  sodium,  potassium,  and  ammonium.  The 
carbonated  alkalies,  i.e.,  the  carbonates  of  these  same  metals,  while  less 
active  than  the  former,  can  still,  especially  when  impure,  act  as  powerful 
corrosives  when  taken  internally.  The  bicarbonates,  however,  of  soda 
and  potash  are  so  mild  that  their  solutions  can  be  applied  in  large  quan- 
tities, as  antidotes  to  acids,  not  only  upon  the  skin,  but  also  internally,, 
and  upon  delicate  surfaces  such  as  the  face  and  eyes. 


Soda  and  Potash. 

These  compounds,  which  are  practically  similar  in  their  reactions  and 
effects,  are  met  with,  as  a  rule,  in  the  form  of  sodium  and  potassium 
carbonates  mixed  with  some  of  the  caustic  alkali. 

They  are  in  common  use,  both  in  the  arts  and  in  the  household,  for 
the  manufacture  of  soap,  and  the  preparation  of  other  sodium  and  potas- 


INORGANIC  POISONS.  323 

sium  compounds.  And  yet  cases  of  poisoning  by  their  means  are  ex- 
tremely rare,  and  usually  are  the  result  of  accident. 

Symptoms. — When  the  solutions  are  concentrated  the  victim  feels  at 
once  an  acrid,  burning  taste,  which  is  usually  enough  to  make  him  try 
and  spit  the  liquid  out,  and  to  wash  out  his  mouth  as  well  as  he  can. 
If  the  solution  is  actually  swallowed,  there  is  a  burning  sensation  in  the 
throat,  reaching  down  to  the  stomach.  This  is  usually  followed  by  in- 
tense pain,  and  by  vomiting,  first  of  mucus  and  then  of  blood.  The 
lips,  tongue,  and  pharynx  become  swollen,  raw,  and  inflamed;  the  voice 
becomes  husky,  and  there  is  much  difficulty  in  swallowing. 

This  is  generally  accompanied  by  symptoms  of  severe  shock.  The 
skin  becomes  cold  and  clammy,  the  pulse  feeble,  and  the  patient  becomes 
extremely  weak  and  exhausted,  sinking  often  into  a  comatose  state. 
Death  may  result  from  this  in  the  course  of  a  few  hours,  but  the  patient 
often  recovers  from  this  only  to  suffer  from  stricture  of  the  oesophagus 
and  consequent  inability  to  swallow  food,  or  from  ulcerations  of  the 
stomach,  or  stricture  of  the  duodenum,  which  prevent  the  food  from  being 
digested.  In  either  of  these  cases  the  patient  may  linger  on  for  weeks, 
months,  or  even  years,  only  to  die  a  miserable  death  from  starvation. 

An  example  of  this  is  given  by  Dr.  Hadden  (Trans.  London  Pathol. 
Soc,  1890,  vol.  xli.,  p.  86),  where  a  stoker  on  board  ship  swallowed,  for 
suicidal  purposes,  several  ounces  of  caustic  potash.  When  seen  a  few 
days  after,  his  mouth  and  pharynx  were  much  swollen  and  charred,  and 
the  patient  was  suffering  greatly.  At  the  end  of  a  week  a  cast  of  the 
oesophagus  was  found  protruding  from  his  mouth,  and  when  carefully 
removed  it  proved  to  consist  of  the  mucous  and  submucous  coats  of  the 
whole  oesophagus  and  the  larynx,  carrying  with  it  some  of  the  circular 
muscular  fibers. 

The  patient  lingered  for  some  time,  but  constriction  began  to  take 
place,  and  more  and  more  difficulty  was  experienced  in  swallowing,  until 
the  poor  fellow  finally  died  at  the  end  of  tliree  months. 

Post=mortem  Appearance. — When  death  has  occurred  in  a  few  days, 
the  mouth,  oesophagus,  and  stomach  will  all  show  extensive  signs  of 
corrosion.  The  mucous  membranes  will  be  much  abraded  and  bloody, 
and  the  exposed  surfaces  raw,  and  often  colored  yellow  or  brown. 

When  the  patient  has  died  from  the  secondary  effects  of  the  poison, 
the  mouth  and  upper  part  of  the  throat  may  have  healed,  but  signs  of 
ulceration  or  of  thickening  and  constriction  will  be  noticed  in  the  oesoph- 
agus and  stomach,  or  in  the  small  intestine. 

Fatal  Dose. — The  smallest  fatal  dose  on  record  is  given  by  Taylor  in 
the  case  of  a  young  lady,  who  died  seven  weeks  after  taking  one  and  a 
half  ounces  of  the  common  potash  solution  of  the  shops,  containing  some 
thirty  or  thirty-five  grains  of  caustic  alkali.  In  other  cases  death  has 
been  reported  from  half  an  ounce  or  so  of  the  dry  poison. 

Time  of  Death. — Taylor  mentions  a  case  of  a  boy  dying  hi  three 
hours  after  drinking  the  poison,  and  other  cases  are  on  record  where 
death  occurred,  from  shock,  within  twenty-four  hours.  The  patient, 
however,  may  linger  for  a  long  time,  two  or  three  cases  being  known 
where  death  occurred  after  two  years,  and  one  case,  quoted  by  Wormley 
from  Sir  C.  Bell,  where  the  patient  died  after  twenty  years. 

Treatment. — Where  the  poison  has  been  swallowed  for  some  minutes 
antidotes  will  have  but  little  effect.     The  alkali  should  be  neutralized  as 


324  A    SYSTEM    OF  LEGAL    MEDICINE. 

far  as  possible  with  diluted  vinegar,  or  weak  organic  acids,  or  by  lemon, 
lime,  or  orange  juice.  Some  good  can  also  be  done  by  giving  milk, 
barley-water,  solutions  of  albumen  or  gum*  and  the  like,  and  also  by 
giving  olive-oil  in  some  quantities,  to  soothe  the  inflamed  surfaces,  and 
also,  perhaps,  to  saponify  any  free  alkali  remaining.  It  is  dangerous  to 
use  the  stomach-pump  where  the  oesophagus  is  likely  to  be  so  corroded, 
for  fear  of  perforation. 

Chemical  Analysis. — The  presence  of  alkalies  can  be  best  told  by 
the  soapy  taste  and  the  reaction  with  litmus  or  other  test-paper.  The 
carbonated  alkalies  can  be  distinguished  from  the  caustic  by  effervescing 
with  acids,  and  from  the  bicarbonates  by  at  once  giving  a  white  precipi- 
tate with  magnesic  sulphate. 

To  distinguish  potash  from  soda  we  can  use  four  different  tests : 

(a)  A  moderately  strong  solution  of  potash  or  its  salts  is  precipitated 
by  a  solution  of  platinic  chloride,  forming  yellow  octahedral  crystals  of 
potassic  platinic  chloride.  A  precisely  similar  compound  is  produced  by 
solutions  of  ammonia,  so,  if  the  latter  be  present,  it  must  be  removed 
by  boiling  with  calcic  hydrate,  or  by  evaporating  to  dryness  and  ignit- 
ing at  a  dull  red  heat,  before  making  the  test. 

(b)  If  a  rather  strong  solution  of  potash  or  its  salts  is  added  to  a 
strong  solution  of  tartaric  acid,  or,  better,  of  acid  sodic  tartrate  formed 
by  adding  a  little  soda  to  the  acid,  it  will  form  a  white  crystalline  pre- 
cipitate of  cream  of  tartar.  This  is  soluble  in  free  mineral  acids,  and 
also  in  the  free  alkalies. 

(c)  When  alkali  solutions  are  carefidly  neutralized  with  dilute  nitric 
acid  and  then  allowed  to  crystallize  on  glass  slides,  the  potassium  nitrate 
will  form  long,  slender,  fluted  prisms.  The  sodium  nitrate,  however, 
crystallizes  in  rhombic  plates. 

(d)  When  a  drop  of  alkali  solution  upon  a  platinum  wire  is  heated  in 
a  Bun  sen  flame  the  yellow  flame  of  sodium  will  always  be  present.  If, 
however,  we  place  in  front  of  the  flame  a  piece  of  cobalt  blue  glass,  it  is 
possible,  if  potash  is  present,  to  distinguish  its  characteristic  violet  flame. 
It  is  more  accurate,  however,  to  make  this  test  before  a  spectroscope,  and 
to  recognize  the  potassium  by  its  two  lines,  one  red  and  the  other  blue. 


Ammonia. 

The  alkaline  salts  of  ammonium  differ  from  those  of  potassium  and 
sodium  by  being  volatile  and  temporary.  Caustic  ammonia,  or  ammo- 
nium hydrate,  is  simply  a  solution  of  the  ammonia  gas  (NH;{)  in  water, 
and  on  heating  or  evaporation  the  gas  disappears,  and  with  it  the  alkaline 
properties.  Ammonium  carbonate  is  a  solid  which  dissolves  freely  in 
water,  but  this  too  is  volatile  in  the  air,  when  dry,  at  ordinary  tempera- 
tures, and  is  readily  driven  from  its  solution  by  heat. 

Accordingly,  in  poisoning  by  ammonia  the  patient,  if  he  survives  a 
short  time,  is  more  apt  to  recover  and  escape  permanent  injury  than  in 
the  case  of  soda  and  potash.  But,  on  the  other  hand,  the  gas  itself  is 
poisonous,  and  liable  to  cause  death  suddenly,  when  inhaled,  not  only 
from  its  caustic  effect  upon  the  air-passages  and  lungs,  but  also  from  its 
action  on  the  central  nervous  system,  causing,  when  concentrated,  a 
paralysis  of  circulation  and  respiration. 


INORGANIC  POISONS.  325 

Caustic  Effects. — Cases  are  not  infrequent  where  persons,  usually 
while  intoxicated,  have  swallowed  small  or  large  doses  of  aqua  ammonia, 
and  suffered  from  the  usual  symptoms  of  caustic  alkali.  Thus  (France 
Med.,  1879,  p.  65)  a  case  is  reported  where  a  few  drops  of  ammonia  were 
taken  by  mistake,  and  almost  immediately  spit  out.  There  resulted 
purely  local  lesions  in  the  mouth  and  throat,  which  became,  in  a  day  or 
two,  very  deep  and  very  painful,  but  healed  up  in  eight  or  ten  days. 

In  another  case  (Boston  Med.  and  Surg.  Jour.,  1891,  vol.  cxxv.,  p.  677), 
a  man,  aged  forty-six,  swallowed  a  gulp  of  household  ammonia.  He  spit 
it  out  at  once,  and  took  diluted  vinegar  and  then  milk.  In  two  hours' 
time  his  lips,  gum,  tongue,  and  tonsils  were  swollen,  raw,  and  much  in- 
flamed. His  voice  was  husky,  his  respiration  slow,  but  he  had  no  vom- 
iting. He  was  treated  with  cold  compresses  around  the  neck,  and  oil, 
milk,  etc.,  internally.  The  second  night  he  developed  symptoms  of  Bright's 
disease,  i.e.,  albumen,  casts,  blood,  and  pus-cells  in  the  urine,  which  was 
verv  scantv,  and  some  headache  and  delirium.  But  when  treated  with 
digitalis  his  kidneys  recovered,  and  the  local  lesions  healed  and  the  man 
was  well  in  eight  or  ten  days. 

In  another  case  (Lancet,  1890,  part  ii.,  p.  1214),  a  man  who  had  taken 
a  mixture  of  ammonia,  turpentine,  and  od,  while  drunk,  suffered  so  badly 
from  dyspnoea  in  an  hour  and  a  half  after  taking  the  poison  that  the  sur- 
geon, to  save  his  life,  performed  tracheotomy.  In  spite  of  rather  grave 
kidney  and  lung  trouble  the  man  slowly  recovered,  and  was  quite  well  in 
less  than  a  fortnight. 

Severer  cases,  ending  in  death,  and  showing  symptoms  very  similar 
to  those  of  rapid  soda  or  potash  poisoning,  can  be  found  occasionally  in 
the  books  or  in  the  journals.  Thus,  Dr.  Garvin  (Boston  Med.  and  Surg. 
dour.,  1880,  vol.  ciii.,  p.  166)  gives  an  interesting  case  of  a  man,  when 
tipsy,  who  took  some  four  tablespoonfuls  of  aqua  ammonia,  remarking 
at  the  time  that  it  smelt  pretty  strong.  Some  of  this  dose  reached  the 
stomach,  for  he  vomited  at  once,  and  complained  of  burning,  not  only 
in  his  mouth,  but  down  his  throat  and  in  his  stomach.  He  died  in  four 
days  and  a  quarter.  A  similar  case  is  given  in  the  Canada  Med.  and 
Surg.  Jour.,  vol.  x.,  p.  449.  Taylor  gives  several  instances  of  this  sort. 
Among  others  he  quotes  from  Dr.  Barclay  a  case  of  a  girl  who  died,  three 
months  after  taking  some  ammonium  carbonate,  from  contraction  of  the 
■oesophagus  and  irritation  of  the  stomach. 

Cerebral  Effects  of  Ammonia. — Besides,  however,  acting  solely  as 
a  caustic,  cases  are  met  with  where  death  occurs  very  rapidly,  and  long 
before  the  inflammation  could  have  produced  fatal  results.  This  occurs 
sometimes  when  taken  in  solution.  Thus  two  or  three  cases  are  quoted 
by  Taylor  where  death  occurred  within  a  few  minutes  after  drinking 
some  amnionic  hydrate. 

But  usually  these  cases  result  from  smelling  and  inhaling  the  gas. 
Thus  a  case  is  mentioned  by  Routier  (France  Med.,  1879,  p.  65)  where  a 
doctor,  in  an  epileptic  fit,  was  given  strong  ammonia  to  inhale,  and  im- 
mediately fell  in  a  syncope  and  died. 

A  very  interesting  report  is  given  by  Dr.  Fairbrother  (St.  Louis  Med. 
and  Sioy.  Jour.,  1887,  vol.  Hi.,  p.  272),  where  three  men  lost  their  lives  and 
a  fourth  was  permanently  injured  by  an  accident  when  setting  wp  an 
ammonia  ice-machine.  They  were  exposed  to  the  gas  for  some  three 
minutes.     One  when  dragged  out  was  comatose  and  unconscious,  and 


326  A   SYSTEM   OF  LEGAL  MEDICINE. 

died  in  fifteen  minutes.  Another  was  suffering  as  though  from  chloro- 
form in  the  stage  of  excitement — i.e.,  he  was  unconscious,  in  wild  delir- 
ium, and  could  not  stand.  He  was  not  improved  by  the  injection  of 
half  a  grain  of  morphine  sulphate,  and  died  suddenly  in  two  hours.  The 
third  was  entirely  conscious  and  walked  home.  He  could  swallow 
readily  and  talk  easily,  but  complained  of  occasional  difficult  breathing, 
and  after  five  hours'  time,  in  a  sudden  attack  of  dyspnoea,  he  gave  two 
or  three  gasps  and  died.  The  last  suffered  from  bronchial  irritation  for 
some  months.  His  leg  was  broken  by  the  fall  and  had  to  be  amputated, 
and  he  became  partially  paralyzed  on  one  side. 

Analysis. — Ammonia  and  its  compounds  can  be  readily  recognized 
by  their  being  volatile,  and  by  their  giving  off  ammonia  gas  when  heated, 
either  by  themselves  or  with  calcium  hydrate  (lime-water).  The  ammo- 
nia gas  not  only  has  its  characteristic  odor,  but  will  also  turn  blue  a  wet 
piece  of  red  litmus-paper  exposed  to  it,  and  will  give  white  fumes  in  the 
presence  of  a  rod  dipped  in  hydrochloric  acid. 


II.    THE   MINERAL   ACIDS. 

Sulphuric,  Hydrochloric,  and  Nitric  Acids.     Also  Chromic 

and  Boracic  Acids. 

These  compounds  in  many  respects  are  the  reverse  of  the  alkalies,, 
just  mentioned.  They  have  a  sour  taste,  turn  blue  litmus-paper  red  and 
most  vegetable  dyestuffs  either  red  or  yellow,  neutralize  alkalies,  and 
dissolve  most  metals,  liberating  hydrogen  or  some  other  gas.  Upon  or- 
ganic matter  and  upon  the  tissues  of  the  body  the  strong  mineral  acids 
act  even  more  violently  than  the  alkalies,  corroding  rapidly  and  fiercely 
any  part  of  the  body  with  which  they  come  in  contact. 

Sulphuric  Acid — Oil  of  Vitriol — H2SOi. 

This  substance  was  known  to  the  alchemists,  and  has  been  an  article 
of  commerce  since  the  middle  ages,  under  the  common  name  of  oil  of 
vitriol.  When  concentrated  it  is  a  heavy,  oily  liquid,  usually  with  a 
yellowish  or  brown  color,  and  no  smell.  It  combines  very  readily  with 
water,  dissolving  in  it  with  the  formation  of  considerable  heat,  and  ex- 
tracting it  from  the  air  and  from  organic  compounds.  It  is  intensely 
corrosive,  charring  organic  compounds  and  destroying  their  substance- 
It  is,  of  course,  less  active  the  more  it  is  diluted. 

Sulphuric  acid,  in  common  with  the  other  mineral  acids,  is  not  often 
used  for  murder,  the  taste  betraying  the  attempt  to  the  victim,  and  the 
symptoms  of  death  from  it  being  characteristic.  Cases,  however,  have 
been  occasional^  reported  where  it  has  been  purposely  administered  to- 
children,  and  also  to  intoxicated  adults,  with  fatal  results. 

It  is  not  uncommonly  used  for  suicide,  especially  among  the  lower 
classes  on  the  Continent.  For  instance,  in  Berlin  it  is  the  commonest 
of  all  poisons,  in  some  recent  years  averagiug  forty  percent,  and  over  of 
all  the  poisoning  cases  taken  in  the  general  hospitals,  while  phosphorus 
came  second,  with  some  twenty  percent.,  and  oxalic  acid  next,  with  some 
eight  percent.     In  that  city  the  cases  seem  most  common  among  the 


INORGANIC   POISONS.  327 

servant-girls,  who  on  comparatively  slight  cause  become  inclined  to  sui- 
cide, and  take  the  first  and  readiest  means  to  attain  their  end.  In  other 
parts  of  Germany  these  cases  are  less  common,  and  in  France  and  Eng- 
land they  average  only  six  or  eight  percent,  of  the  casualties  from 
poison. 

Some  seventy-five  percent,  of  all  the  cases  are  of  women,  who,  as  yet, 
do  not  seem  to  have  found  out  that,  of  all  the  poisons  known,  this  is  the 
most  painful  in  its  effects. 

Cases  of  accidental  poisoning  are  also  occasionally  met  with,  fre- 
quently in  children  ;  while  the  strong  acid  is  not  infrequently  used  for 
throwing  upon  the  face  and  hands  of  rivals  or  enemies.  This  pleasant 
practice  is  also  largely  confined  to  the  gentler  sex,  and  often  results  in 
terrible  and  permanent  disfigurement,  and  sometimes  in  very  serious  in- 
jury to  the  health. 

Symptoms. — These  are,  in  general,  the  same  as  those  of  the  strong 
alkalies.  There  is  great  pain  in  the  mouth,  throat,  oesophagus,  and 
stomach,  if  the  acid  penetrates  as  far.  The  interior  of  the  mouth,  if  it 
can  be  seen,  is  greatly  inflamed,  swollen,  and  covered  with  a  white  lining. 
The  tongue,  in  bad  cases,  is  terribly  swollen,  often  projecting  out  of  the 
mouth,  and  is  gray  in  color,  while  the  salivation  is  profuse. 

After  a  short  length  of  time  come  the  evidences  of  collapse,  sunken 
eyes,  pallid  face,  cold  and  clammy  skin,  impaired  circulation,  and  labored 
breathing.  There  is  great  thirst,  which  cannot  well  be  satisfied,  and 
choking,  retching,  and  vomiting,  often  of  much  blood.  Generally  the 
patients  are  rolling  around  in  agony  on  the  bed,  but  at  other  times,  even 
quite  rapidly,  they  fall  into  a  semi-unconscious  state,  and  he  in  a  state 
of  stupor. 

Death,  under  these  circumstances,  may  occur  in  a  few  hours,  or,  more 
often,  in  one  or  two  days,  either  from  collapse  or  from  perforation  of 
the  stomach.  It  may  also  occur,  sometimes  ver}^  rapidly  indeed,  from 
the  effect  upon  the  air-passages,  even  when  no  acid  has  been  actually 
swallowed.  In  other  cases,  when  the  patients  recover  from  the  immedi- 
ate effects  of  the  poison  they  often  die  in  the  course  of  some  weeks  or 
months  from  the  secondary  effects  of  the  poison,  such  as  strictures  of 
the  oesophagus  or  stomach,  or  from  perforation  of  the  oesophagus.  Ac- 
cording to  Litten  (Berlin  Klin.  Wochensch.,  1881,  p.  616),  in  the  Berlin 
hospitals  some  thirty-nine  percent,  die  while  in  the  hospitals,  and  some 
thirty  percent,  more  from  the  after-effects. 

Treatment. — If  taken  at  once  the  acid  may  be  more  or  less  neutral- 
ized with  bicarbonate  of  soda,  or  magnesia,  taken  in  good  quantities 
with  large  amounts  of  water.  If  these  cannot  be  obtained,  plaster  from 
the  walls  of  rooms  may  be  of  some  service.  The  stomach-pump  must 
not  be  used,  for  fear  of  perforation  ;  but  after  the  acid  has  been  neutral- 
ized, and  before,  if  possible,  swallowing  has  become  too  difficult,  albumen, 
milk,  and  mucilaginous  fluids  of  all  sorts  should  be  taken  into  the 
stomach,  and  the  mouth  and  throat  covered  with  vaseline  and  the  like. 

The  collapse  and  other  symptoms  must  be  treated  as  they  come.  An 
interesting  case,  where  life  was  saved  by  a  little  forethought,  is  reported 
in  the  Glasgow  Med.  Jour.  (1879,  vol.  xii.,  p.  390).  A  child,  thirteen 
months  old,  while  playing,  swallowed  a  few  drops  of  concentrated  sul- 
phuric acid,  and  fell  on  the  floor  in  great  distress.  A  local  doctor  was 
called  in,  and  gave  emetics,  causing  the  child  to  vomit  some  dark-colored 


328  ^   SYSTEM  OF  LEGAL   MEDICINE. 

liquid.  Later  a  prominent  physician  was  summoned,  and  found  the  child 
suffering  greatly  from  acute  laryngitis,  with  breathing  much  affected 
He  sent  the  baby  around  at  once  to  the  hospital,  with  a  note  to  his 
house-surgeon  there  to  be  ready  to  perform  tracheotomy  if  necessaiy. 
Soon  afterward  the  child  got  worse,  but  was  relieved  at  once  by  trache- 
otomy, and  recovered  completely  in  five  weeks'  time.  The  acid  never 
reached  the  oesophagus,  for  the  child  swallowed  food  all  right  the  next 
day. 

Post=mortem  Examination. — This  mainly  shows  the  evidences  of 
acute  inflammation  and  corrosion  upon  all  portions  of  the  body  touched 
by  the  acid.  When  the  action  is  rapid  and  the  acid  strong,  the  contents 
of  the  stomach,  any  effused  blood,  and  even  the  walls  of  the  oesophagus 
and  stomach,  will  generally  show  marks  of  charring,  this  acid  having 
the  peculiar  property  of  browning  or  blackening  most  kinds  of  organic 
matter.  The  skin  also,  where  any  acid  has  fallen  on  it,  will  be  much 
corroded,  and  sometimes  blackened. 

Tests. — In  like  manner  it  is  generally  possible  to  trace  this  poison, 
in  fresh  cases,  by  noticing  the  black  and  burned  appearance  of  any  spots 
upon  the  clothes,  linen,  or  other  material  touched  by  the  acid  or  by  the 
first  vomited  matter.  The  regular  test  for  sulphuric  acid  is  by  means 
of  a  solution  of  barium  chloride,  acidified  with  hydrochloric  acid,  which 
gives  a  white,  insoluble  precipitate  of  barium  sulphate. 

To  extract  the  free  sulphuric  acid  from  the  tissues,  it  is  best  to  soak 
them  thoroughly,  finely  divided,  in  a  little  water,  and  to  evaporate  this 
extract  to  dryness.  It  is  taken  up  with  a  mixture  of  alcohol  and  ether 
in  equal  proportions,  which  dissolves  free  sulphuric  acid  and  also  free 
phosphoric  acid,  if  present,  but  not  their  salts,  nor  free  hydrochloric  or 
butyric  acids.     This  liquid  can  then  be  tested  by  barium  chloride. 

From  experiments  made  by  Gamier  (Ann.  d'  Hyg.,  1884,  vol.  xi.,  p.  227, 
and  1887,  vol.  xvii.,  p.  148)  it  would  appear  that  free  sulphuric  acid  is 
rarely  found  in  the  tissues,  but  that  it  liberates  free  phosphorie  acid  in- 
stead. And  hence,  that  the  presence  of  the  latter,  jn'oved  by  obtain- 
ing a  yellow  precipitate  on  adding  ammonium  molybdate  to  the  alcohol 
and  ether  extract,  is  a  satisfactory  indication  of  the  action  of  the  more 
powerful  acid. 

External  Application  of  the  Acid. — It  is  well  known  that  the  con- 
centrated acid,  oil  of  vitriol,  acts  with  great  violence  upon  the  skin  and 
flesh,  and  not  infrequently  most  serious  injuries  result  from  the  acid 
being  thrown,  either  from  malice  or  by  accident,  upon  the  face  and  skin. 
In  all  those  cases  great  suffering  and  permanent  disfigurement  can  hardly 
be  avoided  excepting  by  prompt  treatment  by  the  victim  or  bystanders. 
It  so  happens  that  sulphuric  acid  does  not  act  instantaneously ;  so,  if 
directly  the  acid  strikes  the  skin  the  injured  parts  are  washed  with  a 
good  stream  of  water,  and  then  any  residual  acid  neutralized  with  sodic 
bicarbonate,  no  harm  will  be  done.  If  water  is  not  at  once  obtainable, 
the  acid  may  be  largely  removed  by  wiping  it  off  thoroughly  with  hand- 
kerchiefs and  cloths,  and  then,  even  if  the  rest  is  not  washed  off  for  some 
few  minutes,  the  results  will  not  be  serious.  These  points  should  be  par- 
ticularly impressed  on  students  in  chemical  laboratories.  A  few  years 
ago  a  School  of  Mines  student,  by  carelessness,  exploded  a  flask  of  hot, 
concentrated  sulphuric  acid,  getting  the  liquid  all  over  his  face  and  hands, 
and  some  even  into  his  eyes.    The  man  himself  rushed  toward  the  sink ; 


INORGANIC  POISONS.  329 

liis  friends  ran  to  help  him,  and  while  some  turned  on  the  water  and 
washed  the  acid  off,  two  others  carried  over  the  sodic  bicarbonate  bottle 
and  deluged  his  face  and  his  eyes  with  it,  pulling  the  eyelids  open  for  the 
purpose.  The  man  was  out  of  college  for  three  or  four  weeks,  but  then 
returned  with  perfect  eyesight,  and  with  hardly  a  perceptible  scar  on  his 
face. 

A  somewhat  similar  accident  with  cold  acid  occurred  in  another  well- 
known  laboratory  a  few  years  ago,  and  was  the  basis  of  a  lawsuit.  The 
student  was  frightfully  burned  on  one  side  of  his  face,  losing  part  of 
his  nose  and  the  sight  of  one  eye,  and  it  was  claimed  that  no  treatment 
was  given  in  the  laboratory,  but  that  the  lad  was  taken  first  to  one  doc- 
tor some  blocks  away,  and  then  to  another,  the  latter  finally  applying 
some  oil. 

Hydrochloric  Acid — Muriatic  Acid — HCl. 

True  hydrochloric  acid  is  an  acid,  irritating  gas,  extremely  soluble  in 
water.  The  acid  of  commerce  is  a  colorless  or  yellowish  liquid,  with  a 
specific  gravity  of  1.15  to  1.20,  and  contains  some  thirty-five  or  forty 
percent,  of  the  gas  dissolved  in  water.  It  has  a  strong,  irritating  smell 
and  acid  taste,  and  produces  white  fumes  when  exposed  to  vapors  of 
ammonia. 

It  is  but  rarely  taken  as  a  poison,  and  then  almost  invariably  from 
accident  or  for  suicide.  Its  symptoms  are  very  much  like  those  of  sul- 
phuric acid,  or  of  the  caustic  alkalies  described  before,  i.e.,  intense  in- 
flammation of  mouth,  oesophagus,  and  stomach,  followed  by  collapse, 
and,  if  these  primary  symptoms  are  not  fatal,  by  secondary  symptoms 
of  stricture  of  oesophagus  or  duodenum. 

As  in  the  other  cases,  the  time  of  death  is  very  variable.  Most  of  the 
acute  cases  reported  have  died  in  one  or  two  days,  although  Wormley 
quotes  a  case  of  death  in  fifteen  hours,  and  an  interesting  case,  dying  in 
seventeen  hours,  is  given  in  the  Lancet  (1884,  part  i.,  p.  65).  In  the  lat- 
ter case  death  resulted  from  collapse,  and,  on  autopsy,  there  were  found 
perforations  of  oesophagus,  stomach,  and  duodenum.  The  mucous  sur- 
face of  the  mouth  was  white.  Blyth  {Poisons :  Their  Effects  and  Detec- 
tion) quotes  a  case  of  death  in  two  hours. 

Some  interesting  cases  of  death  from  secondary  symptoms  have  been 
recorded  of  late  years  (Lancet,  1890,  part  i.,  p.  797 ;  New  Zealand  Mid. 
Jour.,  vol.  ii.,  1889,  p.  241 ;  and  others).  In  the  first  of  these  the  patient 
drank  by  mistake  an  ounce  or  two  of  strong  acid.  He  had  severe  in- 
flammation of  the  stomach,  which  healed  up  satisfactorily  in  twenty  or 
twenty-five  days,  and  in  ten  days  more  he  was  dismissed  as  well.  But 
two  months  after  this  cure  he  returned  to  the  hospital  to  be  treated  for 
intestinal  trouble.  His  stomach  was  opened,  in  the  hopes  of  dilating 
the  stricture  of  the  pylorus  or  duodenum,  which  seemed  to  be  present ; 
but  the  mucous  membrane  of  the  pylorus  was  so  thickened,  and  adhered 
so  closely  to  that  of  the  stomach,  and  there  were  so  many  cicatrices  in 
the  latter,  that  the  surgeon  could  not  find  the  pylorus  at  all,  and  the 
patient  died  in  a  few  days.  It  was  found  afterward  that  the  pylorus 
was  completely  closed. 

In  the  New  Zealand  case  death  occurred  after  four  months  from  strict- 
ure of  the  duodenum  just  below  the  pylorus. 


330  ^   SYSTEM  OF  LEGAL   MEDICINE. 

The  fatal  dose,  as  with  sulphuric  acid,  depends  more  upon  its  strength, 
.and  upon  whether  it  has  actually  reached  the  stomach,  than  upon  its 
quantity.  Cases  of  death  have  been  reported  from  one  or  two  teaspoon- 
fuls  of  concentrated  acid. 

Distinction  from  Other  Acids. — Hydrochloric  acid,  in  distinction  to 
sulphuric  and  nitric  acid,  does  not  leave  any  particular  stain  or  scar  upon 
the  surface  of  the  skin,  although,  when  concentrated  and  allowed  to 
stand,  it  will  set  up  inflammation.  It  does  not  char  organic  substances, 
like  sulphuric  acid,  nor  does  it  turn  woolen  goods  or  hair  or  epidermis 
yellow,  as  does  nitric  acid.  It  is  more  volatile  than  the  other  acids,  arid 
after  a  day  or  two  cannot  be  detected  in  dry  stains. 

The  test  for  hydrochloric  acid,  as  well  as  for  common  salt  and  other 
metallic  chlorides,  is  the  formation  of  argentic  chloride,  a  white  curdy 
precipitate  soluble  in  amnionic  hydrate,  by  the  addition  of  a  solution  of 
argentic  nitrate  acidified  with  nitric  acid.  In  making  this  test  upon 
any  extracts  of  tissues  or  of  the  contents  of  a  stomach,  it  is  important  to 
remember  that  all  the  tissues  contain  sodium  chloride,  and  that  the  gas- 
tric juice,  during  digestion,  contains  about  0.2  percent,  of  free  hydro- 
chloric acid. 

It  has  been  proposed,  to  see  if  the  hydrochloric  acid  in  an  extract  is 
free  or  combined,  to  divide  it  into  two  parts,  to  add  a  little  excess  of 
sodic  carbonate  to  the  one,  and  to  evaporate  both  to  dryness.  Any 
un combined  acid  will  thus  be  driven  off,  and  if,  on  testing  with  acid 
argentic  nitrate,  the  one  with  sodic  carbonate  shows  more  chlorides  than 
the  other,  the  excess  must  have  been  due  to  free  acid. 


Nitric  Acid — Aqua  Fortis — fflST03. 

This  substance,  as  found  in  commerce,  is  a  colorless  or  yellow  corro- 
sive liquid,  with  a  specific  gravity  of  about  1.40.  It  acts  on  organic  sub- 
stances more  rapidly,  and  quite  as  violently,  as  sulphuric  acid,  but  by 
oxidizing  them,  whereas  sulphuric  acid  deprives  them  of  water  and  chars 
them. 

It  has  been  used  for  poisoning  for  some  four  hundred  years,  and  yet 
but  few  cases  are  reported.  When  cases  do  occur  they  are  very  similar  to 
those  from  other  corrosive  poisons,  although  occasionally  accompanied 
with  less  pain.  It  can,  however,  be  at  once  distinguished  from  the 
other  acids  by  producing  yellow,  and  finally  brown,  stains  upon  any  tis- 
sues, or  indeed,  any  substances  of  animal  origin,  with  which  it  comes  in 
contact. 

Death  from  this  poison  majr  result  very  rapidly,  especially  with  chil- 
dren. Thus  Taylor  mentions  a  case  where  a  child,  intentionally  poisoned, 
died  in  a  few  minutes,  and  another  case,  of  an  adult,  in  an  hour  and 
three  quarters.  Usually  death  takes  place  within  twenty-four  hours,  al- 
though occasionally  it  is  delayed  for  some  weeks  or  months,  until  the 
usual  secondary  symptoms  are  developed. 

The  fatal  dose  of  this  poison  is  probably  smaller  than  of  the  other 
mineral  acids,  and  is  generally  given  as  about  one  quarter  of  an  ounce, 
an  amount  which  has  been  known  to  kill  in  two  or  three  instances. 

Treatment  is  usually  unsuccessful,  but  is  conducted  on  the  same  prin- 
ciples as  in  the  case  of  sulphuric  acid. 


INORGANIC  POISONS.  331 

Poisoning  by  Nitric  Acid  Fumes. — When  large  surfaces  of  the  acid 
are  exposed  to  the  air,  the  resulting  fumes,  partly  of  the  acid  itself  and 
partly  of  some  of  the  lower  oxides  of  nitrogen,  are  extremely  poisonous. 
Three  or  four  instances  of  fatal  accidents  from  tins  cause  are  reported 
in  the  journals,  and  quoted  by  the  standard  authorities.  In  almost  every 
case  they  happened  to  chemists  or  druggists,  and  their  assistants,  who 
were  endeavoring  to  clean  up  the  debris  after  breaking  a  jar  or  carboy 
of  nitric  acid. 

The  symptoms  generally  come  on  after  some  little  time,  and  then  de- 
velop more  or  less  rapidly  into  acute  inflammation  of  the  air-passages, 
which  may  prove  fatal. 

An  interesting  case  of  this  class  of  poisoning  is  given  by  Dr.  Temple 
(Boston  Med.  and  Surg.  Jour.,  1884,  vol.  ex.,  p.  496),  where,  out  of  four 
persons  who  tried  to  get  a  broken  carboy  of  acid  out  of  a  store,  one  died 
and  the  rest  were  more  or  less  affected.  One  of  these  was  a  gentleman 
who  was  exposed  to  the  fumes  but  a  few  minutes,  and  was  taken  down 
with  a  moderately  severe  attack  of  pneumonia  in  a  few  days. 

Another,  a  healthy  assistant,  felt  suffocated,  and  found  that  he  was 
relieved  by  going  into  the  open  air  to  breathe.  This  lasted,  off  and  on, 
for  thirty-five  minutes.  In  about  three  hours  he  felt  a  constriction  at 
the  chest,  and  pain  on  inspiration;  he  had  a  cough,  and  his  face  was 
pale,  almost  of  a  lemon  color.  His  pain  and  cough  increased  during  the 
night,  and  next  day  he  was  worse.  The  third  day  he  had  a  slight  cough 
and  some  pain  on  inspiration,  and  felt  very  weak.  There  were  a  few 
moist  rales  over  the  chest.  After  that  he  got  better,  and  was  quite  well 
by  the  end  of  the  week. 

The  third  was  exposed  in  the  same  manner  as  the  one  just  mentioned, 
but  escaped  with  a  severe  cold  for  two  weeks. 

The  last  was  the  proprietor  of  the  shop,  a  healthy  man  of  about  fifty- 
four  years,  who  had  a  longer  exposure  to  the  fumes.  Four  hours  later  he 
complained  of  "  not  feeling  right,"  and  took  a  car  to  his  brother's  house. 
In  an  hour  and  a  half  more  he  felt  worse,  with  a  cough,  and  pain  on 
deep  inspiration,  and  called  a  doctor.  His  pulse  was  rapid  and  weak, 
his  respiration  fast  and  shallow.  The  doctor  prescribed  ten  grains  of 
ammonium  carbonate,  which  relieved  him,  and  he  went  home  feeling 
weak,  and  with  a  dragging  step. 

During  the  night  he  coughed  incessantly,  bringing  up  frothy,  straw- 
yellow  mucus.  In  the  morning  he  felt  easier,  and  took  some  milk,  and 
in  the  afternoon  he  was  free  from  pain,  excepting  a  tightness  around 
the  chest.  But  later  his  pulse  became  very  feeble,  and  in  his  chest  were 
many  coarse  rales,  and  before  night  he  died,  about  thirty  hours  after  the 
accident.  At  the  autopsy  his  lungs  were  oedematous,  with  slight  injec- 
tion of  the  bronchi,  and  more  of  the  mucous  membranes  of  the  trachea 
and  larynx.  His  heart  and  liver  were  injected,  and  there  were  small 
ecchymoses  in  the  right  auricle  of  the  heart. 


Chromic  Acid — Chromic  Anhydride — Cr03. 

This  compound,  which  crystallizes  in  deliquescent  crimson  prisms, 
and  is  extremely  soluble  in  both  water  and  alcohol,  is  frequently  used  in 
medicine  as  a  cautery.     It  gives  but  little  pain,  and  destroys  rapidly  and 


332  A   SYSTEM  OF  LEGAL   MEDICINE. 

deeply,  and  hence  is  often  employed  as  a  substitute  for  electro-cautery  in 
removing  vegetations,  extirpating  tonsils,  and  the  like. 

Most  of  the  text-books  on  materia  medica  and  therapeutics  recom- 
mend it  highly,  and  give  no  mention  of  any  dangers  from  its  free  use ; 
but  of  late  years  a  few  cases  have  been  reported  which  make  it  worth 
while  to  speak  of  it  here. 

For  instance,  Dr.  Fowler  (Brit,  Med,  Jour.,  1889,  part  i.,  p.  1113)  was 
cauterizing  the  tonsils  of  an  emotional  woman,  forty-five  years  old,  with 
the  acid.  The  patient,  in  spite  of  instructions,  swallowed  her  saliva  with 
a  drop  or  two  of  acid  in  it,  and  noticed  a  slight  burning  in  her  throat. 
In  half  an  hour  she  had  violent  pain  in  the  epigastrium,  with  severe  and 
agonizing  vomiting  of  a  green  ropy  fluid,  and  fell  into  a  state  of  collapse. 
Purging  came  on  in  about  an  hour.  She  was  treated  with  stimulants, 
hot- water  bottles,  and  the  like,  and  recovered  in  about  three  hours,  hav- 
ing after  recovery  an  abundant  flow  of  mine. 

A  similar  case  is  reported  by  Tisne,  in  the  Jour,  de  Med.,  Paris,  1887. 

The  acid  can  also  act  violently  when  used  externally.  Thus,  Dr. 
White  ( Univ.  Med,  Mag.,  Phila.,  1889,  vol.  ii.,  p.  51)  gives  a  very  interesting 
and  straightforward  account  of  the  death  of  a  patient  of  his  in  twenty- 
seven  hours,  after  removing  some  vegetation  from  her  genital  organs  by 
a  strong  solution  of  chromic  acid.  The  patient,  after  recovering  from 
the  ether,  complained  of  pain  in  the  vulva,  and  died  in  a  state  of  col- 
lapse. The  liver  and  kidneys,  on  autopsy,  were  found  congested,  and 
on  analysis  contained  chromium. 

In  other  words,  not  only  is  chromic  acid  a  powerful  corrosive,  but 
it  probably  has  some  direct  action  on  the  central  nervous  system  when 
taken  into  the  blood. 

It  is  worth  noticing  that  potassic  dichromate,  K2CroOT,  an  orange-red 
salt  in  common  use  in  the  arts,  also  has  veiy  decided  toxic  properties, 
partly  local,  but  principally  affecting  the  nervous  system,  and  that  a  few 
cases  of  poisoning  have  been  reported  from  its  use. 


Boracic  Acid — Boric  Acid — H3B03. 

Boracic  acid  occurs  in  commerce  as  white  or  colorless  crystals,  easily 
soluble  in  hot,  and  moderately  in  cold,  water.  It  has  a  slight  acid  taste 
aud  reaction,  but  is  non-irritant,  has  no  odor,  and  is  much  used  as  a  mild 
antiseptic,  not,  it  is  believed,  actually  killing  the  germs,  but  preventing 
their  further  growth. 

Some  few  cases  have  of  late  years  been  reported  which  tend  to  show 
that  when  absorbed  by  the  body  in  moderately  large  quantities  it  may 
act  as  a  vigorous  poison.  Thus  in  the  Med,  News  (1882,  vol.  xl.,  p.  571) 
are  qxioted  two  cases  where  death  occurred  from  washing,  with  five-per- 
cent, solutions,  in  one  case  a  large  abscess  and  in  the  other  a  pleural  cav- 
ity. And  cases  of  poisoning,  with  recovery,  are  given  in  the  K.W.  Lancet 
(1888,  p.  22),  and  by  Dr.  Welch  (Med,  Record,  1888,  vol.  xxxiv.,  p.  533)  and 
Dr.  Lemoine  (Gazette  Med.,  Paris,  1890,  p.  205).  The  latter,  who  gives 
fonr  cases  of  poisoning  by  surgical  dressings  of  the  acid,  explains  them 
by  the  fact  that  the  patients  all  had  kidney  trouble,  which  allowed  the 
drug  to  accumulate. 

The  symptoms  were  much  the  same  in  most  of  the  cases.     There  was 


INORGANIC  POISONS.  333 

a  general  rash,  beginning:  near  the  plaee  of  application,  resulting  often 
in  exfoliation.  There  was  loss  of  appetite,  nausea,  and  vomiting;  there 
was  often  more  or  less  trouble  with  the  intellect,  great  depression,  mel- 
ancholia, insomnia,  hallucinations,  and  even  delirium ;  and  in  the  worst 
cases  there  was  collapse. 


III.    THE   HALOGENS   AND   THEIR   SALTS. 

Under  the  above  name  we  include  four  elements,  chlorine,  bromine, 
iodine,  and  fluorine,  whose  sodium  and  potassium  compounds  closely  re- 
semble sea  salt,  sodium  chloride.  These  substances  all  combine  with  one 
atom  of  hydrogen  to  form  acids,  and  their  compounds  with  oxygen  and 
with  various  metals  resemble  each  other  greatly.  They  differ  from  other 
elements  in  having  colored  vapors,  which,  by  the  way,  are  all  intensely 
irritating  to  the  lungs. 

Chlorine — CI. 

This  substance,  a  heavy,  greenish-yellow,  corrosive  gas,  is  manufact- 
ured in  large  quantities  for  bleaching  and  antiseptic  purposes.  It  is  very 
corrosive,  and,  in  any  quantity,  will  set  up  acute  inflammation  of  the 
air-passages.  Inhaled  in  large  amounts  it  produces  narcotism,  and  even 
death,  by  paralysis  of  the  nerve-centers ;  but  although  in  every  qualita- 
tive laboratory  some  student  or  another  always  gets  a  violent  spell  of 
coughing,  from  smelling  too  eagerly  at  the  gas  as  it  is  evolved,  cases  of 
serious  poisoning  are  rare.  In  fact,  one  of  the  few  cases  on  record  has 
just  occurred  (February,  1894)  in  Ithaca,  where,  in  a  foolish  attempt  of 
some  college  boys  to  break  up  a  rival  class  supper  by  injecting  chlorine 
gas  into  the  room,  one  person  in  feeble  health  was  killed,  and  several 
others  severely  affected.  Its  salts  are  not  poisonous,  unless  in  enormous 
doses,  with  the  following  exception  : 

Potassic  Chlorate. — This  salt  occurs  in  the  form  of  colorless  flat 
crystals,  with  a  bitter,  salty  taste,  readily  soluble  in  water.  It  is  largely 
manufactured  for  oxidizing  purposes,  for  use  in  explosives,  and  for  pro- 
ducing oxygen. 

Externally  it  is  a  powerfxd  irritant  upon  mucous  membranes  and 
ulcerated  surfaces,  and  is  used  largely  for  gargling  and  washing  the 
mouth  in  sore  throat,  salivation,  small  ulcers,  and  the  like,  and  also  for 
treating  other  inflamed  surfaces. 

Internally  it  is  a  decided  poison,  and  though  often  swallowed  rather 
freely  in  the  above  disorders,  is,  in  large  doses,  always  to  be  considered 
dangerous. 

The  symptoms  are  usually  those  of  an  irritant,  i.e.,  nausea,  vomit- 
ing, pain  in  stomach  and  abdomen,  dyspnoea,  diarrhoea,  and  the  like, 
with,  when  severe,  more  or  less  collapse.  But  besides  this  it  has  a 
characteristic  action  upon  the  blood,  breaking  down  the  red  blood-cells, 
and  changing  the  haemoglobin  into  brownish  methsemoglobin. 

This  results  in  changes,  inflammation,  and  swelling  of  the  liver  and 
spleen,  and  in  very  marked  trouble  with  the  kidneys.  These  become 
highly  congested,  producing  small  amounts  of  brownish,  thick  urine,  full 
of  albumen,  and  of  brownish-red  casts  containing  broken-down  blood- 
cells.     Following  this  frequently  come  nervous  symptoms,  headache. 


334  A   SYSTEM   OF  LEGAL   MEDLCTNE. 

delirium,  and  coma,  and  the  patients  die  of  collapse,  sometimes  in  a  few 
hours,  but  generally  after  a  da}^  or  two. 

It  has  been  claimed  that  this  action  of  the  salt  was  due  to  its  oxidiz- 
ing power  upon  the  blood ;  but  careful  experiments  by  Hirne  and  others 
have  shown  that  from  ninety  to  ninety-eight  percent,  of  a  dose  of  potas- 
sic  chlorate  can  be  recovered,  unchanged,  from  the  urine  in  the  course 
of  a  few  hours. 

There  is  much  difference  of  opinion  as  to  the  amount  of  this  salt  that 
can  be  taken  with  safety.  Various  experimenters  have  taken  one  ounce 
at  a  time  without  any  special  effects,  although  one  of  these,  Dr.  Foun- 
tain, after  taking  one  and  one  eighth  ounces,  died  in  seven  days  from 
nephritis.  The  smallest  fatal  dose  recorded  is  forty-six  grains,  which 
killed  a  child  of  three  years. 

Dr.  Jacobi,  who  studied  carefully  the  toxicology  of  potassic  chlorate, 
considers  that  the  maximum  amount,  in  divided  doses,  for  twenty -four 
hours,  should  be,  for  infants  under  three,  from  twenty  to  twenty-five 
grains,  and  for  children  older  than  that,  up  to  about  thirty  grains,  while 
for  adults  it  may  amount  to  a  hundred  or  a  hundred  and  twenty-five 
grains. 

Bromine — Br. 

Bromine  is  a  dark  red  liquid,  with  a  very  disagreeable  pungent  smell, 
and  emitting,  at  ordinary  temperatures,  acrid,  irritating,  brownish-red 
fumes.  It  is  slightly  soluble  in  water,  but  more  so  in  alcohol  and  ether, 
and  is  used  to  some  extent,  in  medicine,  as  a  powerful  and  rapid  caus- 
tic, and  occasionally  as  a  vigorous  antiseptic.  When  taken  internally  it 
would  act  as  a  powerful  caustic,  and  indeed  one  case  is  reported  where 
an  ounce  of  bromine,  taken  into  the  stomach,  produced  death,  with 
symptoms  of  active  corrosion  followed  by  collapse,  in  seven  and  a  half 
hours. 

Potassium  Bromide,  KBr. — All  the  metallic  bromides  are  more  or 
less  poisonous,  but  from  experiments  by  Fere  (Compt.  Bend.  Biol.,  1891, 
vol.  iii.,  p.  771)  it  would  appear  that  potassium  bromide,  the  salt  most 
used  in  medicine,  is  five  times  more  poisonous  than  strontium,  and  fif- 
teen times  more  so  than  sodium,  bromide,  both  of  which  may  be  substi- 
tuted for  it. 

Potassium  bromide  acts  distinctly  as  a  nerve  depressor,  and  is  largely 
used  to  quiet  and  soothe  the  nerves  in  cases  of  excessive  excitement. 
Thus,  for  instance,  it  is  of  value  in  the  convulsions  of  children,  sexual 
excitement,  the  vomiting  of  pregnancy,  epilepsy,  tetanus,  strychnine  poi- 
soning, and  the  like ;  and  in  these  conditions  it  is  given  in  large  doses, 
even  half  an  ounce  at  a  time,  without  serious  symptoms. 

When,  however,  it  has  been  pushed  too  far,  or  taken  for  too  great  a 
length  of  time,  it  produces  marked  effects  upon  the  nervous  system. 
The  patients  suffer  from  cerebral  weakness ;  they  are  stupid,  difficult  to 
rouse,  lose  their  memory ;  they  stagger  and  become  dizzy  on  slight  exer- 
tion, sometimes  becoming  partially  paralyzed,  and  are  much  depressed. 
The  body  temperature  is,  as  a  rule,  much  lowered.  They  also  generally 
suffer  from  a  severe  rash,  some  oedema  and  swelling  of  the  skin,  eyelids, 
and  occasionally  mucous  membranes,  and  they  have  a  fetid  breath.  Occa- 
sionally, too,  there  are  symptoms  of  local  irritation.  These  cases  usually 
recover  when  treated  with  stimulants,  and  when  given  plenty  of  water  so 


INORGANIC  POISONS.  335 

us  to  wash  the  salt  from  the  system,  but  occasionally  they  result  in  death 
from  exhaustion,  heart-failure,  and  collapse. 

The  time  of  death,  and  also  the  fatal  dose,  varies  greatly.  In  one 
case  (Dr.  Hamer,  Columbus  Med.  Jour.,  1884,  vol.  iii,  p.  259)  a  woman  was 
given  eighty-five  grains  of  the  salt  every  four  hours.  After  four  days 
another  doctor  found  her  almost  comatose,  muttering  to  herself,  with  a 
temperature  of  95|°,  weak  rapid  pulse,  very  ansemic,  passing  little,  albu- 
minous urine,  and  with  pain  in  head  and  over  ovaries.  The  medicine, 
she  said,  burned  her  mouth  and  throat  whenever  she  took  it.  In  spite 
of  treatment  she  died  in  eight  and  a  half  days  from  the  first  dose. 

In  another  case  (Brit  Med.  Jour.,  1882,  part  i.,  p.  616),  a  doctor  called 
to  treat  a  child  recovering  from  convulsions  prescribed  five  grains  of 
potassium  bromide  every  four  hours.  After  the  first  dose  the  child 
seemed  much  better,  but,  a  few  minutes  after,  drank  down  most  of  the 
medicine,  some  eighty  grains  in  all.  In  ten  minutes  the  child  became 
pale,  with  blue  lips,  and  lay  down  to  rest ;  and  within  five  minutes  more 
it  died  quietly. 

In  general  the  symptoms  of  "bromism"  come  on  gradually,  with 
ordinary-sized  doses,  and  can  be  recognized  in  time  to  prevent  serious 
injury. 

Iodine — I. 

This  occurs  in  soft,  bluish-black,  crystalline  scales,  having  a  metallic 
luster  and  an  irritating  smell  and  taste.  It  volatilizes  slightly  at  ordi- 
nary temperatures,  and  at  about  220°  F.  it  melts  and  changes  into  a  vio- 
let vapor.  It  is  almost  insoluble  in  water,  but  dissolves  freely  in  a  solu- 
tion of  potassic  iodide,  and  also  in  alcohol,  and  ether.  Its  solutions  turn 
.starch  blue. 

Externally  it  acts  as  a  powerful  irritant,  and  if  very  strong,  as  a  caus- 
tic. It  is  largely  used  in  medicine  for  producing  local  counter-irritation, 
and  for  this  purpose  is  painted  011  the  skin,  in  the  form  of  a  tincture. 
If  the  latter  is  strong,  and  is  applied  repeatedly,  it  will  produce  blisters 
and  very  decided  inflammation. 

When  swallowed,  it  acts  as  a  powerful  irritant,  and  when  in  moder- 
ate-sized doses,  ten  and  twenty  grains,  has  been  known  to  produce  death, 
with  the  usual  symptoms  of  a  corrosive  poison. 

It  also  has  certain  specific  effects  when  absorbed  into  the  system, 
either  from  injection  into  a  cyst  or  cavity,  or  by  being  painted  on  an 
ulcerated  surface.  Under  these  circumstances  it  produces  more  or  less 
gastric,  irritation,  shown  by  vomiting,  purging,  and  the  like ;  also  some 
nervous  symptoms,  neuralgia,  disturbed  intellect,  dizziness,  and  so  on ; 
and  finally,  by  its  elimination,  produces  considerable  inflammation  of  the 
kidneys,  and  often  an  eruption  on  the  skin. 

An  interesting  case  of  acute  iodine  poisoning  is  given  by  Dr.  Culpeper 
(Therap.  Gaz.,  1888,  vol.  iv.,  p.  225).  A  colored  woman  painted  both  legs 
of  her  eleven-year-old  boy  with  a  solution  of  iodine  strong  enough  to 
take  off  all  the  skin  from  above  his  knees  to  below  his  ankles.  This  was 
done  at  night,  and  all  night  and  next  day  the  little  fellow  complained 
of  much  local  pain.  At  night  he  had  a  headache,  with  pain  in  stomach, 
bowels,  and  bladder,  and  in  the  back  over  the  kidneys,  and  passed  no 
.urine. 

The  second  day  he  was  worse,  with  diarrhoea  and  vomiting,  and  the 


336  J    SYSTEM   OF  LEGAL   MEDICINE. 

third  day  these  symptoms  increased.  On  the  fourth  day  he  was  suffer- 
ing- from  vomiting,  purging,  and  hiccoughing,  and  iodine  was  found  in 
both  faeces  and  vomited  matter.  He  was  very  dizzy  and  had  fainting- 
fits, while  no  urine  was  passed  at  all,  and  after  five  and  a  half  days  he 
died  quietly,  after  passing  almost  pure  blood. 

His  temperature  did  not  rise  above  98.8°,  although  there  was  much 
raw  surface ;  there  was  total  suppression  of  urine  from  the  beginning ; 
his  intellect  was  clear,  although  he  was  very  giddy  on  taking  the  least 
exertion,  and  he  had  constant  symptoms  of  gastric  irritation. 

Potassium  Iodide,  KI. — This  salt  is  given  in  very  large  doses,  espe- 
cially in  the  latter  stages  of  syphilis,  and  is  usually  borne  quite  well.  It 
must,  however,  be  used  carefully,  or  it  will  give  some  of  the  symptoms  of 
iodine  poisoning,  beginning,  usually,  with  a  rash,  and  continuing  with 
cerebral  symptoms,  and  sometimes  with  lowering  of  temperature.  These 
effects,  as  a  rule,  are  not  dangerous,  and  are  easily  cured  after  stoppage 
of  the  drug. 

IV.   PHOSPHORUS. 

This  substance  was  discovered  by  Brandt,  in  1669,  in  the  residues 
from  urine,  while  searching  for  the  philosopher's  stone.  It  was  named 
from  its  power  of  shining  in  the  dark,  and  for  a  hundred  and  fifty  years 
was  regarded  almost  solely  as  a  curiosity.  In  the  early  part  of  this 
century  it  was  introduced  for  the  manufacture  of  matches,  and  after- 
wards as  a  vermin  killer,  and  since  then  has  been  manufactured  in  large 
quantities. 

Phosphorus  never  occurs  in  nature  excepting  when  combined  with 
oxygen  or  some  other  element.  Its  compounds,  however,  especially  the 
(ortho)phosphates  of  calcium,  magnesium,  sodium,  and  potassium,  are 
found,  widely  distributed,  in  the  form  of  rocks  and  minerals,  in  all  soils, 
in  almost  all  natural  terrestrial  waters,  and  in  the  tissues  and  fluids  of 
plants  and  animals.  In  the  latter  it  chiefly  occurs  in  the  bones  and  the 
brain  tissue. 

It  is  prepared  from  the  ashes  of  bones,  which  are  principally  com- 
posed of  calcium  phosphate,  by  separating  the  calcium  with  sulphuric 
acid,  and  distilling  the  resulting  acid  with  charcoal. 

Properties. — It  is  a  light  yellow,  translucent,  horn-like  solid,  which 
can  be  easily  cut,  and  which  appears  in  commerce  usually  as  small  sticks 
covered  with  a  whitish  coat,  It  has  no  taste,  but  a  peculiar  garlic  smell. 
It  ignites  in  the  air  at  100°  F.,  but  when  in  an  inert  atmosphere  like 
carbon  dioxide,  or  under  water,  it  melts  at  109°  F. 

It  is  practically  insoluble  in  water,  but  dissolves  freely  in  carbon 
disulphide,  and  to  a  less  extent  in  oils,  concentrated  acetic  acid,  and 
ether.  By  suitable  treatment  it  can  be  changed  into  two  if  not  three 
other  varieties  of  phosphorus.  One  only  of  these  is  important,  the  red 
phosphorus,  which  is  a  red  powder,  insoluble  in  the  above  media,  far 
less  combustible  than  the  common  form,  and  non-poisonous.  In  com- 
merce, however,  it  almost  always  contains  a  small  percentage  of  the 
yellow  or  ordinary  phosphorus. 

Physiological' Properties. — In  small  quantities,  this  element  acts  as 
a  stimulant  to  the  nutrition  of  the  tissues,  and  especially  of  the  nerve- 
centers.     It  is,  therefore,  much  used  in  exhaustion,  or  even  disease,  of 


INORGANIC  POISONS.  337 

the  spinal  or  brain-centers,  in  neuralgia,  anaplirodisia,  incipient  myelitis, 
and  the  like.  It  also  stimulates  the  formation  of  bone  tissue,  and  is 
often  employed,  with  iron,  in  cases  of  osteomalacia,  rickets,  and  similar 
diseases.  In  experiments  on  animals  the  spongy  tissue  becomes  denser, 
and  the  hard  tissues  thicken,  in  some  cases  till  the  canal  is  almost  filled  up. 

Poisonous  Properties. — These  have  been  recognized  ever  since  phos- 
phorus was  manufactured  for  commercial  purposes.  In  this  country 
and  England  cases  of  poisoning  by  it  have  been  mostly  confined  to  ac- 
cidents or  murders ;  but  on  the  Continent,  and  especially  in  France,  it  is 
much  used  for  suicide,  and,  some  years,  heads  the  whole  list  of  poisons. 
It  has  the  advantage  of  being  cheap  and  easily  obtained,  but  it  produces 
great  suffering  and,  usually,  a  slow,  lingering  death. 

Symptoms — Rapid  Cases. — In  some  cases,  perhaps  ten  or  fifteen 
percent.,  a  fatal  dose  of  phosphorus  will  act  promptly  and  produce 
death  within  twenty-four  hours  or  so.  Under  these  circumstances  the 
first  symptoms  are  usually  retching  and  vomiting,  with  sharp  pains  in 
the  epigastrium,  and  an  odor  of  phosphorus  both  in  the  breath  and 
vomited  material.  These  symptoms  often  improve  instead  of  growing- 
worse,  but  the  patient  sinks  into  a  state  of  collapse,  and  dies  in  coma, 
•or  in  convulsions. 

Death  may  occur,  under  these  circumstances,  in  but  a  few  hours 
after  taking  the  poison.  Von  Maschka  (Wien.  Med.  Wochensch.,  1884, 
pp.  608,  648)  reports  in  detail  two  cases  of  his  own,  of  a  girl  twenty- 
seven  years  old  and  a  man  sixty-one  years  old,  each  of  whom  died  in 
eight  hours ;  and  quotes  cases  of  death  in  eight,  seven,  and  four  hours 
respectively.  The  last  case,  which  is  quoted  from  Kessler,  was  of  a  child 
seven  weeks  old,  who  had  sucked  the  heads  from  six  or  seven  matches. 

Symptoms — Ordinary  Cases. — In  the  great  majority  of  cases  the 
first  symptoms  do  not  appear  for  some  hours  or  even  days  after  the 
poison  is  taken,  and  then  are  not  very  severe.  They  consist  of  a  feeling 
of  weakness  and  general  ill-health,  with  some  nausea,  and,  perhaps, 
vomiting,  and  some  epigastric  pain.  The  vomited  matter  and  the  breath 
usually  smell  of  phosphorus,  and  occasionally  are  luminous  in  the  dark. 

These  symptoms,  especially  under  treatment,  get  no  worse,  and  in- 
deed often  improve,  for  one  or  two  days  or  even  longer.  There  may  be 
slight  fever,  thirst,  loss  of  appetite,  and  the  like,  but  nothing  to  cause 
much  alarm. 

Then  come  symptoms  of  jaundice,  usually  beginning  with  yellow 
coloring  of  the  conjunctiva?  and  the  presence  of  bile  in  the  urine.  The 
skin  becomes  yellow,  the  stools  are  liver-colored,  and  finally  almost  white 
— "chalk  and  water,"  as  they  are  frequently  described — the  liver  be- 
comes considerably  enlarged,  and  is  painful  on  pressure 

The  kidneys  also  are  affected,  as  is  shown  by  the  urine  being  scanty, 
full  of  albumen,  often  containing  casts  and  blood,  and,  sometimes,  glu- 
cose. Bile  acids  and  bile  pigments  are  present  in  it,  and  not  infrequently 
leucine  and  tyrosine ;  while  under  the  microscope  can  be  seen  small  fat- 
globules,  partly  free  in  the  liquid,  partly  in  epithelial  cells. 

The  patient  by  this  time  is  dangerously  ill ;  nervous  symptoms,  such 
as  delirium,  frequently  of  an  erotic  character,  or  a  heavy  comatose 
sleep,  set  in.  The  temperature  may  fall  very  decidedly,  but  not  infre- 
quently rises,  sometimes  very  high;  and  the  patients  finally  die  of  col- 
lapse, sometimes  in  coma,  sometimes  in  convulsions. 


838  A   SYSTEM  OF  LEGAL  MEDICINE. 

Occasionally,  with  these  signs  of  liver  disease,  come  some  peculiar 
symptoms  of  the  blood.  The  blood  becomes  dark,  not  easily  coagu- 
lated, if  at  all,  with  fewer  red  and  more  white  blood- cells,  and  gives  rise 
to  bleedings  from  different  parts  of  the  body.  Women  frequently  flow 
freely,  as  at  menstrual  periods  (they  invariably  abort  or  have  a  mis- 
carriage when  in  pregnancy),  and  there  may  occur  obstinate  bleedings 
from  the  gums,  nose,  kidneys,  or  bowels.  In  these  cases  the  disease 
may  last  for  a  long  time,  and  the  patients  finally  die  of  anaemia. 

Post=mortem  Changes. — In  the  ordinary  cases  there  will  be  found 
an  extreme  fatty  degeneration  of  the  liver  and  kidneys,  and  also  gener- 
ally of  the  heart,  lungs,  and,  in  fact,  almost  all  the  tissues  of  the  body. 
The  liver,  in  the  early  stages,  is  much  enlarged,  but  afterward  dimin- 
ishes in  size,  and  may  be  much  atrophied.  It  always,  however,  has  more 
or  less  of  a  yellowish  look  when  cut,  and  contains  little  or  no  blood. 
Pieces  of  it  will  sometimes  burn  freely  when  touched  with  a  lighted 
match.  Under  the  microscope  the  cells  appear  much  broken  down  and 
full  of  fatty  globules. 

The  kidneys  present  similar  appearances.  The  cortex  peels  off  easily, 
and  on  section  the  tissue  has  a  yellow  color  and  a  greasy  feeling. 

The  lungs  and  heart  also  show  signs,  generally,  of  fatty  degeneration  • 
the  blood  is  dark  colored,  and  forms  numerous  ecchymoses  in  the  en- 
docardium, the  mediastinum,  and,  in  fact,  all  over  the  bodjr. 

It  used  to  be  stated  that  phosphorus  produced  inflammation,  and 
often  ulceration,  of  the  stomach  and  intestines.  It  really  produces,, 
rather,  a  gastro-adenitis — i.e.,  the  mucous  membrane  becomes  much 
thickened,  white,  and  opaque,  from  a  great  enlargement  of  the  glands 
and  a  fatty  degeneration  of  the  epithelium.  This  also  is  the  case  with 
the  intestines. 

Phosphorus  Poisoning  vs.  Acute  Yellow  Atrophy  of  the  Liver 

When  jaundice  has  once  set  in  it  is  almost  impossible,  by  clinical  means, 
to  distinguish  between  these  two  forms,  if  the  liver,  in  the  phosphorus 
cases,  has  had  time  to  contract.  In  the  earlier  stages  it  enlarges  a  good 
deal,  and  does  not,  as  a  ride,  get  small  until  the  jaundice  has  lasted  two 
or  three  days. 

It  is  claimed  that  in  acute  yellow  atrophy  there  is  far  more  leucine 
and  tyrosine  in  the  urine  than  in  phosphorus  poisoning ;  and  also  that 
the  intestines  contain  gray- white,  knotty  fsecal  matter,  while  in  the  phos- 
phorus cases  the  excreta  are  usually  fluid. 

These  differences,  however,  are  slight,  and  it  is  better  to  trust  for 
distinction  upon  tests  for  phosphorus,  either  in  the  early  vomited  matter, 
or  in  the  intestines  and  tissues  after  death. 

Time  of  Death. — These  cases  usually  die  in  from  three  to  seven 
days,  though  they  sometimes  linger  ten  days  or  a  fortnight.  Out  of  129 
cases  of  all  kinds  looked  up  by  Dr.  Blyth,  17  died  within  twenty-four 
hours,  30  within  two  days,  103  within  seven  days,  22  more  before  ten 
days,  and  4  lived  for  more  than  ten  days,  1  dying  at  the  end  of  eight 
months. 

Treatment  and  Antidotes. — When  once  the  phosphorus  has  been 
absorbed  in  the  circulation  in  sufficient  amounts  to  produce  the  liver 
lesions,  treatment  is  of  but  little  value.  The  poison  must  be  ejected  as 
far  as  possible,  before  it  is  absorbed,  by  vomiting  and  purging,  and  then 
what  remains  must  be,  if  possible,  rendered  inert.     It  is  not  absorbed 


INORGANIC  POISONS.  339 

very  quickly,  for  free  phosphorus  has  been  found  in  the  faeces  for  two 
or  three  days  after  it  was  taken. 

There  are  two  antidotes  to  phosphorus,  of  more  or  less  value,  cupric 
sulphate  and  oil  of  turpentine.  The  copper  salt  forms  a  black  phosphide 
of  copper,  which  is  harmless  and  can  be  removed,  it  is  said,  by  the  kid- 
neys. So  it  is  good  practice,  when  a  patient  is  brought  in,  to  give  him 
an  emetic  of  three  grains  of  cupric  sulphate  in  some  water,  and  to  repeat 
it  at  frequent  intervals. 

The  use  of  oil  of  turpentine  was  introduced  by  Andant,  who  in  1868, 
it  is  said,  met  a  case  of  a  man  who,  to  commit  suicide,  took  a  lot  of 
phosphorus  paste,  and  then,  to  hasten  his  end,  took  a  good  drink  of  tur- 
pentine. To  the  great  astonishment  of  both  physician  and  patient  the 
symptoms  were  slight,  and  recovery  was  rapid. 

At  any  rate,  some  kinds  of  oil  of  turpentine,  probably  turpentines 
that  have  been  exposed  to  the  air  for  a  long  time,  have  undoubtedly  the 
property  of  making  an  inert,  gelatinous  mass  with  the  poison,  and  also, 
very  possibly,  help  to  oxidize  it  and  thus  make  it  harmless.  One  exper- 
imenter, Personne,  poisoned  fifteen  dogs  with  phosphorus,  and  gave 
turpentine  to  ten,  all  of  whom  survived,  while  the  other  five  died  with 
the  characteristic  symptoms. 

It  should  be  given  in  doses  of  from  thirty  to  forty  minims  (2  to  2-g-  gr.) 
every  half -hour  or  so,  for  two  or  three  days. 

Dangerous  and  Fatal  Doses. — The  medicinal  doses  of  phosphorus 
vary  from  one  thirtieth  to  one  twelfth  or  even  one  quarter  of  a  grain. 
In  an  interesting  paper  Mr.  Thompson  (Practitioner,  1872,  part  ii.,  p.  13), 
giving  his  experiences  in  neuralgia,  advises  starting  with  one  eighteenth 
of  a  grain  every  three  hours,  and  increasing  to  one  twelfth  of  a  grain 
and  higher.  He  tells  of  ono  case  where  a  person  took  one  quarter  of  a 
grain  four  times  a  day,  for  three  days,  without  injury.  On  the  other 
hand,  on  page  103  of  the  same  volume,  Dr.  Anstie  tells  how  a  man 
taking  one  thirtieth  of  a  grain  three  times  a  day  for  six  or  seven  days 
(under  three  quarters  of  a  grain  in  all)  developed  distinct  symptoms  of 
poisoning.     The  subject,  in  this  case,  was  highly  neurotic. 

Death  has  been  more  than  once  reported  from  quantities  of  phos- 
phorus varying  from  one  to  two  grains.  Sir  R.  Christison  gives  two 
fatal  cases,  one  from  one  and  a  half  grains  and  the  other  from  about  two 
grains,  and  Galtier,  a  case  where  a  woman  died  from  taking  about  one 
grain  in  the  course  of  four  days.  A  case  was  reported  by  Lobel  of 
Jena  where  a  lunatic  was  killed  by  a  do*e  of  one  eighth  of  a  grain. 

It  is  fair,  accordingly,  to  state  that  from  one  to  two  grains  would 
constitute,  as  a  rule,  a  dangerous  if  not  fatal  dose. 

It  is  not  necessary  for  the  poison  to  be  taken  internally.  A  curious 
case  is  reported  by  Dr.  Hill  (Lancet,  1890,  part  i.,  p.  398),  where  a  ser- 
vant-girl, wishing  to  give  an  interesting  "dark  seance  "to  her  fellow- 
servants,  rubbed  some  phosphorus  paste  on  her  face  and  hands.  The 
resulting  illumination  was  satisfactory  enough,  but  the  poor  girl  died, 
with  characteristic  symptoms,  on  the  eighth  day. 

Poisoning  by  Phosphorus  Vapor — Necrosis  of  the  Jaw. — Soon  after 
phosphorus  was  manufactured  on  a  large  scale,  it  was  noticed  that  work- 
men exposed  to  its  fumes  were  subject  to  a  peculiar  disease  of  the  jaw- 
bone. In  1845  twenty-two  cases  were  reported  in  Austria,  and  two 
years  later  Von  Bilvaand  Geist  discussed  fully  the  etiology  of  sixty- 


340  A   SYSTEM   OF  LEGAL    MEDICINE. 

eight  cases  in  Germany.  Of  late  years,  thanks  somewhat  to  improved 
ventilation,  enforced  cleanliness,  washing  the  months  with-alnm  and 
alkaline  solutions,  and  rejection  of  workmen  with  unsound  teeth,  and, 
more  than  all  these,  to  the  use  of  red  phosphorus,  the  disease  has  almost 
disappeared. 

The  first  symptoms  were  usually  those  of  a  severe  toothache,  gener- 
ally in  the  lower  jaw.  This  would  become  worse,  and  the  aching  teeth 
would  be  pulled  out,  thereby  relieving  the  pain.  But  the  wound  in  the 
gum  would  not  heal ;  offensive  matter  would  ooze  out,  and  the  sockets 
of  the  teeth  would  become  bare  and  exposed. 

Occasionally  this  bare  piece  of  bone  would  slough  off,  with  two  or 
three  neighboring  teeth,  and  the  wound  would  heal  up  all  right.  But 
generally  the  disease  would  spread  slowly  or  fast ;  more  of  the  jaw  would 
become  involved,  the  teeth  falling  out  and  the  bone  being  laid  bare.  The 
gums  would  become  swollen  and  infiltrated,  offensive  pus  would  exude, 
and  often,  if  not  treated,  in  the  course  of  some  months  or  years,  the 
patient  would  die  of  debility,  septic  pneumonia,  or  the  like ;  or  else  get 
well,  though  horribly  deformed  by  the  loss  of  large  masses  of  the  jaw. 

The  disease,  it  would  appear,  is  a  purulent  inflammation  of  the  mar- 
row of  the  bone  (osteomyelitis),  and  spreads  from  the  interior  toward 
the  periosteum.  The  poisonous  fumes  are  usually  supposed  to  enter  the 
system  through  a  decayed  tooth,  but  this  does  not  seem  invariably  to  be 
the  case. 

The  treatment  usually  adopted  is  an  immediate  removal  from  the 
exposure,  followed  by  a  pretty  free  use  of  the  knife.  The  dead  bone  is 
removed  wherever  possible,  and  the  wound  opened  up,  and  thoroughly 
cleansed  by  irrigating  constantly  with  antiseptic  washes.  If  carefulty 
done  it  is  possible  to  remove  the  decayed  bone,  leaving  the  periosteum 
intact,  in  which  case  new  bone  will  frequently  form  and  preserve  both  the 
strength  and  the  shape  of  the  original  jaw.  A  case  of  this  sort,  where 
a  whole  lower  jaw  was  removed  from  a  girl  by  Dr.  Wood,  at  Bellevue, 
in  1857,  is  commented  on  most  favorably,  as  a  specimen  of  American 
surgery,  in  the  Lancet  (1877,  part  i.,  p.  813).  The  patient  recovered 
from  the  operation,  and  died  of  some  brain  disease  three  years  after  the 
operation,  and  the  jaw  was  found  to  be  completely  re-formed.  It  was  pre- 
served as  a  curiosity,  and,  twenty  years  afterward,  was  exhibited  at  a  Medi- 
cal Congress  at  Berlin,  much  to  the  interest  of  the  European  physicians. 

Tests  for  Phosphorus. — The  vomited  material,  as  well  as  the  fseces, 
urine,  and  even  the  breath,  will  generally,  in  the  early  stages  of  poison- 
ing, have  a  peculiar  garlic  smell,  and  shine  in  the  dark.  Besides  this 
there  are  two  methods,  one  discovered  by  Mitscherlich  and  the  other  by 
Dusart,  for  obtaining  good  evidence  of  the  presence  of  minute  traces  of 
phosphorus  or  phosphorous  acid. 

Mitscherlich' s  Test. — If  a  mixture  containing  phosphorus  is  acidu- 
lated with  sulphuric  acid  and  carefully  distilled  on  a  sand-bath,  and  the 
vapors  condensed  in  a  glass  conden  sing-tube  in  a  dark  room,  any  phos- 
phorus present  will  be  volatilized,  and,  in  condensing,  light  up  the  tube. 
If  present  in  any  quantity,  its  amount  can  be  determined  by  oxidizing 
it  with  nitric  acid,  and  then  precipitating  it  with  amnionic  molybdate, 
or  ammonio-magnesic  sulphate,  and  weighing.  But,  in  this  case,  care 
must  be  taken  that  nothing  from  the  flask  is  allowed  to  spatter  over  into 
the  condenser. 


INORGANIC    1'OISONS.  341 

This  luminosity  can  be  observed  for  quite  a  time,  half  an  hour  or 
more,  with  one  fortieth  or  one  fiftieth  of  a  grain  of  phosphorus,  mixed 
with  several  ounces  of  liquid.  It  is  interfered  with  by  the  vapors  of 
alcohol  and  ether,  which  would  be  quickly  volatilized,  and  of  oil  of 
turpentine ;  also  by  calomel,  corrosive  sublimate,  and  large  quantities 
of  iodine.  It  is  not  affected,  however,  by  the  presence  of  organic 
matter. 

Phosphoreted  Hydrogen  Test. — This  gas  is  formed  by  the  action 
of  nascent  hydrogen  on  free  phosphorus  or  on  its  lower  oxides,  and 
burns  with  a  characteristic  green  flame.  Hence,  if  a  suspected  solution 
is  placed  in  an  evolution-flask  containing  zinc  and  dilute  sulphuric  acid, 
from  which  the  hydrogen,  passing  through  a  drying-tube  containing 
caustic  potash  or  lime,  is  led  to  an  ignition-tube  and  is  there  burned,  the 
color  of  the  flame,  if  phosphorus  be  present,  will  change  from  a  faint  blue 
to  a  brilliant  green.  This  flame  can  be  further  tested  by  the  spectroscope. 
The  end  of  the  tube  should  be  kept  cool  in  this  experiment. 

This  test  will  show  the  presence  of  phosphorus  in  as  small  amounts 
as  the  Mitscherlich  test,  and  is  not  interfered  with  by  anything  that  is 
likely  to  be  present. 

V.     ANTDIONY. 

History. — This  element  was  known  to  the  ancients  both  in  its  metallic 
state  and  in  its  salts.  The  metal,  known  as  stibium,  was  used  to  some 
extent  by  both  Greeks  and  Romans,  while  the  black  sulphide,  now  called 
stibnite,  which  is  the  commonest  form  in  which  antimony  occurs  in 
nature,  has  been  used  from  time  immemorial  up  to  the  present  day,  in 
the  East,  on  account  of  the  fine  black  powder  obtained  from  it.  This  is 
mentioned  not  only  in  comparatively  recent  tales,  like  the  Arabian  Nights, 
where  the  women  always  paint  and  touch  up  their  eyebrows  and  eye- 
lashes with  "  kohl,"  but  is  even  alluded  to  in  the  Bible,  when  Jezebel,  be- 
fore putting  her  head  out  of  the  castle  window  to  greet  the  victorious 
rebel,  Jehu,  "  painted  her  face,"  or,  as  the  other  translation  gives  it,  "  put 
her  eyes  into  painting." 

The  name  antimony  was  given  to  it  in  the  middle  ages  by  Basil  Val- 
entine, a  German  monk,  who,  early  in  the  fifteenth  century,  described 
its  medicinal  powers  in  a  book  Currus  Triumphalis  Antimonii.  The 
story  goes  that  while  studying  the  properties  of  some  of  the  metals  he 
threw  the  refuse  from  some  of  his  experiments  into  a  pig-pen,  and  was 
interested  to  see  that,  although  the  pigs  were  violently  purged,  they  grew 
fat  and  strong  under  the  treatment.  He  accordingly  put  some  in  the 
food  at  the  convent,  but,  whether  from  his  carelessness  or  the  poor  con- 
stitution of  the  good  brothers,  he  killed  nearly  all  of  them.  Hence  the 
nickname  antimony — "bad  for  the  monks." 

Paracelsus  was  one  of  the  first  to  parade  its  virtues,  and  he  brought 
it  into  wide  notice,  but,  at  the  same  time,  into  much  disrepute  among 
the  regular  practitioners,  so  that  in  1556  the  Faculty  of  Physic  at  Paris 
condemned  it  as  a  poison,  and  the  Parliament  prohibited  its  use  under 
heavy  penalties.  As  late  as  1609  they  expelled  a  doctor  from  their 
facidty  for  using  the  drug,  and  Guy  Patin,  a  famous  professor  in  Paris, 
published  a  Martyrology  of  Antimony  giving  great  lists  of  the  victims 
from  it.     Its  use,  however,  gradually  spread,  tartar  emetic  was  discovered 


342  A   SYSTEM  OF  LEGAL  MEDICINE. 

in  1631,  and  a  few  years  later  it  was  restored  to  the  pharmacopoeia,  and 
its  use  made  general. 

Later  it  was  used  as  a  panacea ;  it  was  claimed  to  be  an  emetic,  pur- 
gative, diuretic,  stimulant,  sedative,  anti-scorbutic,  and  a  cure  for  acute 
mania.  Cups  were  made  of  antimony  glass,  an  impure  oxide,  which 
gave  purging  properties  to  liquids  drunk  from  it.  It  is  still  used  in 
medicine,  in  the  form  of  tartar  emetic,  to  a  moderate  extent,  but  the  ex- 
cessive claims  for  it  have  disappeared. 

Its  salts  are  active  poisons,  although  not  generally  used  as  such,  and 
cases  of  poisoning  by  it  are  not  very  common,  excepting  when  taken  acci- 
dentally. Taylor,  in  1857,  collected  thirty-seven  cases,  of  which  sixteen 
were  fatal,  and  in  the  course  of  that  year  investigated  three  or  four  cases 
of  murder.  Since  then  it  has  been  of  less  importance,  although  every 
now  and  then  it  has  been  the  basis  of  some  famous  trials — the  Pritchard 
case  and  the  Bravo  or  Balham  case  in  England,  and  the  great  Wharton 
case  in  this  country,  some  details  of  which  last  will  be  given  later. 

Preparation  and  Properties. — The  metal  is  usually  prepared  by 
roasting  and  reducing  the  sulphide,  stibnite.  It  is  a  grayish  white, 
brittle-  solid,  with  metallic  luster,  and  without  taste  or  smell.  It  crys- 
tallizes readily,  and  is  volatile. 

It  does  not  oxidize  in  the  ah*  at  ordinary  temperatures,  but  when 
heated  it  burns  to  the  oxide,  Sb.2Oy.  It  dissolves  in  hot  concentrated 
sulphuric,  hydrochloric,  and  nitric  acids,  but  not  in  alkalies  or  solutions 
of  hypochlorites.  It  is  probably  not  poisonous,  unless,  possibly,  when 
inhaled  as  gas,  when  it  may  easily  become  oxidized,  and  then  produce 
characteristic  symptoms. 

Its  two  important  compounds  are  tartar  emetic,  and  antimonious 
chloride  or  butter  of  antimony. 

Tartar  Emetic,  KSbOG^H^O^ 

This  compound,  formed  by  boiling  antimonious  oxide  with  cream  of 
tartar,  is  sold  as  a  white,  crystalline  powder,  with  a  nauseous,  styptic,  me- 
tallic taste.  It  is  readily  soluble  in  hot,  and  less  so  in  cold,  water ;  strong 
alcohol  fails  to  dissolve  it,  but  proof  spirits  and  wine  dissolve  it  according 
to  the  amount  of  water  which  they  contain.  It  crystallizes  from  its  solu- 
tions in  the  form  of  colorless,  transparent  crystals  of  the  rhombic  form. 

Its  aqueous  solutions  decompose  readily,  on  standing,  by  the  action 
of  molds  and  alga?,  which  form  a  stringy  deposit  in  the  liquid.  It  is 
also  decomposed  by  acids,  alkalies,  plumbic  acetate  and  subacetate,  and 
by  astringent  solutions  containing  tannic  acid,  which  forms  a  more  or 
less  insoluble  compound  with  the  metal. 

Physiological  Effects. — These  have  been  studied  on  animals  as  well 
as  on  man. 

Externally. — When  antimonial  solutions  are  rubbed  on  the  skin  some 
local  irritation  is  produced,  but  the  effects  are  slight.  When  antimonial 
ointments  have  been  used  in  some  quantities,  the  local  irritation  may 
get  so  severe  as  to  form  true  pustular  eruptions  which  look  a  good 
deal  like  smallpox,  accompanied  by  the  specific  effects  of  vomiting  and 
purging,  and  a  lowering  of  the  arterial  tension. 

Similar  results  have  been  produced  on  animals  by  inhaling  antimo- 
niureted  hydrogen. 


INORGANIC  POISONS.  343, 

Internally. — Minute  quantities  produce,  usually,  but  a  slight  nausea 
and  discomfort.  As  the  dose  increases  these  symptoms  get  worse,  until 
with  one  third  or  one  half  of  a  grain,  as  a  rule,  the  patients  begin  to- 
vomit. 

With  still  larger  doses  the  vomiting  becomes  more  and  more  severe, 
with  retching,  much  discomfort,  increased  perspiration,  diminished  pulse, 
muscular  weakness,  and  even  faintness. 

Poisonous  Effects. — When  the  danger  limit  is  reached  the  vomiting 
will  usually  be  violent  and  incessant,  bringing  up  mucus,  often  stained 
with  bile,  and  finally  even  with  blood.  This  seems  to  be  caused,  to 
some  extent,  by  the  local,  irritant  action  of  the  drug,  but,  for  the  most 
part,  by  the  action  of  the  absorbed  antimony  upon  the  vomiting  center 
in  the  medulla.  It  has  been  observed  in  animals  when  a  rubber  bag  was 
substituted  for  the  stomach,  and  is  also  generally  present  when  antimony 
is  given  externally. 

The  intestines  are  also  affected,  and  there  is  violent  and  severe  purg- 
ing, the  stools  becoming  more  and  more  watery,  and  often  having  the 
"  rice-water  "  appearance  noticed  in  cholera.  Later  they  may  be  bloody. 
There  is  generally  pain  and  purging  in  the  oesophagus  and  stomach,  and 
a  great  deal  of  thirst.  The  resemblance  to  cholera  is  often  strengthened 
by  cramps  in  the  extremities. 

The  urine  is  often  increased  at  the  outset,  but,  a  little  later,  is  gener- 
ally scanty,  sometimes  containing  blood,  and  may  be  completely  sup- 
pressed. 

The  nervous  system  is  often  affected,  with  more  or  less  loss  of  sensa- 
tion, and  occasionally  with  convulsions.  The  patients  almost  always  are 
greatly  depressed,  and  feel  wretchedly  weak  and  miserable. 

The  circulation  is  affected  very  early,  the  arterial  tension  being 
lowered  by  the  action  of  the  drug  not  only  on  the  heart-centers  them- 
selves, but  also  on  the  peripheral  vasomotor  system. 

Finally,  when  the  severe  symptoms  have  lasted  for  some  time,  there 
are  distinct  signs  of  collapse.  The  face  becomes  pale  and  haggard,  the 
eyes  sunk,  the  skin  cold  and  clammy,  the  extremities  cold,  the  pulse  weak, 
the  respiration  slow.  Death  may  occur  from  exhaustion,  in  a  stupor,  or 
in  convulsions  or  even  delirium. 

Other  Symptoms. — Occasionally,  the  vomiting  and  purging  is  slight 
or  even  absent,  and  the  victims  suffer  from  intense  prostration,  almost 
from  the  start,  and  die  from  failure  of  respiration  and  circulation,  owing 
to  the  action  of  the  drug  on  the  centers  in  the  medulla. 

Chronic  Cases. — In  other  cases  the  drug  is  administered  in  small 
doses  repeated  at  successive  intervals.  The  same  amount  of  poison  is 
more  apt  to  kill  in  this  way  than  when  given  in  one  large  dose,  because 
in  the  latter  case  it  is  often  rejected  at  once  by  the  violent  vomiting. 
These  chronic  cases  are  characterized  by  nausea  and  persistent,  though 
not  very  violent,  vomiting,  with  purging  or,  occasionally,  constipation, 
and  with  veiy  marked  depression.  The  food  cannot  be  digested,  the  cir- 
culation gradually  fails,  and  the  patients  get  weaker  and  weaker,  and 
finally  die  of  exhaustion. 

The  Pritchard  Case. — Instances  of  both  acute  and  chronic  antimony 
poisoning  occurred  in  the  above  case  ( Edin.  Med.  Join:,  1 865,  vol.  ii..  p.  1 63, 

and  Archives.  Gen.,1865,  part  ii,  p.  267),  where  a  doctor,  in  g 1  practice 

in  Glasgow,  was  convicted  of  murdering  both  wife  and  mother-in-law. 


^44  ^  SYSTEM  OF  LEGAL  MEDICINE. 

His  wife  was  taken  down,  in  the  autumn,  with  nausea,  vomiting-,  and 
general  ill-health,  and  after  a  week  or  two  went  to  Edinburgh  to  visit 
her  parents,  and  improved  rapidly.  On  her  return  she  again  began  to 
suffer  from  retching,  vomiting,  cramps,  pain  in  the  stomach  and  intes- 
tines, and  great  prostration,  and  finally  died  some  ten  weeks  after  she 
came  back. 

While  she  was  ill,  her  mother,  Mrs.  Taylor,  came  on  to  nurse  her,  and 
was  attacked  with  similar  symptoms  a  day  or  two  after  her  arrival.  She 
then  recovered;  but  one  evening,  a  fortnight  later,  after  taking  some 
supper,  she  became  violently  ill,  vomited,  and  then  fainted,  fell  into  a 
comatose  state  soon  afterward,  and  died  of  collapse  in  six  or  eight  hours. 

Chemical  examination  of  the  remains  showed  the  presence  of  anti- 
mony in  the  organs,  blood,  and  urine  of  both  victims,  and  tartar  emetic 
was  also  found  in  food  and  medicines  used  by  them  both.  It  was  believed 
that  Mrs.  Pritchard's  case  was  a  characteristic  one  of  chronic  poisoning, 
but  that  Mrs.  Taylor  died  from  acute  antimony  poisoning  complicated 
by  the  presence  of  a  little  mercury,  and  possibly  of  some  opium. 

Post=mortem  Appearances. — These  usually  indicate  more  or  less  in- 
flammation of  the  stomach,  and  also  of  the  intestines.  They  are  not,  as 
a  rule,  very  marked,  and  in  a  few  cases  have  been  entirely  absent,  as,  for 
instance,  in  the  body  of  Mrs.  Taylor,  just  mentioned.  The  blood  is  un- 
usually fluid,  and  the  viscera  are  frequently  much  engorged ;  the  lungs, 
especially,  are  apt  to  show  signs  of  emphysema,  effusion  into  the  pleura, 
and  the  like. 

Indeed,  it  may  be  said  that  there  are  no  particular  lesions  distinctly 
characteristic  of  antimony  poisoning,  and  death  from  the  latter  has  not 
infrequently  taken  place  with  but  slight  changes  in  the  body. 

Prognosis. — Antimony  poisoning  differs  very  distinctly  from  arsenic 
poisoning,  which,  in  some  respects,  it  resembles  by  responding  more  or 
less  well  to  treatment.  In  the  first  place,  the  poison  is  largely  eliminated 
from  the  system  by  the  incessant  vomiting  and  purging,  and  what  re- 
mains unabsorbed  can  be  neutralized  by  giving  solutions  of  tannin,  or 
of  green  tea  or  other  vegetable  astringents,  and  also  of  albumen,  all  of 
which  form  comparatively  insoluble  compounds  with  the  antimony.  The 
depression  and  prostration,  which  form  such  a  marked  feature  of  the  ill- 
ness, must  be  counteracted  by  stimulants  and  warmth. 

Thus  cases  are  reported  of  recovery  from  doses  of  one  hundred  and 
seventy  grains  [Med.  Bee.,  1883,  vol.  xxiv.,  p.  401),  and  of  half  an  ounce 
(Am.  Jour.  Med.  Sci.,  1853,  vol.  xxv.,  p.  131)  and  even  more,  of  tartar 
emetic,  after  it  had  been  largely  absorbed  and  had  produced  character- 
istic symptoms. 

Dangerous  and  Fatal  Doses. — It  is  very  hard  to  determine  with  this 
poison  at  what  size  of  dose  to  fix  the  danger  limit.  Cases  are  on  record 
where  very  violent  symptoms  have  been  produced  with  minute  quantities. 
Thus  Dr.  Richardson  (Lancet,  1856,  part  i.,  p.  400)  prescribed  for  a 
patient,  who  had  warned  him  that  he  was  easily  affected  by  antimony, 
fifteen  minims  of  antimony  wine  (two  grains  of  tartar  emetic  to  the 
ounce),  causing  thereby  incessant  nausea  for  many  hours,  with  abdominal 
pain  and  griping,  faintness.  general  exhaustion,  and  such  prostration 
that  the  victim  could  not  leave  his  room  for  three  or  four  days.  Other 
cases  are  reported  where  really  serious  results  came  from  half  a  grain  or 
so  of  the  poison. 


IX0RGAN1C  POISOXS.  345 

Death  has  been  caused  in  a  child  recovering  from  measles  by  three 
fourths  of  a  grain  in  one  hour,  and  in  a  medical  student,  with  all  the 
usual  symptoms  of  acute  poisoning,  by  two  grains.  Other  fatal  cases 
have  been  reported,  in  children  from  doses  of  ten  and  fifteen  grains,  and 
in  adults  from  twenty  grains  and  over. 

According  to  Taylor,  doses  of  from  ten  to  twenty  grains  are  distinctly 
dangerous  for  adults,  if  taken  at  one  time,  and  less  than  that  if  taken  in 
divided  doses. 

On  the  other  hand,  undoubted  tolerance  exists  in  many  persons,  both 
in  health  and  disease,  for  very  much  larger  doses.  Thus  in  the  old- 
fashioned  treatment  of  pneumonia,  abandoned  now  for  some  years,  and 
also  in  pleurisy  and  fevers,  it  was  thought  good  practice  to  give  twenty, 
forty,  sixty  grains,  and  even  more,  in  twenty -four  hours,  in  doses  of  from 
two  to  five  grains  each.  In  most  cases  these  did  not  cause  emesis,  purg- 
ing, or  other  severe  symptoms,  and  in  some  cases,  at  least,  they  seemed  to 
be  of  benefit  to  the  patient. 

It  was  customary,  in  these  cases,  to  try  to  establish  a  tolerance  in  the 
first  day  or  two,  after  which  the  heroic  treatment  coidd  continue  without 
much  danger.  If,  however,  after  the  second  day  emesis  and  purging 
continued,  it  was  very  dangerous  .to  push  the  drug  any  further.  As  it 
was,  a  good  many  patients  probably  died  from  the  treatment,  even  if 
cured  of  the  disease. 

Time  of  Death. — As  before  mentioned,  Taylor  reports  a  case  of  a 
child  dying  from  tartar  emetic  in  three  quarters  of  an  hour. 

In  healthy  adults  death  has  occurred  from  this  poison  in  seven  hours, 
and  two  or  three  deaths  have  been  reported  in  ten  hours.  As  a  rule, 
however,  the  patients  live  for  twenty-four  hours  at  least,  and  generally 
die  in  the  course  of  some  days  after  the  fatal  dose. 

Elimination  of  the  Poison. — The  poison  absorbed  into  the  system  is 
eliminated  with  considerable  rapidity  by  the  kidneys,  and  also  in  the 
milk,  and  through  the  mucous  membranes  of  the  stomach.  To  prove 
the  latter,  Dr.  Brinton  (Lancet,  1853,  part  ii,  p.  599)  injected  ten  grains 
of  tartar  emetic  into  the  femoral  artery  of  a  dog,  who  at  once  fell  in  col- 
lapse, and  in  fifteen  minutes  antimony  was  found  in  the  contents  of  the 
stomach. 

The  poison  is  also  eliminated  by  the  liver,  and  in  chronic  cases  it  is 
common  to  find  inflammation  of  both  liver  and  kidneys. 

But,  more  than  other  poisons,  tartar  emetic  is  largely  expelled  from 
the  body  by  vomiting  and  purging,  so  that  it  is  impossible  to  tell  how 
much  of  a  given  dose  ever  enters  the  circulation  at  all.  It  is  this  prop- 
erty which  causes  such  uncertainty  about  the  size  of  a  fatal  dose. 

For  all  these  reasons,  in  a  chemical  examination  it  is  very  rare  to 
find  any  large  amount  of  antimony  in  the  body,  and  to  insist,  as  lawyers 
are  fond  of  doing,  that  unless  a  full  poisonous  dose  is  isolated  from  the 
tissues  the  victim  did  not  die  of  antimony  poisoning,  is  absurd.  In- 
deed, while  criminals  have  been  convicted  of  antimony  poisoning,  and 
plenty  of  bodies  undoubtedly  poisoned  by  antimony  have  been  analyzed, 
it  is  doubtful  if  such  quantities  of  absorbed  antimony  have  ever  been 
separated  from  a  dead  body. 

To  illustrate  this,  it  may  be  mentioned  that  in  the  Pritehanl  ease. 
above  mentioned,  antimony  was  found  in  all  the  tissues  and  organs  of 
the  bodies  of  both  women,  but  in  small  quantities,  the  liver,  intestines, 


346  A   SYSTEM  OF  LEGAL   MEDICINE. 

kidneys,  and  stomach  of  Mrs.  Taylor  containing  about  one  and  a  half 
grains,  and  the  same  organs  of  Mrs.  Pritchard,  about  four  and  a  half 
grains.  In  the  Ann  Palmer  case,  in  1865,  the  internal  organs  contained 
about  four  grains,  and  in  the  Hardman  case,  from  one  half  to  three 
fourths  of  a  grain. 

Tests  for  Antimony. — (a)  Sulphureted  Hydrogen. — If  this  gas  is 
passed  through  a  warm  solution  of  tartar  emetic  or  other  antimony  salt, 
acidified  with  hydrochloric  acid,  there  will  be  formed  an  orange-red  pre- 
cipitate of  antimonious  sulphide,  Sb2S3.  The  precipitate  readily  dis- 
solves in  concentrated  hydrochloric  acid  and  in  caustic  alkalies,  but  not 
in  amnionic  hydrate.  This  hydrochloric  acid  solution,  when  cold,  if 
added  to  several  times  its  bulk  of  water  will  form  a  white  precipitate, 
which  dissolves  readily  in  tartaric  acid. 

This  test  is  very  delicate,  being  perceptible  with  1-10,000  of  a  grain 
of  antimonious  oxide  in  five  grains  of  solution ;  but  when  made  in  com- 
plex solutions  containing  organic  matter  and  other  compounds,  the  color 
of  the  precipitate  is  often  obscured  by  the  color  of  the  solution,  and  the 
precipitate  itself  may  be  masked  by  the  precipitation  of  sulphur. 

(b)  Beinsch's  Test. — When  a  bright  strip  of  metallic  copper  is  boiled 
with  a  solution  of  antimony  acidified  with  hydrochloric  acid,  the  copper 
will  become  coated  with  a  violet  or  gray  coating  of  metallic  antimony. 
This  may  easily  be  mistaken  for  the  similar  deposits  made  by  arsenic, 
bismuth,  mercury,  and  other  metals. 

The  deposits  of  antimony,  arsenic,  and  mercury  will  produce  subli- 
mates, when  the  washed  and  dried  slips  of  copper  are  heated  in  a  small 
reduction -tube.  The  antimony  sublimate  will  be  near  the  slip,  and  amor- 
phous or  granular,  with  very  few  if  any  crystals ;  while  the  arsenic  will 
sublime  half  an  inch  or  so  from  the  copper  and  consist  almost  wholly 
of  octahedral  crystals.  The  mercury  sublimate  is  composed  of  small 
globules. 

But,  better  than  this,  if  the  coated  copper  is  boiled  with  a  dilute  solu- 
tion of  caustic  potash,  the  antimony  will  dissolve,  especially  if  the  copper 
is  lifted  out  and  exposed  to  the  air  every  now  and  then.  This  solution, 
when  acidified  with  hydrochloric  acid  and  concentrated,  will  give  an 
orange-red  precipitate  with  sulphureted  hydrogen. 

(c)  Zinc  Test. — If  a  drop  of  an  antimonial  solution,  acidified  with 
hydrochloric  acid,  is  placed  in  a  platinum  dish,  and  a  small  piece  of  zinc 
is  placed  in  it,  there  will  form  on  the  platinum  a  black  or  brownish  stain 
of  metallic  antimony.  This  can  be  identified  by  moistening  it  with 
nitric  acid,  evaporating  it  to  dryness,  and  touching  the  spot  with  am- 
monium sulphide,  which  will  form  orange-red  antimonious  sulphide. 

(d)  Marsh's  Test. — This  test,  when  made  exactly  as  described  in  the 
next  section  under  the  tests  for  arsenic,  will  give  similar  reactions  for 
antimony.  In  case  it  is  thought  best  to  test  the  gas  by  making  stains 
on  porcelain,  or  by  depositing  the  metal  in  the  tube,  by  the  Berzelius 
Marsh  test,  the  antimony  can  be  distinguished  from  arsenic  by  not  dis- 
solving in  a  hot,  strong  solution  of  bleaching  powder.  They  both  dis- 
solve in  yellow  amnionic  sulphide  solution,  but  antimony  leaves,  on  evap- 
oration, orange-red  stains  of  antimonious  sulphide,  insoluble  in  ammonia, 
and  soluble  in  concentrated  hydrochloric  acid,  while  the  deposit  of  yel- 
low arsenious  sulphide,  formed  in  the  same  way,  dissolves  in  ammonia, 
but  not  in  hydrochloric  acid. 


INORGANIC  POISONS.  347 

A  better  and  more  satisfactory  method  of  distinguishing  the  two 
metals  is  by  passing  the  gas  into  a  solution  of  argentic  nitrate.  The 
antimony  will  be  deposited  as  black  argentic  antimonide,  Ag:jSb,  while 
any  arsenic  present  will  dissolve  in  the  liquid.  To  proVe  the  presence 
of  antimony  in  the  deposit,  the  latter  is  filtered  off  (the  nitrate  being- 
reserved  so  as  to  examine  it  later  for  arsenic)  and  boiled  with  dilute 
hydrochloric  acid,  which  will  dissolve  the  antimony  and  not  act  on  the 
silver.  The  latter  is  then  filtered  off,  and  the  solution  tested  with  sul- 
phureted  hydrogen. 

This  test  is  extremely  delicate,  and  will  give  a  good  deposit  (Wormley) 
with  1-20,000  grain  of  antimonious  oxide,  or  1-8000  grain  of  tartar  emetic. 

Separation  from  Organic  Material. — When  examining  material  like 
food,  medicines,  vomited  matter,  the  contents  of  the  stomach  and  intes- 
tines, and  the  like,  it  is  possible  to  extract  antimony  by  acidulating  with 
a  little  hydrochloric  acid,  and  then  heating  with  tartaric  acid,  straining, 
and  filtering.  The  solution  is  then  treated  with  sulphureted  hydrogen 
and  allowed  to  stand  for  some  hours,  and  the  precipitate  filtered  off. 

This  precipitate,  which  will  contain  all  the  antimony  as  sulphide, 
along  with  sulphur  and  the  sulphides  of  other  metals,  should  be  boiled 
in  strong  hydrochloric  acid,  until  the  sulphur  fumes  have  disappeared, 
and  then  filtered,  if  necessary.  This  solution  can  be  tested  by  the  zinc 
and  Reinsch's  tests,  and  also  by  the  addition  of  a  large  quantity  of  water, 
in  which  case  the  resulting  white  precipitate  should  be  soluble  in  tartaric 
acid,  and  react  with  sulphureted  hydrogen.  Or  it  may  be  placed  in  a 
Marsh's  apparatus  and  passed  into  argentic  nitrate. 

In  examining  the  tissues  for  absorbed  antimony  the  organic  matter 
should  be  destroyed  as  thoroughly  as  possible  by  boiling  with  hydro- 
chloric acid  and  potassic  chlorate,  and  the  antimony  separated  from  the 
solution,  as  before,  by  sulphureted  hydrogen. 

When  the  exact  quantity  of  antimony  is  to  be  determined,  the  pre- 
cipitate thus  obtained  should  be  purified  by  evaporation  in  an  evaporat- 
ing-dish  with  some  strong  nitric  acid,  and  then,  after  moistening  the 
residue  with  a  strong  solution  of  potash,  by  reevaporation  and  fusion. 
The  antimony  is  then  dissolved  out  with  boiling  tartaric  acid,  and  re- 
precipitated  by  sulphureted  hydrogen,  after  adding  a  little  hydrochloric 
acid.  This  precipitate,  carefully  washgd,  can  be  collected  on  a  weighed 
filter,  washed,  dried,  and  weighed. 

The  Wharton  Case. — The  whole  question  of  the  tests  for  antimony 
was  worked  over  most  carefully  in  connection  with  this  famous  case. 
In  1872  Mrs.  Wharton,  a  member  of  a  well-known  and  prominent  Mary- 
land family,  was  tried  for  the  murder  of  General  Ketchum.  The  latter 
had  been  taken  violently  ill  while  visiting  at  her  house,  and  died,  under 
rather  suspicious  circumstances,  a  few  days  later;  while,  at  the  same 
time,  another  friend  of  the  family  had  suddenly  fallen  ill  and  nearly 
died,  after  taking  some  refreshments  in  the  same  house.  In  both  cases 
there  were  various  money  transactions  which  might  have  acted  as  an  in- 
ducement for  a  crime,  and  also,  in  both  cases,  suspicious-looking  sedi- 
ments were  found  in  liquids  given  the  invalids  by  Mrs.  Wharton. 

The  symptoms  of  General  Ketchum,  and  the  post-mortem  condition 
of  the  body,  were  consistent  with,  though  not  especially  characteristic 
of,  antimony  poisoning,  so  the  case  turned  entirely  upon  the  chemical 
evidence. 


348  A    SYSTEM    OF  LEGAL    MEDIC  I XE. 

The  latter  indicated  the  presence  of  tartar  emetic  in  considerable 
quantities  in  both  the  liquids  mentioned  and  in  the  stomach  of  General 
Ketchum.  But  unfortunately,  in  every  case,  the  original  solutions  and 
the  resulting"  precipitates  were  thrown  away,  so  that,  when  the  tests  were 
disputed,  it  was  impossible  to  confirm  them.  The  principal  chemical 
witness  for  the  prosecution  testified  that  both  the  sediment  in  a  glass  of 
milk  punch,  and  the  contents  of  the  stomach,  gave  a  brownish-red  pre- 
cipitate with  sulphureted  hydrogen,  after  acidifying  with  hydrochloric 
acid;  that  this  dissolved  in  boiling  hydrochloric  acid;  that  this  solution, 
when  diluted  with  large  amounts  of  water,  gave  a  white  precipitate,  which 
dissolved  in  tartaric  acid,  and  gave  an  orange-red  precipitate  when  the 
tartaric  acid  solution  was  again  treated  with  sulphureted  hydrogen. 

The  above  tests  are  a  pretty  certain  indication  of  the  presence  of 
antimony,  but  they  were  not  confirmed  by  any  others,  except  by  a  very 
unsatisfactory  Marsh's  test  made  by  another  chemist.  Nor  were  any  of 
the  precipitates  saved  or  shown  in  court,  although  the  amount  of  tartar 
emetic  in  the  stomach  was  estimated  roughly  at  twenty  grains.  Besides 
this,  no  attempt  was  made  to  remove  any,  far  less  all,  of  the  organic  mat- 
ter, before  making  the  tests. 

This  carelessness  ruined  the  case,  for  several  experts  were  brought  in 
to  testify  that  the  metal  itself,  under  those  circumstances,  should  have 
been  produced.  They  even  went  to  the  extreme  of  making  up  a  solu- 
tion of  gelsemium  extract,  chloral,  beef  tea,  white  of  egg,  and  milk, 
which  they  claimed  was  a  fair  reproduction  of  the  contents  of  General 
Ketchum's  stomach  after  death,  and,  by  using  nearly  though  not  quite 
the  same  steps,  produced  results  which  to  the  jury  seemed  to  agree  more 
or  less  closely  with  those  produced  by  antimony.  In  short,  they  fought 
so  hard  that  the  jury  disbelieved  the  chemical  evidence  on  the  other  side, 
and  accordingly  acquitted  the  prisoner. 

Whether  the  testimony  of  some  of  the  experts  did  not  overstep  the 
limits  of  scientific  and  impartial  evidence  is  an  open  question ;  but  there 
is  absolutely  no  doubt  that,  in  any  case  of  this  sort,  a  chemist  is  unpar- 
donably  careless  unless  he  saves  with  the  utmost  care  everything  sub- 
mitted to  him,  and  preserves,  and  brings  into  court,  if  at  all  possible, 
every  particle  of  poison  that  he  can  isolate.  (See  the  Wharton  trial,  pub- 
lished by  Bait.  Gazette,  1872 ;  also  Reese,  Am.  Jour.  Med.  Sciences,  April, 
1872 ;  Williams,  Med.  and  Surg.  Reporter,  1872 ;  Aiken,  Richmond  and 
Louisville  Med.  Jour.,  1873,  vol.  xv.,  p.  7 ;  and  others.) 

Butter  of  Antimony — Antimony  Chloride — SbCls. 

This  compound,  which  at  ordinary  temperatures  is  a  yellow  semi-solid 
mass,  not  unlike  butter,  is  used  to  some  extent  in  pharmacy,  dissolved  in 
hydrochloric  acid,  and  is  occasionally  met  with  in  cases  of  poisoning. 

Its  first  symptoms  are  those  of  an  active  irritant  or  sometimes  cor- 
rosive poison,  followed  by  extreme  exhaustion  and  signs  of  collapse  in 
the  course  of  a  very  few  hours.  If  this  stage  can  be  passed  there  is  a 
fair  chance  of  recovery,  the  few  deaths  recorded  taking  place  within 
twenty-four  hours.     (See  Taylor,  Treatise  on  Poisons.) 

For  treatment  it  is  well  to  give  magnesia  and  other  mild  alkalies  in 
milk,  albumen  solutions,  and  the  like.  Also  to  give  infusions  of  tannin, 
and  to  treat  the  symptoms  of  collapse  with  stimulants. 


IXORGAXIC  roisoxs.  349 

A  simple  test  for  this  substance  in  solution  is  the  addition  of  a  large 
amount  of  water,  when  a  white  precipitate  of  oxychloride  will  be  formed. 

Antimoniureted  Hydrogen. 

According  to  Richardson  {Lancet,  1856,  part  i.,  p.  508),  this  gas,  in- 
haled into  the  lungs  of  animals,  will  cause  death  from  collapse,  with  the 
characteristic  symptoms  of  vomiting  and  purging.  No  cases  have  been 
recorded  where  it  has  been  injurious  to  man. 


VI.      ARSENIC. 

History. — The  poisonous  properties  of  this  element,  which  is  by  far 
the  best  known  and  most  important  of  all  the  mineral  poisons,  have 
been  recognized  from  the  earliest  ages  of  chemistry.  The  name  is  first 
mentioned  by  Dioscorides  Pedanius,  a  physician  of  Cilieia,  who  published 
a  celebrated  book  on  materia  niedica,  about  the  beginning  of  the  second 
century  a.d.  He  speaks  of  arsenikon,  or  auri  pigmentum,  as  a  yellow 
or  golden  mineral,  coming  from  Mysia  or  from  Pontus,  with  poisonous 
and  astringent  properties,  "  making  sores,  burning  violently,  eating  away 
the  hair."  Later,  in  his  book  on  poisons,  "  rispl  Ir^rripiw')  0app.iy.cuo,"  he 
states  how  the  same  mineral  taken  internally  "  gives  violent  pains  in 
the  stomach  and  intestines,  corroding  them  fiercely.  Hence  they  must 
take  something,  as  soon  as  possible,  to  mitigate  the  burning  and  to  pro- 
duce smooth  and  easy  vomiting."  He  mentions  as  antidotes  the  juice  of 
the  mallow,  decoction  of  linseed,  milk,  and  other  soothing  beverages. 

The  above  evidently  refers  to  the  yellow  sulphide,  As2S3,  orpiment, 
a  not  uncommon  mineral,  which  can  be  easily  purified,  as  Dioscoride.; 
mentioned,  by  gentle  calcination. 

It  was  probably  not  long  after  this  that  the  white  arsenic,  arsenicum 
sublirnatum,  was  discovered,  for  it  is  mentioned  by  Geber  in  the  ninth 
century,  and  in  the  early  middle  ages  we  find  it  ah-eady  an  article  of 
commerce,  well  known  for  its  poisonous  properties. 

One  of  the  earliest  arsenic  cases  on  record  is  carefully  recorded  in 
the  French  archives  under  the  date  of  1384.  A  wandering  minstrel, 
called  Wondreton,  was  arrested  in  Paris  for  trying  to  poison  King 
Charles  VI.  of  France,  his  brother  the  Duke  of  Valois,  and  the  Dukes 
of  Berri,  Burgundy,  and  Bourbon.  During  the  trial,  under  the  stimu- 
lus of  torture,  he  confessed  that  he  had  received  detailed  instructions 
for  the  crime  from  Charles  the  Bad,  King  of  Navarre.  He  was  told  that 
there  was  a  white  powder,  arsenicum  sublirnatum,  to  be  found  at  the 
apothecary  shops  in  Pampeluna,  Bordeaux,  Bayonne,  and  all  the  large 
towns  through  which  he  wotdd  travel.  "  If  a  man  eats  from  it  a  piece 
as  large  as  a  pea  he  will  never  live.  Take  it  and  put  it  into  their  soups, 
wine,  or  meat,  wherever  it  can  be  done  in  safety."  It  is  pleasant  to 
learn  that  this  early  attempt  proved  abortive,  and  that  the  troubadour 
was  duly  executed. 

From  that  time  on,  arsenic  seems  to  have  been  a  favorite  agent 
for  secret  poisoning.  In  a  celebrated  English  case  in  1618  Sir  Thomas 
Overbury,  secretary  to  King  James  I.,  died  of  slow  poisoning  in  the 
Tower,  at  the  hands  of  Lord  Rochester  and  his  wife,  the  infamous  Lady 


350  A  SYSTEM  OF  LEGAL   MEDICLNE. 

Essex.  Upon  the  trial  it  appeared  that  arsenic  and  cantharides  had 
first  been  employed,  but  as  the  victim  proved  unusually  resistant,  aqua 
fortis,  mercury,  powdered  diamonds,  lunar  caustic,  and  "  a  great  spider" 
had  also  been  administered,  and  he  was  finally  killed  by  a  strong  dose 
of  corrosive  sublimate. 

The  most  wholesale  poisoning,  however,  which  the  world  ever  saw 
took  place  in  Europe  from  the  middle  of  the  seventeenth  to  the  begin- 
ning of  the  eighteenth  century,  when  three  women,  Tophania  in  Naples, 
Spera  in  Rome,  and  the  beautiful  Marquise  de  Brinvilliers  in  Paris,  dis- 
tinguished themselves  above  their  fellows  by  the  skillful  use  of  slow  poi- 
sons. The  stories  told  of  this  time  seem  really  incredible.  It  is  stated 
that  the  strength  of  the  drugs  was  so  proportioned  as  to  kill  the  victim 
in  a  week,  a  month,  or  a  year,  with  perfect  surety,  and  without  any  re- 
markable symptoms.  The  most  celebrated  of  the  three,  La  Tophania,  is 
believed  to  have  killed  over  six  hundred  persons,  and  used  to  send  her 
drops,  the  aqua  tophana,  all  over  Italy  to  her  clients,  among  the  fashion- 
able women  of  the  day.  In  some  cases,  it  is  said,  when  the  wives  who 
wished  to  rid  themselves  of  their  husbands  were  too  poor  to  buy  the 
medicine,  she  used  to  send  them  vials  of  it  gratis.  A  letter  to  Hoffman, 
in  1718,  from  Gavelli,  physician  to  the  Emperor  Charles  VI.,  states  that 
the  drops  were  composed  of  crystallized  arsenic  dissolved  in  water  dis- 
tilled with  the  herb  IAnaria  cymbalaria. 

In  those  days,  and,  indeed,  well  up  to  the  early  part  of  this  century, 
it  was  impossible  to  distinguish  arsenic,  with  any  certainty,  in  the  bodies 
of  patients,  or  even  in  the  drugs  themselves.  But  after  Orfila,  Reinsch, 
Marsh,  and  others  had  made  their  famous  researches  on  the  subject,  it 
gradually  became  understood  that  of  all  poisons  arsenic  was  the  one 
most  easily  and  surely  recognized  by  chemical  tests.  And  yet,  even  up 
to  the  present  day,  owing  to  its  wide  distribution,  its  cheapness,  its  lack 
of  taste,  the  similarity  of  its  symptoms  with  those  of  ordinary  diseases, 
and  the  widespread  knowledge  of  its  powers  and  properties,  arsenic  is 
still  used,  aud  used  probably,  far  more  generally  than  is  supposed,  for 
criminal  poisoning,  as  well  as  for  suicides. 

We  may  even  boast,  in  our  own  country,  of  having  furnished  individ- 
uals, in  the  last  few  years,  who  would  not  be  unfit  companions  for  the 
worthies  mentioned  above.  Mrs.  Sherman,  for  instance,  in  New  Haven, 
disposed  of  three  husbands,  and  some  seven  or  eight  children,  stepchil- 
dren and  others,  without  suspicion,  and  was  only  caught,  by  accident, 
on  the  death  of  husband  number  four.  While  Mrs.  Robinson,  at  Som- 
erville,  Mass.,  from  February,  1885,  to  August,  1886,  poisoned  no  less 
than  six  members  of  her  immediate  family,  besides  at  least  two  or  three 
more  on  previous  occasions,  and  she  was  only  suspected  on  the  last  case. 

This  seems  to  throw  rather  a  slur  upon  the  state  of  medical  science 
in  these  two  localities ;  but  it  is  not  a  very  easy  matter  to  distinguish 
the  symptoms  of  arsenic  poisoning.  And  while  the  Sherman  woman 
carefully  selected  rather  old  and  inferior  physicians  to  attend  her  vic- 
tims, Mrs.  Robinson  adopted  a  far  more  bold  and  ingenious  plan.  She 
waited  until  her  relatives  were  sick  of  some  well-defined  disease,  and 
had  them  treated  by  the  best  physicians  in  Massachusetts ;  and  after 
these  had  made  a  satisfactory  diagnosis,  she  would  kill  them  off  rapidly, 
with  arsenic,  before  the  time  of  the  next  visit.  The  first  woman  was 
•caught  by  the  accidental  summoning  of  a  bright  young  doctor,  who  at 


INORGANIC  POISONS.  351 

once  recognized  the  case ;  while  the  physician  who  attended  Mrs.  Rob- 
inson's last  son  thought  it  strange  that  a  blow  in  the  back  of  the  neck 
should  have  such  unusual  sequela^,  and  ordered  an  autopsy. 

Modern  Statistics. — At  present,  however,  the  cases  of  arsenic  poison- 
ing are  not  as  abundant  as  might  be  imagined.  In  the  famous  May- 
brick  trial,  Dr.  Tidy,  for  the  defense,  claimed,  without  much  contradic- 
tion in  court,  that  the  symptoms  of  arsenic  poisoning  were  so  varied 
because  there  were  so  very  many  cases  of  it  known  and  studied.  Dr. 
Stevenson,  who  appeared  for  the  crown,  looked  the  matter  up  after  the 
trial,  and  found  that,  as  a  matter  of  fact,  this  was  not  the  case.  In  the 
five  volumes  of  the  reports  of  the  Registrar- General  of  England,  from 
1883  to  1887  inclusive,  he  collected  the  following  statistics.  (Guy's  Hos- 
pital Reports,  1889,  p.  307.) 

DEATHS   FROM   POISONING    (1883   TO    1887    INCLUSIVE)    IN  ENGLAND  AND  WALES. 

Opium 646  Phosphorus  and  matches 71 

Lead 437  Alcohol 66 

Carbolic  acid 332  Chloral 52 

Prussic  acid 132  Arsenic 51 

Oxalic  acid 120  Sulphuric  acid 49 

Strychnine 106  Amnionic  hydrate 45 

Vermin-killer   59  Nitric  acid 29 

Hydrochloric  acid 90  Mercury  and  its  salts 26 

Potassic  cyanide 74 

Average  cases  of  arsenic  per  year,  10.2. 

.  In  this  country,  where  the  sale  of  arsenic  is  not  attended  with  nearly 
•so  many  precautions,  and  where  Paris  green  and  " Rough  on  Rats"  are 
articles  of  such  common  use,  cases  of  arsenic  poisoning,  especially  for 
suicidal  purposes,  are  more  frequent. 

In  the  Forty-sixth  Annual  Registration  Report  of  Massachusetts, 
published  by  the  secretary  of  the  commonwealth  (1888,  p.  412),  there  is 
found  a  list  showing  the  deaths  from  arsenic  in  Massachusetts  from  1877 
to  1887  inclusive : 

DEATHS  FROM   ARSENICAL   POISONING. 

Years.  Homicidal.     Suicidal.     Accidental.     Total. 

1877,  six  months 2  . .  2 

1878 2  1  3 

1879 6  ..  6 

1880 2  3  2  7 

1881 3  ..  3 

1882 2  ..  2 

1883 3  1  4 

1884 16  ..  16 

1885 12  1  13 

1886 6*  14  2  22 

1887 1  35  . .  36 

9  98  7  114 

In  a  New  York  City  Board  of  Health  report  for  1892  are  published 
.some  interesting  statistics,  which  tell  much  the  same  stoiy. 

The  cases  of  homicide  are  not  given,  but  the  accidental  deaths  for 

*  Robinson  cases,  recorded  in  year  when  investigation  was  made. 


37)2  A    SYSTEM  OF  LEGAL   MEDICINE. 

twenty-one  years  and  the  cases  of  suicide  for  the  year  1891  are  reported 
in  much  detail. 

Accidental  Deaths  in  New  York  City  from  1870  to  1891  inclusive. 

Illuminating-gas    (of    which    266  Oxalic  acid 14 

were  from  1880  to  1891inclusive). 279  Ether 11 

Opium,  morphine,  etc 179  Potash 8 

Lead 113  Aconite 8 

Carbolic  acid 58  Potassic  chlorate 7 

Arsenic  and  its  compounds 42  Muriatic  acid 6 

Chloroform 34  Nitric  acid 6 

Chloral 26  Phosphorus 6 

Mercury 19  Minor  poisons 27 

Coal  gas 14 

Total  number  of  deaths 977 

In  this  table  arsenic  stands  far  higher  in  the  list  than  it  does  in 
England,  while  the  next  table,  that  of  suicides,  shows  the  same  astonish- 
ing state  of  things  as  in  Boston. 

Suicides  in  Neiv  York  City  for  the  Year  1891. 

Gunshot 104      Carbolic  acid 9 

Hanging 50      Drowning 9 

i  Paris  green  ....  20  )  Prussic   acid  and  potassic  cyanide 

Arsenic  ■]  Rough  on  rats . .  12  >  •  •  35          (each,  3) 6 

(  White  arsenic  . .   3  )  Chloroform 3 

Cuts  and  stabs 24      Strangulation 3 

Falls  and  leaps 22  Aconite  ( ?),   ammonia,   belladonna, 

Illuminating-gas 19  corrosive  sublimate,  ether,  muri-. 

Morphine  and  opium  (each,  5)  .  . .  10          atic  acid  (each,  1) 6 

Total  number  of  suicides 300 

It  is  difficult,  on  comparing  these  figures  with  the  English  statistics,, 
not  to  believe  that  there  are  far  too  few  restrictions  upon  the  sale  of 
arsenic  in  this  country.  Surely  the  number  of  suicides  alone  from 
arsenic  in  one  city  like  New  York,  or  one  State  like  Massachusetts,  ought 
not  to  be  three  or  four  times  as  many  as  all  the  cases  in  England  and 
Wales.  Indeed,  some  stringent  legislation  on  the  subject  was  passed  in 
Massachusetts  the  year  of  the  above  report. 

Occurrence  in  Nature. — Arsenic  is  found  to  some  extent  in  a  free 
state,  as  a  black  metallic  solid.  It  is  more  frequently,  however,  extracted 
from  some  of  many  minerals,  in  which  it  occurs  combined  with  metals 
such  as  iron,  copper,  cobalt,  and  nickel,  or  with  sulphur.  The  most  im- 
portant ore  of  arsenic  is  the  arsenical  iron  pyrite,  or  mispickel,  FeAsS, 
but  the  arsenides  of  iron  and  of  cobalt  are  also  quite  common.  The  lat- 
ter, indeed,  is  often  powdered  and  sold  in  bulk,  as  a  fly  poison,  under  the 
name  of  "cobalt." 

The  two  sulphides  of  arsenic,  orpin  lent,  As2S3,  and  realgar,  As2  S2, 
are  not  uncommon  minerals,  and  we  also  occasionally  find  in  nature 
small  quantities  of  arsenious  acid,  As20:i,  and  of  arseniates. 

Besides  this,  arsenic  in  small  quantities  is  distributed  very  widely. 
As  a  common  impurity  of  iron  pyrites  it  occurs  in  many  soils,  generally 
in  an  insoluble  state,  and,  being  also  found  in  sulphur,  it  is  present  in 
almost  all  samples  of  oil  of  vitriol,  and  of  the  many  compounds — hydro- 


INORGANIC  POISONS.  353 

chloric  acid,  bleaching  powder,  sulphates,  carbonates,  and  hydrates  of 
soda  and  potash,  and  the  like — prepared  by  its  use.  From  the  sulphuric 
acid  it  also  finds  its  way  into  the  various  superphosphates  and  other 
artificial  manures,  and  hence  into  plants ;  so  that  arsenic  has  been  dis- 
covered in  turnips,  cabbages,  potatoes,  and  other  common  vegetables,  as 
well  as  in  straw,  wood,  and  charcoal. 

From  its  association  with  pyrite  it  is  not  at  all  uncommon  to  find 
arsenic  in  coal,  in  quantities  running  as  high  as  fifteen  or  twenty  grains 
to  the  pound.  This  arsenic  is  of  course  volatilized  on  burning,  and  again 
appears  in  the  smoke  and  soot. 

Arsenic  is  also  a  common  impurity  in  many  metals  and  metallic  salts. 
It  is  difficult  to  get  zinc  perfectly  free  from  all  traces  of  it,  and  it  is  fre- 
quently found,  sometimes  in  comparatively  large  quantities,  associated 
with  antimony  and  bismuth,  as,  for  instance,  in  common  drugs  like 
tartar  emetic  and  bismuth  subnitrate.  Of  course,  in  all  these  cases  it 
never  occurs  as  crystallized  white  arsenic. 

It  is  present  in  small  quantities  in  sea-water,  and  is  frequently  found, 
sometimes  to  a  medicinal  extent,  in  mineral  waters.  Thus  it  has  been 
traced  in  practically  all  the  iron  or  chalybeate  springs,  both  of  this 
country  and  abroad,  and  has  been  found  in  the  celebrated  waters  of 
Vichy,  Ems,  Wiesbaden,  Pyrmont,  Ripoldsau,  Carlsbad,  and  others. 
Among  the  most  famous  arsenical  springs  are  those  of  Bourboule,  in 
France,  and  of  Roncegno,  in  the  Southern  Tyrol,  in  which  last  water 
Glaser  and  Kalmann  (Berichte,  vol.  xxi.,  1888,  pp.  1G37,  2879)  found 
nearly  nine  and  a  half  grains  of  arsenic  acid  (equivalent  to  over  seven 
grains  of  white  arsenic)  to  the  gallon.  In  this  country  some  interesting 
arsenical  springs  have  been  found  in  the  Yellowstone  Park,  the  water 
from  the  Hygeia  Spring,  for  instance,  which  is  much  used  for  bathing, 
containing  about  one  fifth  of  a  grain  of  white  arsenic  to  the  gallon 
(A.  Hague,  1885). 

Arsenic  in  Graveyards. — The  arsenic  naturally  present  in  the  soil  is 
almost  always  combined  with  iron,  in  such  an  insoluble  form  that  hot 
concentrated  acids  are  necessary  to  separate  it.  In  several  instances, 
bodies  have  been  buried  for  months  in  an  arsenical  soil,  even  in  wet 
weather,  and  no  trace  of  arsenic  has  penetrated  the  corpse.  (See  Son- 
nenschein,  Gerichtl.  Ghemie,  1881,  p.  139.)  These  cases  occurred,  how- 
ever, when  the  system  of  arsenical  embalming,  now  so  common  in  the 
United  States,  was  either  prohibited  or  unknown.  And  at  present  the 
graveyards  are  so  filled  with  soluble  salts  of  arsenic,  from  this  cause. 
that  post-mortem  absorption  in  this  way  must  be  considered  as  quite 
possible,  if  not  indeed  probable,  in  many  cases.  It  was  claimed  at  one 
time,  by  as  good  an  authority  as  Orfila,  that  arsenic  was  a  normal  con- 
stituent of  the  body.     This,  however,  has  been  completely  disproved. 

Occurrence  in  the  Arts. — Besides  the  cases  above  mentioned  of  sul- 
phuric acid  and  its  compounds,  where  arsenic  is  accidentally  present  in 
substances  largely  used  for  manufacturing  purposes,  there  are  many 
special  ways  in  which  arsenic,  more  or  less  disguised,  is  widely  distrib- 
uted and  freely  used. 

In  Medicine. — Arsenic  is  usually  prescribed  by  regular  practitioners 
in  the  form  of  Fowler's  solution,  a  one-percent,  solution  of  white  arsenic 
in  potassium  bicarbonate.  Occasionally  the  arsenates  of  soda  and  potash 
are  used  for  the  same  purposes  (Brett's  and  Pierson's  solutions).     But, 


354  ^    SYSTEM  OF  LEGAL  MEDICINE. 

leaving  aside  the  numerous  quack  medicines,  which  vary  from  the 
"  complexion  wafers,"  containing  infinitesimal  traces  of  arsenic,  to  the 
blisters  of  almost  pure  arsenious  acid  which  have  been  used,  with  often- 
times such  fatal  results,  by  the  "  cancer  doctors,"  we  also  find  in  the 
catalogues  of  nearly  all  the  manufacturing  chemists  many  varieties  of 
arsenic-containing  pills,  under  the  most  varied  names.  The  amount  of 
arsenic  in  these  pills  varies,  as  a  rule,  from  one  twentieth  to  one  thirtieth 
of  a  grain,  and  it  is  generally  combined  with  either  iron,  strychnine,  or 
quinine,  so  as  to  act,  as  far  as  possible,  as  a  general  tonic,  a  nerve  tonicr 
or  as  an  antidote  to  malaria. 

As  a  Household  Poison. — The  amount  of  arsenic  compounds  sold  and 
used  for  this  purpose  is  enormous.  "  Rough  on  Rats  "  is  the  most  com- 
mon, and  consists  practically  of  pure  arsenious  acid.  It  is  very  com- 
monly used,  especially  in  cities,  for  committing  suicide ;  while  occasion- 
ally murders,  and  frequently  accidents,  are  reported  from  its  use. 

Paris  green,  or  aceto-arsenite  of  copper,  known  to  chemists  as 
Schweinfurth  green,  is  in  frequent  use  not  only  on  potato  and  tomato 
vines,  but  also  on  fruit  trees  and  different  kinds  of  plants  and  vegetables, 
to  rid  them  of  noxious  insects.  Its  bright  color  is  the  best  safeguard 
against  accidental  poisoning,  which  is  largely  confined  to  cattle  and  stock 
feeding  upon  the  poisoned  plants.  It  is,  however,  constantly  used  for 
suicide. 

London  purple,  a  waste  product  from  the  aniline  factories,  contain- 
ing some  forty  percent,  of  white  arsenic,  is  also  largely  employed  instead 
of  Paris  green. 

As  a  fly  poison,  metallic  arsenic  slightly  oxidized,  powdered  "  cobalt,'r 
and  papers  steeped  in  solutions  of  arsenic  or  of  alkaline  arsenites,  are 
widely  sold.     These  have  served  as  a  source  of  poison  in  many  cases. 

Arsenic  soaps,  consisting  of  white  arsenic,  alkali,  and  soft-soap  boiled 
down  together,  are  in  common  use  on  sheep  farms  to  rid  the  animals  of 
lice  and  similar  vermin.  They  have  frequently  caused  death  by  acci- 
dent ;  in  one  case  a  whole  family  of  five  or  six  persons  was  destroyed  by 
using  drinking-water  carried  in  a  pail  in  which  this  soap  had  been  kept. 

Finally,  solutions  of  arsenic  are  occasionally  used,  more,  however,  in 
Europe  than  in  this  country,  to  eradicate  weeds.  Indeed,  only  a  couple 
of  years  ago,  in  a  little  Scotch  village  near  Edinburgh,  over  a  hundred 
people  were  seriously  poisoned  with  sugar  bought  from  the  local  grocer, 
which,  as  was  afterward  proved,  had  been  in  the  same  cargo  with  some 
leaky  cans  of  "weed  killer."     {Lancet,  1891,  part  i.,  p.  900.) 

In  Paints,  Wall-paper,  Fabrics,  etc — Arsenic  is  the  source  of  many 
brilliant  colors,  as,  for  instance,  the  Paris  or  Schweinfurth  and  Scheele's 
greens,  and  also  certain  brilliant  purple  colors.  These  contain  large 
quantities,  often  thirty  percent,  or  forty  percent,  of  arsenic,  and,  being 
distinctly  poisonous,  should  be  used  with  great  care.  Accidents  are 
liable  to  occur  from  children  licking  these  colors  from  the  covers  of 
books,  kindergarten  toys,  Christmas  cards,  and  the  like.  Occasionally 
also  there  may  occur  cases  where  dresses,  curtains,  and  other  fabrics,  or 
even  wall-papers,  unglazed  and  thickly  coated  with  such  pigments,  may 
prove  injurious.  These  colors,  however,  are  nowadays  rarely,  if  at  all, 
used  in  places  where  fchey  might  prove  dangerous,  and  their  use  in  wall- 
papers has  disappeared  almost  entirely. 

In  the  manufacture,  however,  of  many  of  the  aniline  dyes  arsenic 


INORGANIC  POISONS.  355 

acid  is  frequently  used  for  oxidation,  and  although  almost  entirely  re- 
moved in  subsequent  operations,  generally  leaves  traces  of  arsenical 
compounds  behind.  The  arsenic  thus  left  is  in  extremely  small  quanti- 
ties, and  as  a  ride  can  have  no  injurious  effects ;  and  yet  such  is  the 
common  prejudice  against  the  very  word  arsenic  that  the  merest  trace 
of  it  is  enough,  in  the  common  opinion,  to  cause  a  suspicion  of  poison- 
ous properties. 

A  curious  case  of  this  sort  came  under  the  writer's  notice  in  1889 
(Swain  vs.  Scliiejfelin).  Nearly  a  hundred  people  in  Brooklyn,  one  night, 
after  indulging  in  ice-cream  made  by  one  confectioner,  were  taken  with 
symptoms  of  acute  irritant  poisoning.  Most  of  the  cases  were  diagnosed 
as  due  to  arsenic,  and  were  treated  as  such,  but  some  doctors  withheld 
their  diagnosis,  largely  on  account  of  the  rapid  and  complete  recovery  <  >f 
all  the  cases.  An  inspector  of  the  Board  of  Health,  prowling  around  the 
ice-cream  factory,  came  across  a  small  bottle  of  a  red  solution,  used  for 
coloring  the  strawberry  ice-cream,  tested  it  for  arsenic  with  Marsh's  test, 
reported  it  full  of  arsenic,  and  held  it  responsible  for  all  the  symptoms. 
Whereupon  the  ice-cream  manufacturer  brought  suit  for  $10,000  dam- 
ages against  the  firm  supplying  the  coloring  matter,  for  selling  him 
poisonous  goods.  The  resulting  lawsuit  showed  great  carelessness  in 
the  manufacture  of  the  ice-cream,  and  it  was  proved  that  the  cream  in 
question  had  been  made  up  from  some  left  over  from  a  previous  occa- 
sion, which  had  been  melted  up  and  refrozen.  The  symptoms,  also,  were 
evidently  those  corresponding  to  ptomaine  (tyrotoxicon)  poisoning,  and 
not  to  arsenic.  But  although  the  arsenic  in  the  coloring  matter  was  so 
minute  in  quantity  that  the  whole  bottle  could  have  been  drunk  with 
impunity,  and  the  dye  was  so  powerful  that  only  one  and  a  half  or  two 
ounces  (half  a  wine-glass  full),  containing  from  one  thirtieth  to  one  fiftieth 
of  a  grain  of  white  arsenic,  were  used  for  twenty-six  quarts  of  the  cream, 
the  intelligent  jury  brought  a  verdict  against  the  chemical  firm,  and  the 
verdict  was  sustained  by  a  higher  court. 

(a)  Metallic  Arsenic. 

This  substance  is  occasionally  found  native  in  sufficient  quantities 
and  purity  to  be  used  as  such,  but  is  generally  prepared  by  reducing  the 
arsenious  oxide  with  coal  or  charcoal. 

When  pure  it  is  steel-gray  in  color,  with  a  metallic  luster.  It  is  very 
brittle.  In  moist  air  it  slowly  oxidizes,  and  becomes  dull  and  dark  gray 
in  color.  When  heated  it  volatilizes,  without  melting,  with  a  character- 
istic garlic  odor.  At  a  red  heat  it  burns  with  a  bluish  flame,  emitting 
white  fumes  of  arsenic  acid. 

It  is  not  soluble  in  hydrochloric  acid,  but  dissolves  in  sulphuric  and 
nitric  acids,  the  latter  oxidizing  it  to  arsenic  acid.  If  this  last  solution 
is  evaporated  to  dryness  and  then  moistened  with  a  strong  solution  of 
argentic  nitrate,  it  will  turn  a  brick-red  color,  owing  to  the  formation 
of  argentic  arsenate. 

It  can  be  readily  recognized  by  this  test,  and  also  by  the  fact  that  it 
is  easily  soluble  in  a  hot,  strong  solution  of  bleaching  powder. 

A  better  test,  however,  is  to  put  it  into  a  narrow  reducing-tube,  and 
to  heat  it  until  it  sublimes.  The  sublimate,  which  is  of  a  steel-blue 
color,  or  when  very  faint  is  brown,  can  be  chased,  on  careful  heating,  up 


35G  ^   SYSTEM  OF  LEGAL   MEDICINE. 

and  down  the  tube,  and,  especially  if  a  little  air  is  admitted,  can  be  easily 
turned  into  a  white  deposit  of  arsenious  oxide,  with  its  characteristic 
octahedral  crystals. 

Poisonous  Effects. — Metallic  arsenic,  as  such,  is  supposed  to  have 
no  marked  effects  on  the  system,  but  it  is  readily  oxidized  to  arsenious 
oxide,  in  which  case,  of  course,  it  has  the  properties  of  that  substance. 

In  the  few  cases  of  poisoning  reported,  it  has  been  used  either  pure 
or  as  cobalt,  a  native  arsenide  of  cobalt,  powdered  to  serve  as  a  fly 
poison,  and  its  effects  have  been  in  every  respect  similar  to  these  of  ar- 
senious oxide. 

(b)  Arsenious  Oxide — As2Os. 
White  Arsenic,  Arsenious  Acid  ("Rough  on  Rats"). 

As  before  mentioned,  this  substance  has  been  known  as  a  poison  for 
many  hundred  years,  and  is  indeed  almost  universally  meant  by  the 
term  arsenic. 

It  occurs  in  small  quantities  in  nature,  but  is  manufactured  for  the 
market  in  enormous  quantities,  by  roasting'  and  subliming  arsenical 
ores,  such  as  mispickel  or  arsenical  iron  pyrites,  FeAsS.  The  fumes  are 
condensed  in  a  series  of  brick  chambers,  upon  the  walls  and  floor  of 
which  the  arsenic  collects,  in  large  or  small  crystals.  In  some  places 
the  arsenic  is  caught  in  iron  hoods  placed  over  the  roasting-furnaces. 
These  get  hot  enough  to  melt  some  of  the  arsenic,  which  fuses  into  a 
thick,  glassy  cake,  with  loose  layers  of  white  crystals  upon  it.  This 
last  layer  is  chipped  off  of  the  cake  by  hand. 

Properties,  Physical  and  Chemical. — Arsenic  is  usually  sold  as  a 
white,  heavy  powder,  but  occasionally  as  the  hard  solid  masses  of  molten 
arsenic  described  above.  The  latter  are  colorless  and  almost  transparent 
when  fresh,  but  on  exposure  to  the  air  soon  become  opaque  and  white, 
looking  like  porcelain,  owing  probably  to  a  partial  crystallization.  The 
powder  may  be  formed  from  grinding  these  lumps,  but  generally  comes 
from  grinding  the  crystals,  which  are  octahedral  and  vary  greatly  in  size. 
Many,  indeed,  are  quite  small  enough  to  pass  the  finest  grindstones  un- 
crushed,  varying  in  size  from  1-250  to  1-5000  of  an  inch  in  diameter. 

Hence  under  the  microscope  it  is  often  possible  to  identify  a  specimen 
of  arsenic  by  carefully  studying  (a)  the  percentage  of  crystals,  (b)  their 
size  and  diameter,  and  (c)  their  surface,  striatums,  brilliancy,  etc.  This 
was  attempted,  with  very  considerable  success,  by  Prof.  E.  S.  Dana,  of 
New  Haven,  in  the  famous  Mary  Stannard,  or  Hayden,  trial,  where  he 
tried  to  show,  first,  that  the  arsenic  found  in  the  girl's  stomach  was 
identical  with  that  bought  by  Mr.  Hayden  a  few  days  before ;  and  second, 
that  the  package  of  arsenic  claimed  to  have  been  bought  by  the  defend- 
ant a  few  days  before  in  the  neighboring  town,  had,  in  fact,  come  from  a 
different  locality.  The  microscopic  appearance  is  altered  to  some  extent 
by  soaking  in  water  and  other  fluids,  but  often  not  enough  to  spoil  this 
examination. 

Arsenic  is  quite  heavy,  one  teaspoonful  weighing  about  one  hundred 
and  fifty  grains,  and  a  tablespoonful  about  three  hundred  and  fifty  grains, 
or  about  three  fourths  of  an  ounce.  (Taylor.)  It  is,  however,  perfectly 
possible  to  suspend  quite  large  quantities  in  thick  liquids,  like  cocoa, 
gruel,  and  the  like,  so  that  its  presence  is  not  suspected. 


INOBGANIC  POISONS.  357 

Small  doses  of  arsenic  have  no  taste,  but  when  in  large  doses  its  taste 
has  been  variously  described  as  slightly  acid,  metallic,  sharp,  sweetish, 
salty,  and  so  on.  This  can  be  entirely  concealed  by  the  taste  of  food  or 
drink. 

Arsenic  is  sparingly  soluble  in  water,  and  even  less  so  in  organic 
liquids,  like  tea,  milk,  beer,  etc.  According  to  Taylor,  cold  water,  allowed 
to  stand  on  arsenic  for  many  hours,  dissolves  from  one  half  to  three 
quarters  of  a  grain  to  the  ounce. 

If  the  water  is  boiled  on  it  for  an  hour  and  then  allowed  to  cool,  it 
retains  some  twelve  grains  to  the  ounce.  The  amorphous  or  vitreous 
arsenic  dissolves  some  three  times  more  readily  in  cold  water,  and  in 
boiling  water  dissolves  to  the  extent  of  fifteen  or  sixteen  grains  (Seidel 
in  Maschka,  Gerichth  Medeein).  Its  solution  is  slightly  acid  in  reaction, 
ami  deposits  octahedral  crystals  on  cooling  or  evaporation.  Arsenic  is 
easily  soluble  in  both  acids  and  alkalies,  the  latter  forming  salts  of  meta- 
arsenious  acid,  HAs02,  or  occasionally  of  the  normal  acid,  H3As03. 
Arsenic  in  alkali  solution  tends  to  oxidize  into  the  arsenic  oxide,  As^O,, 
and  hence  is  somewhat  used  as  a  reducing  agent. 

It  sublimes  at  a  low  red  heat  in  the  form  of  a  white  cloud,  and  if 
charcoal  is  present,  with  a  garlic  odor.  It  deposits  readily  in  octahedral 
crystals. 

Properties,  Physiological. — Iu  small  quantities  arsenic  acts  as  a 
distinct  tonic.  It  increases  the  appetite  and  the  nutrition  of  the  body. 
Its  effects  are  most  marked  upon  the  stomach  and  intestines,  but  it  also 
seems  to  directly  benefit  the  blood,  and  to  stimulate  the  nervous  system. 

It  is,  indeed,  largely  used  as  a  medicine  in  a  wide  range  of  diseases. 
Next  to  quinine  it  is  the  most  valuable  drug  for  the  treatment  of  mala- 
ria. It  is  largely  used  for  dyspepsia,  for  a  variety  of  skin  diseases,  and 
especially  in  the  treatment  of  certain  nervous  diseases,  like  chorea,  for 
example. 

In  these  cases  it  is  given,  as  a  rule,  in  the  form  of  Fowler's  solution, 
in  doses  rangiug  from  five  or  six  drops  up  to  sixty  drops  a  day. 

The  latter  dose,  twenty  drops  three  times  a  day,  is  about  as  high  as  it 
is  safe  to  go,  and  when  kept  up  for  a  long  time  may  produce  trouble.  In- 
deed, when  given  medicinally,  in  full  doses,  for  some  time,  arsenic  often 
seems  to  accumulate  in  the  body,  and,  when  once  the  more  marked 
symptoms  begin  to  show  themselves,  the  injurious  effects  often  distinctly 
increase,  for  days  and  weeks  after  the  drug  has  been  discontinued. 

The  first  injurious  symptoms  noticed  with  these  full  medicinal  doses 
are  usually  connected  with  the  digestion,  and  consist  of  nausea,  vomiting, 
pain,  and  diarrhoea ;  and  also  with  the  skin,  itching,  eczema,  conjunctivitis, 
and  the  like.  These  symptoms  can  easily  develop  into  those  of  chronic 
poisoning,  mentioned  below. 

Poisonous  Symptoms. — When  arsenic  has  been  administered  in  doses 
large  enough  to  endanger  life  the  symptoms  that  may  present  themselves 
are  very  numerous.  It  is  acknowledged  by  all  the  best  authorities  that 
arsenic  symptoms  present  more  anomalies  than  those  of  any  other  poi- 
son, and  to  insist,  as  is  often  done  in  a  defense,  notably  in  the  case  of 
Mrs.  Maybrick,  that  arsenic  is  not  the  cause  of  death  because  one  or  two 
common  symptoms  are  absent,  is  wholly  unjustifiable.  The  effects  of 
arsenic  vary  with  the  size  of  the  dose,  with  its  form,  whether  dry  or  in 
solution,  with  the  emptiness  and  condition  of  the  stomach,  with  the  gen- 


358  ^   SYSTEM  OF  LEGAL  MEDICINE. 

eral  health  and  idiosyncrasy  of  the  patients,  with  the  treatment  given  to- 
them,  and  many  other  conditions. 

It  must  be  remembered  that  arsenic  is  not  only  an  irritant  like  sul- 
phuric acid  or  caustic  alkali,  but  has  certain  specific  effects  as  well.  Thus, 
in  the  ordinary  forms  of  arsenic  poisoning,  we  have  symptoms  of  irrita- 
tion and  inflammation  of  the  gastro-intestinal  tract,  vomiting,  nausea, 
tenesmus,  j)ain  in  the  stomach  and  abdomen,  and  the  like. 

In  other  cases  the  arsenic  seems  to  pass  directly  into  the  blood  and 
thus  into  the  cerebrum,  and  overwhelms  the  whole  nervous  system. 
The  stomach  symptoms  may  be  entirely  absent,  and  the  patient  fall  into 
a  heavy  narcotic  sleep,  and  die  in  a  state  of  coma. 

While  the  poison  is  being  eliminated,  a  process  which  begins  very 
soon  after  it  is  taken,  it  generally  causes  fatty  degeneration  in  the  liver, 
heart,  and  kidneys,  the  symptoms  from  which  are  often  very  prominent. 
And  with  these  we  often  find  an  irritation  of  the  conjunctiva,  and  also 
of  the  skin,  with  pains  in  the  legs  and  lower  extremities. 

Finally,  if  the  arsenic  is  in  the  system  for  some  length  of  time,  a  week 
or  more,  we  are  apt  to  have  a  series  of  chronic  nervous  symptoms, 
due  to  a  gradually  progressing,  multiple,  peripheral  neuritis,  which  may 
finally  terminate  in  complete  paralysis. 

Accordingly  we  can  roughly  subdivide  the  cases  of  arsenical  poison- 
ing into  four  heads:  1.  Acute;  2.  Sub-acute;  3.  Cerebral  or  narcotic; 
4.  Chronic. 

i.  Acute  Cases. — As  a  rule,  where  large  doses  of  arsenic  have  been 
taken  the  main  action  of  the  poison  is  upon  the  digestive  tract.  The 
first  symptoms  noticed  are  of  weakness  and  faintness,  generally  in  half  an 
hour  or  an  hour  after  the  dose.  Then  comes  vomiting,  violent  and  inces- 
sant, a  very  constant  symptom,  beginning  generally  within  two  or  three 
hours  after  the  dose  and  continuing  almost  always  until  death.  The 
vomited  matter  is  partly  a  watery  secretion,  and  partly  a  thick  glairy 
mucus,  often  containing  bile  and  sometimes  streaked  with  blood. 

Accompanying  this  is  dryness  of  mouth  and  throat,  great  thirst,  and 
pain  in  the  stomach.  This  last  is  usually  strongly  marked,  and  is  a  sensa- 
tion of  burning.  Next  comes  diarrhoea,  a  less  constant  symptom,  which 
is  absent,  or  comes  very  late,  in  many  well-marked  cases.  It  is  usually 
accompanied  with  a  good  deal  of  tenesmus.  The  discharges  are  gener- 
ally yellowish,  and  very  loose,  often  of  the  rice-water  type,  and  occasion- 
ally bloody.  The  urine  is  usually  scanty,  of  a  dark  red  color,  and  is- 
sometimes  entirely  suppressed. 

After  these  symptoms  have  lasted  a  greater  or  less  time  there  are 
signs  of  collapse.  The  pidse  gets  quick  and  feeble,  the  face  white  and 
sunken,  the  eyes  deep,  the  lips  blue,  the  skin  cold  and  clammy,  often 
covered  with  a  cold  sweat,  and  the  patient  dies  sometimes  in  convulsions 
and  sometimes  in  coma. 

These  cases  usually  die  rapidly,  in  six  to  twelve  hours  as  a  rule,  cer- 
tainly in  less  than  twenty-four  hours,  and  the  cause  of  death  seems  to  be 
the  shock  from  the  intense  inflammation  of  the  stomach  and  intestines. 
Some  of  the  cases  are  a  good  deal  like  cases  of  cholera. 

2.  Sub=acute. — If  the  dose  of  arsenic  is  smaller,  or  the  excess  of  the 
poison  is  eliminated  quickly  by  vomiting,  antidotes,  and  the  like,  the 
above  symptoms  may  be  less  strongly  marked,  may  come  on  more  slowly, 
and  continue  longer. 


INOEGAXIC  POISONS.  359 

In  these  cases  the  vomiting  is  the  most  consistent  and  constant  symp- 
tom, and  the  stomach  and  abdomen  are  usually  distended  and  very  ten- 
der. All  of  the  above-mentioned  symptoms  of  inflammation  of  the  digest- 
ive tract  are  or  may  be  present,  but  in  addition  we  have  the  signs  of 
inflammation  of  the  liver  and  kidneys.  Arsenic  is  eliminated  by  these 
organs  in  a  very  short  time,  that  is,  two  to  four  hours  after  its  ingestion, 
and  if  in  large  quantities,  almost  invariably  sets  up  acute  inflammatory 
changes,  with  fatty  infiltration.  This  change  in  the  kidneys  is  indicated 
by  scanty,  high-colored  urine,  containing  albumen,  casts,  and  occasion- 
ally blood. 

The  skin,  which  is  hot  and  dry  in  long-continued  cases,  often  gets 
covered  with  a  rash ;  the  tongue  is  cracked  and  dry ;  the  lips  and  gums 
are  often  inflamed  and  bleed  easily ;  the  patients  are  more  or  less  jaun- 
diced, and  the  eyes  become  yellow,  with  congested  conjunctiva?.  The 
patients  often  complain  of  pains  in  the  legs  and  thighs.  Death,  which 
occurs  in  two  or  three  days  or  even  later,  is,  as  before,  generally  from 
collapse,  and  is  preceded  by  prostration  and  then  coma,  or  by  delirium. 

Appearance  of  First  Symptoms. — The  first  signs  of  poisoning,  such  as 
faintness  and  nausea,  usually  appear  pretty  rapidly,  i.e.,  within  an  hour 
after  taking  the  poison.  Cases  are  on  record  where  the  symptoms  came 
on  in  the  act  of  eating  poisoned  food.  On  the  other  hand,  even  when 
large  doses  have  been  taken  well-marked  symptoms  have  been  delayed 
for  many  hours. 

This  seems  due,  in  some  cases,  to  the  arsenic  being  mixed  with  food 
and  hence  not  being  easily  absorbed,  and  in  some  cases  to  the  action  of 
sleep,  or  the  use  of  morphine  or  of  alcohol.  In  most  of  these  cases  the 
later  symptoms  belonged  to  the  narcotic  type. 

In  one  case  {Med.  Gas.,  1851,  vol.  vii.,  p.  722)  a  strong,  healthy  man, 
while  drinking,  took  half  an  ounce  of  arsenic  in  a  glass  of  beer,  wash- 
ing the  poison  down  with  some  water.  He  vomited  once  in  an  hour  or 
so,  and  then  lay  down  and  slept  till  the  next  morning,  when,  about  nine 
hours  after  taking  the  poison,  the  characteristic  symptoms  of  vomiting, 
thirst,  pain  in  the  abdomen,  etc.,  appeared.  His  brother,  who  slept  in 
the  same  bed,  considered  his  sickness  was  caused  by  his  drink,  and  did 
not  learn  of  the  arsenic  until  noon.     The  man  died  in  about  three  days. 

In  another  case  (Hartshorn,  Phila.  Med.  Exam.,  1855,  vol.  xi.,  p.  707), 
where  the  symptoms  were  delayed  for  sixteen  hours,  a  girl  took  a  dose 
of  powdered  arsenic  at  9  p.m.  and  another  at  9  a.m.  the  next  morning. 
About  eleven  o'clock  she  had  hysteria,  but  no  evidences  of  an  irritant 
poison,  and  they  gave  her  water,  the  first  she  had  taken  for  thirty-six 
hours.     At  1  p.m.  there  appeared  violent  pain  and  vomiting. 

In  still  another  case  (Lond.  Med.  Times,  1849,  vol.  xix.,  p.  26),  no 
marked  symptoms  occurred  for  twenty-three  hours ;  but  there  were  sus- 
picious that  the  patient  was  under  the  influence  of  morphine  at  the  time. 

Time  of  Death. — This  varies  greatly,  but,  as  a  rule,  takes  place  in  less 
than  twenty-four  hours  when  large  doses  have  been  taken. 

Out  of  twenty-nine  recent  cases  in  Massachusetts,  quoted  by  Dr. 
Abbot  (Boston  Med.  and  Surg.  Jour.,  1889,  vol.  cxx.,  p.  480),  the  longest  lasted 
six  days  and  the  shortest  six  hours,  while  the  average  time  was  sixteen 
hours.  The  average  of  the  rest,  leaving  out  the  six-day  case,  was  about 
eleven  hours. 

The  shortest  time  on  record  is  given  by  Dr.  Taylor  as  twenty  min- 


300  A   SYSTEM  OF  LEGAL  MEDICINE. 

utes,  and  in  another  case  (Von  Tschudi,  Wien.  Med.  Wochensch.,  1851, 
p.  455)  a  peasant  is  stated  to  have  taken  a  small  lump  of  arsenic,  mixed 
with  water,  and  died  in  half  an  hour.  These  rapid  cases,  as,  for  instance, 
the  one  quoted  below,  where  death  occurred  in  an  hour,  are  usually  of 
the  cerebral  or  narcotic  type  ;  but  Taylor  gives  an  interesting  case  {Guy's 
Hospital  Reports,  1851,  p.  183),  where  a  woman  took  a  teaspoonful  of  pow- 
dered arsenic,  with  a  little  water,  on  an  empty  stomach ;  had  vomited 
thoroughly  and  was  suffering  great  pain  when  the  doctor  saw  her  in  an 
hour  and  a  half ;  and,  in  spite  of  treatment,  died  of  collapse  in  two  hours 
and  a  half. 

Death  may  be  delayed  for  quite  a  time  after  the  administration  of 
the  poison.  Cases  of  death  in  six  and  seven  days  are  not  at  all  uncom- 
mon, and  patients  have  been  known  to  linger  for  weeks  or  even  months, 
and  still  die  from  the  effect  of  the  arsenic,  either  upon  the  digestion  or, 
secondarily,  upon  the  liver  and  kidneys. 

A  famous  case,  often  quoted,  is  that  of  Dr.  Alexander  (Med.  Times 
and  Gaz.,  1857,  p.  389),  a  prominent  Irish  clergyman,  who  was  given  some 
arrowroot  in  which  the  grocer  had  carelessly  mixed  arsenic.  In  spite 
of  prompt  treatment  he  died  in  sixteen  days,  and  on  the  trial  of  the 
grocer  for  manslaughter  it  was  proved  that  his  death  was  due  directly 
to  the  poison,  although  not  a  trace  of  poison  could  be  found  in  the 
body. 

Illustrative  Cases. — Dr.  Taylor  quotes  an  interesting  example  of  sub- 
acute arsenical  poisoning  in  the  case  of  some  three  hundred  and  forty 
children  in  an  industrial  school  near  London,  who  were  given  milk 
diluted  with  water  from  a  boiler  containing  a  solution  of  arsenic.  The 
amount  of  arsenic  taken  by  each  child  was  about  a  grain,  and  the  symp- 
toms, shivering,  pain  in  the  stomach,  and,  in  most  cases,  vomiting,  de- 
veloped within  an  hour.  In  about  three  hours  after  the  meal  they  had 
more  or  less  severe  pain  in  the  forehead  and  watery  running  of  the  nose. 
Seven  had  a  croupy  sort  of  cough,  three  vomited  blood,  and  one  passed 
blood  by  the  bowels.  Some  had  distinct  gastritis ;  but  as  the  cause  of 
sickness  was  speedily  recognized,  and  treatment  was  applied  at  once,  all 
recovered,  and  only  six  were  being  treated  at  the  end  of  a  week.  The 
treatment  consisted  of  giving  gum-water  with  albumen,  and  of  keeping 
up  vomiting  by  emetics  and  greasy  water  for  twelve  hours,  finishing 
with  doses  of  castor-oil. 

A  famous  example  of  one  of  these  cases  was  that  of  the  Due  de  Choi- 
seul  Praslin,  who,  when  arrested  after  brutally  and  clumsily  murdering 
his  wife,  poisoned  himself  with  a  large  dose  of  arsenic.  The  story  goes 
that  the  clever  and  ingenious  French  detectives,  before  taking  him  to 
prison,  searched  him  and  his  clothes  thoroughly  from  head  to  foot. 
They  finally  made  him  change  his  coat  and  put  on  a  dressing-gown,  in 
the  pocket  of  which  there  happened  to  be,  unknown  to  them,  a  package 
of  arsenic,  which  he  had  bought  some  time  previously,  probably  for  his 
wife's  benefit.  He  took  this,  and  in  a  few  hours  began  to  vomit  vio- 
lently. He  had  no  diarrhoea,  except  an  involuntary  movement  on  the 
second  day,  had  no  conjunctivitis,  no  cramps,  no  pain  in  his  abdomen 
until  the  fourth  day,  probably  owing  to  his  having  been  given  some 
morphine  early  in  the  attack. 

His  doctors,  the  best  in  Paris,  were  much  bothered,  diagnosed  it 
for  the  first  two  days  as  cholera,  and  then  as  laudanum  poisoning,  and 


IXOEGAXIC  POISONS.  361 

finally  found  out  the  true  cause  by  analyzing  the  ejecta.  He  died  of 
collapse  on  the  sixth  day. 

An  interesting-  series  of  cases  of  this  class  is  reported  by  Dr.  Steven- 
son (Guy's  Hospital  Reports,  1875,  vol.  xx.,  p.  145),  where  eight  persons 
in  one  family  were  poisoned  by  drinking  water  kept  in  a  pail  which  had 
been  used  for  an  arsenical  sheep-wash.  Five  of  these  died,  in  six,  seven, 
twelve,  thirteen,  and  thirteen  days  respectively  from  the  time  of  the 
fatal  dose.  Of  the  eight  patients,  all  had  persistent  and  violent  vomit- 
ing; only  four  (three  of  whom  died)  had  diarrhoea,  seven  had  conjunc- 
tivitis, and  five  had  a  rash  or  eruption  on  the  skin. 

3.  Cerebral  or  Narcotic— In  these  cases  the  signs  of  gastric  or  in- 
testinal irritation  are  almost  entirely  absent.  The  principal  symptoms 
are  great  feebleness,  with  a  weak  pidse  and  cold  skin,  dizziness  and  pal- 
lor, and  cold  extremities.  The  patients  generally  sink  into  a  heavy  nar- 
cotic sleep,  from  which  they  cannot  be  roused,  and  die  in  a  state  of  coma. 
Sometimes  they  may  remain  conscious,  although  sinking,  until  near  the 
end,  and  die  in  a  state  of  collapse,  occasionally  with  convulsions. 

These  cases  are  not  very  commonly  met  with,  and  usually  are  due 
to  the  rapid  absorption  of  the  poison,  which  has  either  been  taken  in 
solution,  or,  if  dry,  in  large  quantities  on  an  empty  stomach. 

The  time  of  death  in  these  cases  is  usually  quite  short.  These 
patients  rarely  survive  twenty-four  hours,  and  have  been  known  to  die 
very  rapidly  indeed. 

Death  in  One  Hour. — One  of  the  most  rapid  cases  ever  reported  is 
given  by  Dr.  Finley  (Lancet,  1883,  part  ii.,  p.  943).  A  healthy  man,  aged 
fifty-one,  had  drunk  by  mistake,  upon  an  empty  stomach,  a  solution  con- 
taining about  twenty-six  grains  of  arsenic.  He  was  taken  almost  at 
once  with  faintness  and  collapse,  with  some  epigastric  pains.  He  was 
brought  to  the  hospital  in  about  half  an  hour,  and  had  not  yet  vomited. 

His  symptoms  were  cold  skin,  a  free,  clammy  sweat,  feeble,  slow 
pulse,  shallow  respiration,  pupils  moderately  dilated.  He  was  still  con- 
scious, and  complained  of  headache,  constriction  across  the  chest,  and 
pain  in  the  epigastrium.  Emetics  did  not  work ;  they  washed  out  the 
stomach,  but  without  effect,  He  was  put  to  bed,  given  brandy,  hot- 
water  bottles,  warm  blankets,  and  the  rest ;  but  in  spite  of  everything 
he  sank  rapidly,  became  pulseless,  and  died  in  one  hour  from  the  time 
he  took  the  poison. 

Post-mortem  examination  showed  intense  congestion  of  the  mucous 
membrane  of  the  stomach,  with  some  congestion  of  the  trachea  and 
larynx.  The  intestines,  spleen,  and  heart  were  normal,  except  for  an 
ecchymosis  on  the  endocardium  of  the  left  ventricle.  The  liver  and 
kidneys  were  congested,  and  arsenic  was  found  in  the  contents  of  the 
stomach,  the  tissues,  and  in  the  liquid  remaining  in  the  bottom  of  the 
bottle. 

In  another  case  (Edin.  Med.  Jour.,  1843,  vol.  lix.,  p.  350)  a  girl,  aged 
twenty,  took  some  two  ounces  of  dry  arsenic  on  an  empty  stomach,  and 
although  she  vomited  soon,  died  in  two  hours  and  a  half  from  collapse. 

These  cases  do  not  always  terminate  rapidly.  For  instance,  Dr.  Wil- 
lard  (Maryland  Med.  Jour.,  1885,  vol.  xii.,  p.  333)  gives  an  instance  of  a 
healthy  girl,  twenty -three  years  old,  who  took  a  teaspoonful  of  "  Rough 
on  Rats,"  dissolved  in  tea,  just  after  midnight.  Soon  afterward  she  vom- 
ited and  fainted,  and  she  was  found  next  morning  unconscious,  with 


362  A   SYSTEM  OF  LEGAL  MEDICINE. 

symptoms  of  extreme  pallor  and  weak,  rapid  pulse.  Vomiting  was  in- 
duced by  zinc  sulphate,  aud  at  two  o'clock  in  the  afternoon  she  recov- 
ered consciousness.  She  complained  of  a  dryness  of  the  throat  but  no 
pain,  and  was  weak  and  sleepy.  Her  stupor  increased,  and  she  died 
comatose  at  about  three  o'clock,  fifteen  hours  after  the  fatal  dose.  On 
post-mortem  examination  her  stomach  was  found  to  be  much  inflamed. 

4.  Chronic  Cases. — The  previous  symptoms  all  had  reference  (a)  to 
the  local  irritation  of  the  digestive  tract,  (b)  to  the  later  lesions  of  the 
liver  and  kidney,  and  (c)  to  an  overwhelming-  effect  on  the  central  nerv- 
ous system. 

We  now  come  to  a  class  of  cases  where  the  symptoms  are  chiefly  due 
to  lesions  of  the  nerve  fibers  themselves,  resulting  frequently  in  almost 
complete  paralysis. 

These  effects  of  arsenic  have  been  known  for  a  long  time.  Peter 
Abano,  for  instance,  in  the  thirteenth  century,  states  in  his  treatise  De 
Venenis  Eorumqiie  Bemediis  that  "  whoever  gets  realgar  in  his  drink  suf- 
fers thirst  and  heat  and  drought,  and  is  either  cured,  or  dies,  or  remains 
paralyzed  and  contracted."  He  further  quotes  a  case  of  such  paralysis. 
Ambroise  Pare  and  other  writers  of  the  sixteenth  century  fully  con- 
firmed his  statement.  And  yet  in  recent  times  these  symptoms  have 
been  largely  overlooked,  and  have  only  been  brought  into  prominence 
in  the  last  ten  years. 

These  symptoms  occur  in  two  different  sets  of  cases :  that  is,  in 
patients  who  are  recovering  from  the  effects  of  an  acute  or  sub-acute 
attack,  or  else  in  cases  where  the  poison  has  been  administered  for  some 
time  in  comparatively  small  doses. 

These  latter  are  not  uncommonly  met  with  in  practice,  from  the  ex-, 
cessive  use  of  arsenic  as  a  medicine.  This  rarely  happens  with  careful 
treatment.  The  head  of  one  of  the  New  York  nerve  clinics  told  me  that 
out  of  several  hundred  patients  who  had  been  treated,  in  his  clinical 
practice,  with  full  doses  of  Fowler's  solution,  two  cases  only  had  suffered 
from  the  effects  of  arsenic.  These  two,  however,  had  by  some  careless- 
ness of  his  assistants  become  almost  completely  paralyzed. 

Dr.  Dana  (Brain,  1887,  vol.  ix.,  p.  456)  tells  of  a  man  aged  forty-eight 
who  had  been  suffering  with  chronic  gastralgia  for  twenty-eight  years, 
and  finally  was  treated,  at  Bellevue,  with  Fowler's  solution  in  gradually 
increasing  doses.  After  two  months  the  dose  reached  thirty  drops  of 
Fowler's  solution  three  times  a  day,  or  nine  tenths  of  a  grain  of  arsenic 
per  diem.  This  lasted  for  nearly  a  month,  when  nervous  symptoms  came 
on,  and  resulted  in  complete  paralysis. 

Another  similar  case  is  given  by  Roucher  and  Brouardel  (Ann.  (VHyg., 
1874,  vol.  xlii.,  p.  406),  when  similar  disturbances  resulted  from  a  much 
milder  course  of  arsenic.  A  girl,  twenty-two  years  old,  suffering  with 
persistent  eczema,  was  given  Fowler's  solution  for  the  first  fortnight  at 
the  rate  of  thirty  drops  (three  tenths  of  a  grain  of  arsenic)  per  day,  and 
for  two  weeks  more  at  the  rate  of  forty  drops  (four  tenths  of  a  grain 
of  arsenic)  per  day.  She  began  the  fifth  week  with  twenty  drops  three 
times  per  day,  but  after  one  day  went  back  to  forty  drops,  and  then 
in  a  day  or  two  stopped  the  treatment.  Nervous  symptoms  came  on 
almost  at  once,  resulting  in  marked  paralysis  at  the  end  of  five  or  six 
weeks. 

But  besides  these  and  other  isolated  cases,  there  have  been  of  late 


IXOEGANIC  POISONS.  363 

years  two  well-defined  epidemics  of  chronic  arsenic  poisoning,  which 
have  been  thoroughly  studied  by  the  best  French  physicians,  and  from 
which  the  symptoms  of  this  disease  have  been  clearly  defined. 

In  one  case  some  four  hundred  and  thirty-five  people,  in  the  village 
of  Hyeres,  were  poisoned  by  wine  containing  from  about  one  sixth  to 
two  and  a  half  grains  of  arsenic  to  the  quart.  The  sickness  was  at  first 
thought  to  be  "  mucus  fever,"  then  grippe,  and,  when  five  or  six  old  peo- 
ple had  died  from  it,  and  almost  every  family  in  the  neighborhood  was 
suffering  from  it,  the  illness  was  at  last  traced  to  the  wine  from  a  neigh- 
boring vineyard.  There  was  naturally  great  excitement ;  the  proprietor 
was  accused  of  having  intentionally  poisoned  his  wine,  and  was  thrown 
into  prison.  But  it  appeared,  on  investigation,  that  the  trouble  was  all 
due  to  an  accident,  a  barrel  of  white  arsenic  having  been  mixed  in  with 
the  plaster,  which  was  applied  in  small  quantities  to  the  grapes  before 
pressing. 

The  other  case,  which  although  it  involved  fewer  people  was  still 
more  curious,  is  reported  in  full  in  the  Annates  d'Hygiene  (1889,  vol.  xxii.. 
p.  36)  and  elsewhere.  In  July,  1888,  a  civil  suit  was  commenced  in 
Havre  against  the  owner  of  a  small  apartment-house,  with  a  pharmacy 
-on  the  ground  floor,  on  account  of  the  unsanitary  condition  of  the 
premises.  In  accordance  with  the  excellent  French  custom,  a  commis- 
sion of  four  of  the  best  doctors  in  France,  Messrs.  Brouardel,  Delaunay, 
Huchon,  and  Pouchet,  came  down  from  Paris  to  investigate.  They  ex- 
amined thoroughly  the  drainage,  plumbing,  soil,  wall-papers,  etc.,  studied 
carefully  the  symptoms  of  the  invalids,  and  after  a  complete  investiga- 
tion, aided  largely  by  the  results  of  the  Hyeres  epidemic,  decided  that 
the  illness  came  from  small  doses  of  arsenic. 

This  started  the  authorities  on  a  new  track,  and  it  was  soon  found 
that  a  young  clerk,  Pastre  Beaussier,  employed  in  the  drug-store,  had, 
from  pique,  fear  of  dismissal,  and  other  reasons,  amused  himself  by  poi- 
soning first  his  employer  and  then  his  fellow-clerks  and  servants.  He 
had  reached,  at  the  time  this  was  found  out,  in  the  space  of  barely  two 
years,  the  respectable  tale  of  fifteen  victims,  three  of  whom  died,  and 
the  rest  of  whom  were  more  or  less  completely  paralyzed. 

The  symptoms  of  the  Havre  and  the  Hyeres  cases  were  the  same, 
and  may  serve  as  a  model  for  all  cases  of  chronic  arsenic  poisoning. 

(a)  Trouble  with  the  Digestion. — The  patients  would  first  notice  a 
feeling  of  sickness  and  nausea,  which  increased,  almost  always,  to  actual 
vomiting.  This  vomiting  was  quite  characteristic ;  it  was  not  painful, 
nor  did  it  leave  pain  or  a  burning  feeling  in  the  stomach ;  it  was  quite 
frequent,  running  up  often  to  seven  or  eight  times  a  day ;  the  vomited 
matter  was  full  of  mucus  and  bile.  Occasionally,  however,  it  occurred 
only  two  or  three  times  during  the  illness. 

Sometimes  the  patients  became  quite  feverish,  with  some  typhoid 
symptoms.  Intestinal  troubles  were  less  marked,  and  lasted,  as  a  rule, 
but  a  short  time. 

(b)  Symptoms  hi  Larynx  and  Bronchi,  Skin  Symptoms. — After  some 
little  time  the  patients  developed  decided  symptoms  of  a  catarrhal  in- 
flammation of  the  larynx  and  bronchi.  They  suffered  from  coughing, 
spitting  of  mucus  and  occasionally  of  blood,  loss  of  voice,  with  sibilant 
and  sonorous  rales  in  the  bronchi.  Indeed,  at  Hyeres,  the  doctors  at 
this  stage  diagnosed  the  illness  as  grippe,  and  prescribed  accordingly. 


364  A    SYSTEM   OF  LEGAL  MEDICLNE. 

Accompanying  this  was  intense  coryza,  with  inflammation  and  running' 
of  the  nose,  often  spreading  to  the  eyes  and  producing  more  or  less 
marked  con j  uncti vitis. 

With,  or  before,  these  catarrhal  symptoms  there  developed  a  cutane- 
ous eruption,  beginning  with  redness  and  swelling  of  the  eyelids,  the 
scrotum,  and  then  of  different  parts  of  the  body.  This  was  often  fol- 
lowed with  exfoliations  and  by  loss  of  the  nails.  The  eruptions  varied 
greatly,  being  vesicular,  pustular,  sometimes  rubeolic,  or  like  urticaria, 
The  surface  of  the  skin  was  more  or  less  pigmented,  frequently  becom- 
ing a  dirty  brown  color,  especially  on  the  neck,  the  rump,  and  the  ex- 
tremities, and  also  in  the  armpits,  under  the  knees,  and  around  the 
anus.  In  autopsies  arsenic  was  found  in  the  skin,  nails,  and  hair,  and 
it  is  claimed  that  these  symptoms  may  have  been  caused  by  the  elimina- 
tion of  the  poison  in  that  way. 

(c)  Disturbances  of  Sensation. — Next  to  these  symptoms  there  came 
more  or  less  marked  trouble  with  the  nervous  system.  This  began  with 
headaches,  severe  and  persistent,  over  the  whole  head,  and  an  unpleasant 
numbness  in  the  legs  and  feet,  One  of  the  fellow-clerks  of  Pastre 
Beaussier  testified  that  he  used  to  keep  hitting  the  soles  of  his  feet,  be- 
hind the  counter,  with  a  spatula,  to  try  to  keep  up  the  circulation.  This 
numbness  was  often  accompanied  with  painful  cramps. 

Then  came  extreme  pain,  sometimes  shooting,  more  often  grinding, 
situated  chiefly  in  the  calves  and  thighs.  The  patients  complained  of 
dogs  biting  the  calves  and  the  soles  of  their  feet.  There  was  an  in- 
creased sensibility  of  the  skin  ;  a  child  complained  of  butterflies  running 
up  and  down  his  back.  In  almost  all  of  the  cases  the  pressure  of  the 
bedclothes  became  unendurable. 

There  was  some  loss  of  general  sensation  in  hands  and  feet,  It  was 
hard  to  feel  the  ground  or  to  hold  small  objects.  In  almost  all  cases 
there  was  an  anaphrodisia. 

(d)  Disturbances  of  Motion. — In  every  case  the  disturbances  of  sensa- 
tion preceded  those  of  motion,  and  in  light  cases  the  latter  were  hardly 
perceptible.  In  the  severe  cases,  however,  they  gradually  increased  to 
almost  complete  paralysis. 

They  began  with  some  muscular  weakness,  first  noticed  in  the  legs. 
The  patients  were  easily  fatigued ;  found  it  hard  to  mount  the  stairs  j 
threw  the  legs  out  in  front  when  they  walked. 

Then  they  lost  the  power  of  walking ;  they  had  to  drag  themselves 
along.  When  they  stood  up  they  had  to  grasp  some  support,  or  keep 
changing  their  feet  all  the  time.  The  feet  became  flabby  and  hung 
when  at  rest.  Similar  symptoms  were  noticed  in  hands  and  arms,  the 
"  wrist-drop  "  usually  appearing  after  the  "  foot-drop."  The  tendinous 
reflexes  were  constantly,  and  the  cutaneous  reflexes  generally,  absent. 
The  plantar  reflex  was  feeble,  but  still  existed  in  many  cases.  The  cre- 
master  and  abdominal  reflexes  were  normal. 

If  treated  at  the  onset  of  the  paralysis,  the  patients  usually,  though 
slowly,  recovered.  But  if  the  poisoning  still  continued,  the  paralysis 
became  more  and  more  complete,  and  the  patients  died  usually  of 
dyspnoea  and  syncope,  from  heart  failure,  though  without  any  decided 
lesions. 

Death  sometimes  resulted  from  fatty  degeneration  of  the  liver  and 
kidney,  caused  by  the  elimination  of  the  poison. 


INORGANIC,  POISONS.  365 

Chronic  Symptoms  after  Large  Doses. — Very  similar  disturbances 
of  the  sensory  and  motor  nerves  are  frequently  met  with  in  patients 
who  have  recovered  from  the  acute  or  sub-acute  symptoms  of  large 
doses.  It  is  supposed,  in  these  cases,  that  the  arsenic,  slowly  working 
out  of  the  system,  permeates  it  and  affects  it  in  the  same  way  as  when 
given  for  a  long  time. 

Scolosuboff,  for  instance,  in  an  important  paper  (Compt.  Rend.  Biol., 
1875,  part  ii.,  pp.  309,  313),  gives  two  cases.  One  of  these,  who  was  a 
porter,  who,  for  a  syphilitic  eruption,  rubbed  into  his  scrotum,  arm,  and 
nose  an  alcoholic  solution  of  arsenic,  and  also  an  arsenic  pomatum.  He 
soon  had  vomiting  and  gave  up  this  treatment ;  but  in  two  weeks  entered 
the  hospital  suffering  from  numbness  and  tingling  in  his  hands  and  feet, 
and  great  muscular  feebleness.  In  spite  of  careful  treatment  his  symptoms 
got  worse  for  ten  or  twelve  months,  after  which  he  began  to  improve. 

His  second  case,  which  is  more  characteristic,  was  of  a  woman  forty- 
eight  years  old,  who  took  a  dose  of  arsenic  instead  of  chalk,  and  began 
to  vomit  in  one  hour,  keeping  up  the  vomiting  constantly  for  forty-eight 
hours.  In  four  or  five  days  she  noticed  a  feeling  of  cold  and  numbness 
at  the  ends  of  her  fingers  and  toes.  Then  the  cold  reached  her  forearms 
and  legs,  and  she  had  great  feebleness  in  her  hands  and  feet.  In  ten 
days  she  could  not  walk  without  assistance,  and  in  fifteen  days  she  took 
to  bed  permanently,  almost  completely  paralyzed. 

Dr.  Miles  (Phila.  Med  News,  1883,  vol.  xlii.,  p.  257)  quotes  a  similar 
case  of  a  lawyer,  twenty-four  years  old,  who  with  six  other  people,  of 
whom  two  died,  ate  some  pie  accidentally  poisoned  with  arsenic.  He 
vomited  soon  after  eating,  and  after  some  hours  vomited  incessantly  all 
night  long.  This  subsided  in  three  days,  leaving  him  much  prostrated. 
His  bowels  did  not  move.  In  four  or  five  days  he  had  marked  fever, 
and  in  six  days  he  noticed  aching  and  numbness  aboitt  his  knees  and 
then  his  feet.  In  nine  days  he  noticed  numbness  in  his  fingers  and 
hands,  as  far  as  the  wrist,  with  loss  of  power  in  his  forearms ;  while  his 
legs,  at  this  time,  from  the  knees  down,  were  almost  completely  para- 
lyzed. His  face  was  puffed  and  swollen.  In  four  weeks  he  had  severe 
pain  from  the  knees  down,  and  a  little  later  in  his  hands  and  fingers. 
The  symptoms  got  worse  for  two  or  three  months,  and  then  gradually 
improved  under  treatment. 

A  typical  case  of  this  sort  was  seen  by  the  writer  recently  (Novem- 
ber, 1893),  in  the  person  of  a  German  clerk,  thirty-nine  years  old,  of 
good  history  and  previous  health,  who  in  November,  1892,  took  five 
cents'  worth  (a  big  tablespoonful)  of  Paris  green.  In  three  quarters  of 
an  hour  he  vomited  and  felt  severe  pain  in  the  abdomen,  and,  after 
being  without  treatment  for  three  days,  went  to  the  Presbyterian  Hos- 
pital. Two  weeks  later  he  lost  sensation,  more  or  less  completely,  in 
the  legs  and  forearms,  and  soon  afterward  began  to  lose  power  in  the 
legs  and  hands.  The  sensation  returned  in  about  six  weeks  more,  but 
the  loss  of  power  became  worse  up  to  some  three  months  and  a  half 
from  the  time  of  taking  the  poison,  after  which  he  very  slowly  im- 
proved. He  never  lost  power  completely,  though  quite  unable  to  walk 
or  to  use  his  hands  or  forearms.  In  April  he  had  a  macular  eruption 
all  over  his  body,  which  was  cured  by  sulphur  ointment. 

In  April  he  was  removed  to  Bellevue,  where  under  careful  treatment 
lie  slowly  improved,  the  hands  recovering  quicker  than  the  feet.     In 


366  ^   SYSTEM  OF  LEGAL  MEDICINE. 

about  eleven  months  he  began  to  recover  the  use  of  his  legs,  and  in 
November,  after  one  year's  illness,  he  was  just  able  to  move  around  on 
crutches,  after  being  assisted  out  of  his  chair. 

Lesions  Peculiar  to  these  Symptoms. — It  has  been  claimed  by 
Seguin  (Jour.  Nervous  and  Mental  Diseases,  1882,  vol.  ix.,  p.  665)  and  others 
that  these  peculiar  nervous  symptoms  are  due  to  an  affection  of  the 
spinal  cord,  of  the  nature  of  a  diffused  myelitis.  It  is,  however,  gener- 
ally agreed  at  present,  by  the  best  authorities  (see  Rouchet,  Ann.  d-Hyg., 
1874,  vol.  xlii.,  p.  406  ;  Starr,  Med.  News,  1887,  vol.  1.,  p.  173 ;  and  others), 
that  the  symptoms  are  caused  by  a  general  peripheral  neuritis,  an  actual 
degeneration  of  the  nerve  fibers  themselves,  progressing  from  the  ex- 
tremities toward  the  cord. 

These  lesions  are  very  similar  to  those  produced  by  lead  poisoning 
and  by  chronic  alcoholism,  and  it  is  often  quite  hard  to  distinguish  be- 
tween them. 

The  lead  paralysis  can  usually  be  diagnosed,  first,  by  beginning,  as 
a  rule,  in  the  hands  and  arms  before  the  feet  and  legs,  the  "  wrist-drop," 
for  instance,  occurring  before  the  feet  are  affected  at  all ;  and  secondly, 
by  the  almost  constant  presence  of  the  "  lead  line,"  the  bluish-black  line 
along  the  gums. 

.  It  is  usually  stated  that  the  alcoholic  paralysis  must  be  recognized 
by  the  history.  In  this  connection  it  is  well  to  remember  that  the  nerve 
lesions  are  caused  not  so  much  by  the  excessive,  as  by  the  chronic,  use 
of  alcohol.  For  instance,  a  friend  of  mine  told  me  of  a  patient  of  his,  a 
woman  of  good  family  and  position,  brought  in  by  her  sisters  for  treat- 
ment of  partial  paralysis.  Her  symptoms  were  due  to  the  modest  dose 
of  two  milk-punches  a  day,  taken  for  five  or  six  weeks  at  a  time,  at  a 
physician's  advice,  because  she  had  become  worn  out  by  attendance  at 
a  sick-bed.  It  is  also  worth  remembering  that  alcohol  produces  these 
symptoms  more  commonly  in  women  than  in  men. 

Another  point  in  the  diagnosis  is  the  fact  that  in  arsenic  paralysis 
the  mind  is  usually  unimpaired,  while  in  alcoholic  and  sometimes  in  lead 
paralysis  there  are  marked  mental  delusions.  The  peculiar  delusion  con- 
sidered characteristic  of  alcohol  is  the  "  time  and  place  aphasia."  The 
patients  cannot  judge  how  long  they  have  been  talking,  how  long  they 
have  been  in  the  office ;  cannot  tell  what  room  they  are  in,  will  agree 
when  told  that  they  are  in  a  strange  city,  and  the  like,  although  in  other 
respects  they  may  be  perfectly  sound  in  mind. 

A  rather  striking  case,  showing  how  good  physicians  may  be  misled 
in  dealing  with  such  cases,  occurred  in  Boston  some  few  years  ago  (Bos- 
ton Med.  and  Surg.  Jour.,  1887,  vol.  cxvi.,  \).  423),  and  was  discussed  at  a 
meeting  of  Massachusetts  doctors. 

It  appeared  that  a  young  fellow,  worth  some  $4,000,000,  who  was  lead- 
ing a  rather  fast  career  in  Boston,  was  looked  up  at  last  by  his  family. 
They  found  him  extremely  ill  at  the  Beacon  Street  house  of  a  friend,  in 
some  of  whose  projects  he  had  invested  large  sums  of  money.  He  was 
being  attended  by  his  friend,  his  friend's  wife,  and  by  an  apothecary, 
but  not  by  a  physician.  A  good  doctor  was  summoned,  and  found  him 
almost  completely  paralyzed  from  head  to  foot.  He  had  but  few  move- 
ments left,  and  had  lost  almost  all  sense  of  touch  in  his  extremities,  and 
besides  this  he  had  symptoms,  severe  vomiting  and  the  like,  of  consid- 
erable gastric  inflammation. 


INORGANIC  POISONS.  3G7 

His  vomit  and  urine  were  analyzed  for  arsenic  with  positive  results 
(one  quarter  and  one  third  of  a  grain  of  arsenic  in  the  vomited  material, 
one  twelfth  of  a  grain  in  the  urine),  so  he  was  removed  to  another  house, 
.and,  under  careful  treatment,  slowly  recovered. 

It  appeared  that  he  had  been  on  a  regular  spree  before  he  was  taken 
ill,  and,  in  fact,  had  been  living  for  some  time  at  a  house  of  bad  repute, 
and  had  now  and  then  been  taken  to  Beacon  Street  for  dinner,  and  back 
again,  in  a  carriage.  He  related  how,  when  at  dinner  at  his  friend's 
house,  he  had  taken  certain  articles  of  food  which  always  made  him  ill. 
The  doctor  who  related  this  closed  his  story  by  stating  that  the  facts 
had  been  laid  before  the  district  attorney,  and  that  a  prosecution  might 
result. 

Whereupon  a  distinguished  doctor  in  the  meeting  informed  his  friends 
that  he  took  a  lively  interest  in  this  tale,  because,  a  few  months  before, 
.a  very  pleasant,  gentlemanly-looking  man  had  called  him  in  to  see  a 
friend  lying  sick  at  his  house.  The  patient  was,  as  described,  lying 
crippled  with  paralysis,  and  had  symptoms  of  vomiting ;  but  his  friend 
kindly  gave  a  full  history  of  his  previous  career,  and  carefully  explained 
that  his  condition  might  be  due  to  alcohol,  syphilis,  diarrhoea,  or  malaria,. 
The  doctor  did  not  state  exactly  what  diagnosis  he  did  make,  but  con- 
fessed that  the  idea  of  arsenic  never  entered  his  head. 

Prognosis  and  Treatment. — As  before  stated,  these  patients,  if 
treated  properly  and  in  time,  usually  recover,  although  when  the  paral- 
ysis has  once  fairly  set  in  the  treatment  is  long  and  tedious.  It  consists, 
as  a  rule,  of  nerVe  tonics  like  strychnine,  of  doses  of  salicylate  of  soda,  of 
massage  to  try  to  keep  up  the  tone  of  the  muscles,  and  of  wholesome  and 
stimulating  food.    Morphine  may  have  to  be  applied  to  relieve  the  pain. 

Poisoning  by  External  Application. — As  may  be  noticed  in  one  of 
the  cases  lately  mentioned,  the  characteristic  symptoms  of  arsenic  poi- 
soning may  be  produced  by  the  application  of  dissolved,  and  also  of  dry, 
arsenic  upon  the  skin,  and  upon  any  of  the  mucous  surfaces.  Cases  of 
criminal  poisoning  have  been  described  where  arsenic  was  applied  to  the 
rectum  and  to  the  vagina.  In  these  cases  the  poison  was  rapidly  absorbed, 
and  produced  symptoms  of  gastric  irritation  as  well  as  of  local.  The 
.absorption  is  more  rapid  if  applied  upon  a  raw  or  inflamed  surface,  but 
cases  are  numerous  where  death  has  resulted  from  the  application  of 
arsenical  ointment,  or  even  of  dry  arsenic,  upon  the  scalp,  or  upon  the 
healthy  and  unbroken  skin. 

A  well-known  example  of  this  occurred  in  England  in  1878,  when 
seventeen  children  died  from  dusting  the  skin  and  private  parts  with  a 
violet-powder,  containing  some  thirty-five  or  forty  percent,  of  dry  arsenic 
instead  of  gypsum.  Several  cases  of  severe  illness,  and  indeed  of  death, 
have  been  reported,  time  and  time  again,  from  the  efforts  of  quack  doc- 
tors to  burn  out  cancerous  and  other  ulcers  with  white  arsenic,  orpi- 
ment,  and  other  arsenical  compounds,  or  from  the  careless  use  of  arsen- 
ical soaps  and  washes. 

In  all  these  cases  a  local  inflammation  is  invariably  first  observed, 
but  this  is  rapidly  followed  by  the  ordinary  arsenical  symptoms,  the 
arsenic,  when  once  absorbed,  showing  the  characteristic  stomach  and  in- 
testinal lesions,  as  well  as  the  later  effects  upon  the  nervous  system. 

Dangerous  and  Fatal  Doses  of  Arsenic. — The  above-mentioned 
chronic  symptoms  of  arsenic  poisoning  have  sometimes  occurred  after 


368  J   SYSTEM  OF  LEGAL  MEDICINE. 

the  taking  of  but  small  doses  of  arsenic,  if  kept  up  for  a  long  time. 
Thus  Dr.  Putnam  (Boston  Med.  and  Surg.  Jour.,  vol.  cxviii.,  p.  646 ;  vol. 
cxix.,  p.  1)  describes  a  case  of  slight  neuritis  from  doses  of  four  or  five 
drops  of  Fowler's  solution  (one  twenty-fifth  to  one  twentieth  of  a  grain  of 
arsenic),  when  taken  three  times  a  day  for  a  month,  and  states  that  six 
or  seven  drops  a  day  have,  after  long  continuance,  proved  poisonous. 
Generally  it  is  possible,  especially  in  chorea,  to  run  up  the  doses  of 
Fowler's  solution  to  thirty  or  forty  and  even  to  sixty  drops  (six  tenths 
of  a  grain  of  arsenic)  per  day  without  inconvenience.  It  must  be  remem- 
bered, however,  that  the  poison,  in  spite  of  Taylor  and  others,  is  to  some 
extent  cumulative,  and  that  the  symptoms,  once  started,  are  liable  to  in- 
crease in  severity  for  some  time  after  the  stoppage  of  the  drug. 

Generally  a  dose  of  from  one  third  to  one  half  a  grain,  taken  in  a 
soluble  form,  will  produce  symptoms  of  vomiting  and  other  gastric 
trouble ;  and  from  three  to  four  grains  of  white  arsenic  are  usually 
enough  to  produce  death.  The  smallest  fatal  dose  on  record  (Provincial 
Med.  and  Surg.  Jour.,  1848,  p.  347)  was  in  the  case  of  a  woman  who  took, 
possibly  for  abortion,  about  one  half  of  an  ounce  of  Fowler's  solution 
(two  and  one  sixth  grains  of  arsenic)  in  varying  doses  between  Saturday 
and  Wednesday.  She  was  ill  on  Friday  with  fever,  but  without  vomit- 
ing, purging,  or  pain  in  the  stomach  ;  she  had  frequent  fainting-fits  on 
Saturday ;  and  on  Sunday,  after  improvement,  died  in  a  fainting-fit. 
Her  stomach  and  small  intestines  were  inflamed. 

Arsenic  Eating. — Directly  contrary  to  all  the  statements  in  the  last 
paragraph  are  the  facts,  fully  proven,  that  in  certain  parts  of  the  world, 
notably  in  Lower  Austria  and  in  Styria,  and  also  in  the  Punjab  in  India, 
people  exist  who  have  trained  themselves  to  eat  with  impunity,  at  more 
or  less  regular  intervals,  arsenic  in  considerable  quantities. 

These  curious  facts  were  first  brought  into  notice  by  Von  Tschudi 
(Wien.  Med.  Wochensch.,  1851,  p.  453)  apropos  of  a  poisoning  ease  in 
Vienna,  where  a  girl,  accused  of  poisoning  a  young  Austrian  officer, 
was  acquitted  on  statements  by  three  witnesses  that  the  latter  was  an 
arsenic  eater.  In  this  paper  Von  Tschudi  stated  that  arsenic  was  com- 
monly eaten  by  the  peasantry  to  improve  their  personal  appearance,  to 
benefit  their  "  wind "  in  climbing  mountains,  and  for  aphrodisiac  pur- 
poses ;  that  they  began,  usually,  with  doses  of  one  half  a  grain  or  so 
once  a  week,  and  that  this  was  increased  up  to  some  four  grains  or  more 
at  a  time.  He  also  mentioned  that  grooms  and  hostlers  in  Vienna  were 
accustomed  to  give  arsenic  to  their  horses  to  improve  their  coats.  These 
statements,  especially  when  repeated  and  embellished  by  Professor  John- 
ston in  his  Chemistry  of  Common  Life,  were  violently  attacked  by  Chris- 
tison  and  others,  who  stated  in  the  most  positive  manner,  both  in  their 
writings  and  on  the  witness-stand,  that  they  were  entirely  contrary  to 
the  universal  experience  of  physicians  and  physiologists  all  over  the 
world.  Nevertheless  they  were  proved  to  be  correct,  notably  by  Dr. 
McLagan  (Edin.  Med.  Monthly,  1864,  vol.  x.,  p.  204),  in  whose  presence 
two  peasants  swallowed  pieces  of  arsenic  weighing  five  and  six  grains 
respectively.  The  urine  passed  by  these  men,  on  analysis,  contained 
arsenic. 

These  facts  have  been  set  up  by  the  defense  in  almost  every  impor- 
tant arsenic  case  of  late  years,  to  explain  the  presence  of  small  quanti- 
ties of  arsenic  in  the  body  of  the  victim.     A  notable  example  of  this 


INORGANIC   POISONS.  369 

took  place  in  the  famous  Maybrick  trial  in  Liverpool,  1889.  On  this 
occasion,  besides  several  corroborating  circumstances,  sucn  as  a  well- 
proven  inducement  for  the  crime,  the  agreement  of  the  symptoms  and 
post-mortem  appearance  of  the  body  with  those  of  arsenic  poison,  and 
the  consensus  of  all  the  physicians  in  attendance  on  Mr.  Maybrick,  some 
two  days  before  his  death,  that  he  was  being  poisoned,  there  were  three 
points  of  vital  importance  to  the  defense  which  had  to  be  explained  in 
order  to  save  the  defendant. 

These  were  :  first,  the  presence  of  arsenic,  although  in  small  quantities, 
in  the  liver  and  intestines  of  Mr.  Maybrick ;  secondly,  the  presence  of 
arsenic  in  large  quantities,  and  in  numerous  forms,  either  in  Mrs.  May- 
brick's  room,  or  in  articles  belonging  to  her,  or  to  which  she  had  free 
access ;  thirdly,  the  fact  that  after  suspicions  had  been  aroused  and 
food  proven  free  from  arsenic  had  been  provided  for  the  patient,  a  nurse 
saw  Mrs.  Maybrick  enter  her  husband's  room,  secretly  take  a  bottle  of 
beef  extract  from  the  room,  and  bring  it  back  and  replace  it  in  the  room, 
in  a  few  minutes,  full  of  arsenic. 

The  defense  claimed,  first,  that  Mr.  Maybrick  was  an  arsenic  eater. 
This  was  based  on  some  rather  slight  evidence.  There  was  a  colored 
valet,  who  said  that  eight  or  nine  years  before,  in  Norfolk,  Va.,  his  mas- 
ter used  to  send  him  out  for  arsenic,  fifty  cents'  worth  at  a  time,  and  stir 
it  into  his  beef -tea  in  small  quantities  with  a  spoon.  There  was  also  some 
evidence  to  show  that  he  was  a  hypochondriac,  and  used  to  dose  himself 
with  all  kinds  of  drugs,  but  there  was  no  direct  proof  of  arsenic  eating 
in  late  years. 

Secondly,  they  claimed  that  Mrs.  Maybrick  used  the  various  solutions 
of  arsenic,  the  extracts  of  arsenical  fly-papers,  and  the  packages  of  rat 
poison,  white  arsenic,  and  the  rest,  which  were  in  her  possession,  as  cos- 
metics. In  fact,  she  stated  that  she  had  made  the  fly-paper  extracts  to 
remove  an  eruption  from  her  face,  before  a  ball.  This  was  all  quite  un- 
supported by  other  evidence  of  any  sort,  And  thirdly,  Mrs.  Maybrick 
stated  on  the  stand  that,  remembering  a  white  powder  which  her  hus- 
band was  in  the  habit  of  using,  she  had,  at  his  request,  put  a  teaspoonful 
of  it  into  the  beef  extract.  These  explanations,  it  might  be  remarked, 
were  of  more  effect  upon  the  outside  public  than  on  the  jury. 

The  writer  has  been  able  to  find  out  only  one  authenticated  case  of 
arsenic  eating  that  has  been  proven  in  court  in  this  country  or  in  Eng 
land.  Dr.  Charles  H.  Porter,  of  Albany,  in  an  interesting  pamphlet  pub- 
lished, in  1862,  about  various  arsenic  cases  in  which  he  was  interested, 
states  that  in  the  trial  of  Sarah  Harrington,  at  Delhi,  Delaware  County, 
N.  Y.,  in  March,  1861,  for  the  murder  of  her  husband,  witnesses  showed 
clearly  that  the  victim,  a  hostler,  had  for  years  used  arsenic  as  a  medi- 
cine for  horses,  and  had  it  constantly  in  his  possession.  Others  swore 
that  he  frequently  took  it  himself,  and  four  different  persons  testified  to 
seeing  him  take  some  on  different  occasions  some  years  before  his  death. 
The  man  died  after  a  seventeen-days  illness,  and  some  five  and  a  half 
grains  of  arsenic  were  found  in  his  body,  some  on  his  tongue,  and  some 
in  the  contents  of  his  stomach,  while  he  had  been  sick  in  bed  for  some 
time  before  the  symptoms  of  arsenic  poisoning  appeared. 

Any  general  habit  of  arsenic  eating  for  the  complexion,  health,  or 
any  other  purpose,  is,  it  is  believed,  unknown  at  present  in  this  city,  New 
Tork,  or  in  the  eastern  part  of  the  United  States.     It  is  denied  by  the 


370  J   SYSTEM  OF  LEGAL  MEDICINE. 

leading  physicians,  especially  by  those  working  in  nervous  diseases,  who 
certainly  ought  to  know  if  it  exists,  and  by  the  leading  druggists,  both 
wholesale  and  retail.  An  examination  at  several  of  the  leading  New 
York  hospitals  has  brought  to  light  only  one  case,  of  late  years,  that  of 
an  actress  who  claimed  to  have  mined  her  health  by  arsenic  pills,  but 
who  was  suffering  from  a  cocaine,  and  an  alcohol,  habit  at  the  same  time. 

Occasionally,  however,  a  true  case  of  arsenic  eating  is  met  with.  A 
well-known  physician  stated  to  me  positively,  a  little  time  ago,  that  he 
knew  one  woman,  of  the  demi-monde,  who  was  accustomed  to  take  small 
doses  of  Fowler's  solution  for  her  complexion,  which  was  unusually  pink 
and  white,  and  that  he  beliered  the  same  was  true  of  one  or  two  others. 

The  commonly  advertised  "  arsenic  wafers,"  and  similar  compounds 
for  the  complexion,  do  not,  as  a  rule,  contain  more  than  infinitesimal 
traces  of  arsenic. 

Treatment  and  Antidotes. — In  treating  a  case  of  arsenic  poisoning, 
the  first  thing  to  do  is  to  remove  as  much  as  possible  of  the  poison  from 
the  body,  and  next  to  make  insoluble  what  remains.  After  this  has  been 
done  the  physician  must  try  to  counteract  the  symptoms  as  best  he  can. 

It  is  accordingly  good  practice  to  induce  thorough  vomiting  as  soon 
as  possible,  by  tickling  the  throat,  by  warm  water,  mustard  and  water, 
and  the  like,  or,  better,  by  drugs  like  zinc  sulphate,  cupric  sulphate,  or 
tartar  emetic.  The  last  drug  in  full  doses,  five  or  six  grains,  is  probably 
best,  as  it  acts  on  the  bowels  as  well  as  the  stomach,  and  thus  helps  to 
remove  the  poison  from  the  intestines  also.  Doses  of  castor-oil  are  also 
valuable.  These  should  be  followed  by  an  antidote,  and  then  the  stomach 
should  be  washed  out  thoroughly  with  a  stomach-pump. 

The  best-known  antidote  for  arsenic  is  the  freshly  precipitated  ferric 
hydrate,  which  forms  insoluble  compounds  with  solutions  of  arsenious 
acid.  This  should  be  prepared  on  the  spot,  by  mixing  ferric  chloride 
or  ferric  sulphate  with  an  excess  of  amnionic  hydrate,  or,  better,  of  sodic 
bicarbonate,  and  straining  the  precipitate  through  a  handkerchief  or 
piece  of  loose  rag.  Perhaps  the  best  antidote  is  where  ferric  sulphate 
is  mixed  with  an  excess  of  magnesia,  and  the  whole  is  taken  together ; 
for  besides  the  value  of  the  ferric  hydrate,  the  magnesium  sulphate  thus 
formed  has  a  good  effect  upon  the  bowels. 

This  iron  precipitate  is  perfectly  harmless  and  should  be  given  in 
large  quantities,  a  spoonful  or  so  at  a  time,  mixed  with  a  good  deal  of 
warm  water.  Numerous  instances  are  on  record  where,  sometimes  by 
natural  means,  vomiting  and  the  like,  and  at  other  times  by  prompt  treat- 
ment, patients  have  survived  even  very  large  doses,  two  ounces  and  more, 
of  arsenic.  Recovery,  however,  even  from  light  doses,  is  slow,  and  often 
leaves  troublesome  chronic  symptoms. 

It  must,  moreover,  be  remembered  that  the  crystals  of  white  arsenic, 
and,  still  more,  particles  of  Paris  green,  have  a  way  of  sticking  fast  to 
the  mucous  membrane  of  the  stomach,  and  becoming  embedded  in,  or 
covered  by,  a  thick,  slimy  mucus,  which  will  not  be  dislodged.  Under 
these  circumstances  neither  antidotes,  emetics,  nor  stomach-pumps  will 
have  the  slightest  effect.  Every  hospital  physician  can  give  instances 
where  the  ferric  hydrate  has  been  given  by  the  basinful,  and  the  stom- 
ach washed  out  till  long  after  the  washing  showed  no  sign  of  suspended 
matter,  and  yet  a  pr>st-niortem  examination  would  show  the  stomach 
perfectly  green  with  the  poison. 


INORGANIC  rOISONS.  371 

Post=mortem  Appearance  of  the  Body. — As  a  rule,  after  arsenic 
poisoning  the  body  remains  in  a  better  state  of  preservation  than  is 
ordinary.  The  preservation  is  generally  proportional  to  the  amount  of 
arsenic  found  in  the  body.  This  is  not  invariably  the  case,  for  Dr.  Tidy 
reports  that  the  bodies  of  two  children  who  died,  as  above  mentioned, 
from  arsenical  violet-powder,  decomposed  unusually  fast. 

On  examining  the  body  critically  there  is  noticed,  as  a  rule,  nothing 
abnormal  about  the  brain,  lungs,  spleen,  or  bladder.  The  blood  is  gen- 
erally dark  and  fluid,  but  there  are  usually  evidences  of  two  distinct 
classes  of  lesions :  first,  an  inflammation  of  the  gastro-intestinal  tract, 
and  secondly,  a  fatty  degeneration  of  the  liver,  heart,  and  kidneys. 

The  Stomach, — This  generally  shows  marked  traces  of  an  inflammation 
of  the  mucus  coat,  even  when  the  poison  has  been  administered  exter- 
nally. Sometimes  the  whole  interior  of  the  stomach  is  covered  light  red 
or  brown.  In  other  cases  there  is  more  or  less  sub-mucous  ecchymosis, 
with  groups  or  streaks  of  reddish  dots.  Generally  there  are  inflamed 
and  injected  patches,  principally  toward  the  pylorus.  These  signs  of  in- 
flammation appear  quite  rapidly  after  the  poison  is  taken,  and  have  been 
found  well  marked  in  cases  of  two,  three,  four,  and  five  hours'  duration. 
Occasionally,  especially  where  death  has  been  of  the  narcotic  or  cerebral 
variety,  the  marks  of  inflammation  may  be  very  sbght,  but  they  are  al- 
most invariably  present  to  a  greater  or  less  extent. 

Often  particles  of  solid  poison  can  be  found  adhering  to  the  walls  of 
the  stomach  in  thick,  pasty,  whitish-gray  (or  green,  with  Paris  green) 
spots  or  patches,  surrounded  by  a  ring  of  brightly  injected  membrane. 
On  scraping  off  the  spots  the  mucus  coat  below  is  seen  much  inflamed, 
and  occasionally  corroded.  In  spite  of  the  vomiting  the  stomach  usu- 
ally contains  some  thin,  odorless  liquid,  colored  brown  or  sometimes  red, 
often  with  white  masses  of  mucus  and  other  solid  matter  floating  in  it. 

The  Intestines. — The  small  intestines  generally  present,  though  in  a 
less  marked  degree,  the  same  signs  of  inflammation  as  the  stomach — that 
is,  patches  of  red,  sometimes  large,  sometimes  small,  occasionally  con- 
tinuous for  quite  a  distance.  The  contents  are  fluid,  often  bloody,  and 
sometimes  contain  the  poison  in  lumps  or  sediments. 

The  large  intestine  is  not  inflamed  excepting  when  the  patient  has 
survived  for  some  days.  It  is  generally  contracted  and  empty,  and  cov- 
ered with  white  stringy  mucus. 

The  Tongue,  Pharynx,  and  (Esophagus. — These  occasionally  show  signs 
of  more  or  less  acute  inflammation,  especially  where  the  poison  has  been 
repeatedly  administered,  or  where  the  arsenic  has  been  taken  in  a  dry 
form,  or  has  adhered  more  or  less  to  the  throat  itself.  The  oesophagus, 
in  such  cases,  shows  patches  and  streaks  of  dull  or  even  bright  red,  and 
sometimes  has  been  found  corroded. 

We  now  come  to  an  entirely  different  class  of  lesions,  which  has  been 
comparatively  overlooked  by  most  of  the  authors  and  experts ;  that  is, 
the  evidences  of  fatty  degeneration  in  the  heart,  liver,  and  kidneys. 
These  do  not  appear  quite  as  soon  as  the  gastro-intestinal  lesions,  but 
after  some  hours  are,  when  carefully  looked  for,  almost  as  regular  and 
as  characteristic. 

The  Heart. — This  organ  is  in  normal  condition  if  death  occurs  rapidly  ; 
but  if  life  has  been  prolonged  for  some  hours  the  walls  are  usually  less 
firm,  look  pale  and  yellowish,  and  under  the  microscope  show  signs  of 


372  ^   SYSTEM   OF  LEGAL   MEDICINE. 

fatty  degeneration.  This  appearance  has  been  observed  as  soon  as  six 
hours  after  taking  the  poison,  and  has  been  absent  in  a  case  of  ten  hours, 
although  it  can  almost  always  be  found,  when  carefully  looked  for,  in 
cases  that  have  lasted  as  long  as  that. 

Another  common  appearance  in  arsenic  poisoning  is  ecchymosis  on 
the  muscular  tissue  under  the  endocardium.  This  may  be  found  all 
over  the  interior  of  the  heart,  but  is  generally  to  be  seen  on  the  left  ven- 
tricle, on  the  posterior  wall  or  the  intra- ventricular  septum.  In  some 
eases  the  ecehvmosis  covered  half  the  surface  of  the  left  ventricle. 
{Lancet,  1862,  vol.  i.,  p.  325.) 

The  Liver. — The  symptoms  of  fatty  degeneration  are  more  marked  in 
this  organ  than  in  any  other.  The  arsenic  is  stored  up  in  it  very  quickly 
after  entering  the  blood,  and  in  its  efforts  to  excrete  the  poison  it  rapidly 
becomes  diseased,  probably  undergoing  an  acute,  parenchymatous  in- 
flammation, resulting  in  changes  in  its  tissue.  The  organ,  when  death 
occurs  after  a  few  hours'  time,  is  usually  enlarged,  more  firm  than  usual, 
looking,  on  section,  yellow,  either  in  streaks  or  all  over,  and  presents  a 
characteristic  appearance  under  the  microscope. 

The  Kidneys. — These  also  rapidly  become  inflamed  from  the  excretion 
of  the  poison,  and  imdergo  changes  in  the  tissue,  beginning  with  the 
parenchyma.  They  are  usually  found  somewhat  enlarged,  pale  and  soft, 
and  on  section  show  a  thickened  cortex  and  a  yellowish- gray  color,  first 
on  the  surface,  and  later  in  spots  and  streaks,  when  the  fatty  degenera- 
tion has  affected  the  tubules. 

It  should  be  remembered  that  death,  in  sub-acute  cases,  results  from 
the  inflammation  of  the  liver  and  kidneys  almost  as  often  as  from  the 
inflammation  of  the  stomach  itself.  Accordingly,  in  cases  of  suspected 
poisoning  these  organs  should  be  carefully  examined,  and  any  symptoms 
of  fatty  degeneration  should  be  accounted  for  by  previous  history  or  by 
analysis. 

TESTS  FOR  ARSENIC. 

i.  Solid  Arsenic. — Arsenic,  when  in  a  solid  state,  can  be  easily  recog- 
nized by  several  simple  tests. 

It  is  only  slightly  soluble  in  water,  and  when  stirred,  or  even  boiled 
in  it,  floats  like  a  white  film  on  the  surface,  or  forms  little  dry  masses 
on  the  top  or  at  the  bottom  of  the  liquid.  With  the  addition  of  a  little 
alkali  it  is  readily  dissolved,  without  changing  color,  and  it  is  soluble  in 
both  hydrochloric  acid  and  nitric  acid  when  heated. 

More  characteristic,  however,  is  its  behavior  when  it  is  sublimed,  or 
when  it  is  volatilized  after  reduction. 

{a)  Sublimation  Test. — When  white  arsenic,  arsenious  oxide,  is  heated, 
it  sublimes  readily,  without  melting,  in  the  form  of  a  white  cloud,  and 
condenses  in  the  form  of  octahedral  crystals.  This  can  be  done  before 
the  blow-pipe,  upon  a  piece  of  charcoal,  in  which  case  the  arsenic  is  first 
reduced  to  a  metallic  form,  which,  as  it  oxidizes,  emits  the  characteristic 
garlic  odor. 

When  small  quantities,  however,  are  to  be  tested,  it  is  best  done  in  a 
small  reduction-tube,  one  sixteenth  of  an  inch  or  so  in  diameter  and  some 
three  inches  long.  This  tube  is  cleaned  and  dried,  and  the  substance,  in 
ilie  form  of  a  dry  powder,  is  placed  in  the  closed  end  and  heated  till  it 


IN 011 G  A  NIC '  POISONS. 


373 


sublimes,  and  deposits  on  the  glass  as  a  white  cloud.  This  can  be  distin- 
guished from  similar  white  rings  made  by  calomel,  corrosive  sublimate, 
ammonium  salts,  oxalic  acid,  and  other  compounds,  first  by  the  shape 
and  character  of  the  crystals,  and  second  by  its  dissolving  in  hot  nitric 
acid  and  responding  to  some  or  all  of  the  tests  mentioned  later.  A 
simple  test  is  to  evaporate  the  solution  gently  to  dryness,  and  to  touch 
it  with  a  drop  of  strong  argentic  nitrate,  when  it  will  form  a  brick-red 
deposit  of  silver  arsenate. 

(/>)  Reduction  T>jst. — Another  and  perhaps  surer  test  is  to  heat  the  pow- 
der in  a  little  reduction-tube  with  a  closed  end  drawn  to  a  point  (Figs. 
75  and  76),  either  mixed  with  some  carbonaceous  flux,  like  potassic  ferro- 
■cyanide,  or  else  with  a  little  sliver  of  charcoal  above  it  in  the  tube.     If 


Fig.  75.— Ordinary  Reduction-Tube,  with  Charcoal  Splinter. 

the  charcoal  is  heated  till  it  glows,  any  white  arsenic  in  the  powder  will, 
on  heating,  be  reduced  to  metallic  arsenic,  which  will  give  a  garlic  odor, 
and  deposit,  further  up  the  tube,  in  a  black  or  brownish  ring. 

This  ring  may  be  distinguished  from  similarly  colored  ones  formed 
by  mercury  and  cadmium  salts :  first,  by  not  being  globular  in  appear- 
ance under  the  microscope ;  second,  by  dissolving  in  a  hot,  strong  solu- 


Fig.  76.— Special  Reduction-Tube,  when  flux  is  used,  drawn  out  after  mixture  is  inserted. 


tion  of  bleaching  powder  and  in  hot  nitric  acid  (the  solution  in  the 
latter  will  respond,  as  above,  to  argentic  nitrate) ;  and  third,  by  forming 
white  octahedral  crystals  when  gently  heated  after  the  end  of  the  tube 
has  been  nipped  off.  The  test  is  very  delicate,  responding  (Wormley) 
to  1-10,000  of  a  grain  of  arsenic. 

2.  Tests  for  Arsenic  in  Pure  Solutions. — Occasionally,  after  a  com- 
pound supposed  to  be  arsenic  has  been  isolated  by  other  means,  it  is  de- 
sirable to  test  it  by  every  possible  means,  so  as  to  thoroughly  identify  it. 
For  this  purpose  the  following  tests  are  sometimes  useful : 

(a)  Ammonio-Argmtic  Nitrate  Test.— This  reagent— freshly  formed  by 
•carefully  adding  a  weak  solution  of  amnionic  hydrate  to  a  strong  solu- 
tion of  argentic  nitrate  until  the  brown  precipitate  first  produced  is  al- 
most entirely  redissolved — when  added  to  an  aqueous  solution  of  arseni- 
ous  oxide  will  produce  a  light  yellow  precipitate  of  argentic  arsenite, 
Ag3As03.  ,       _ 

This  precipitate  readily  dissolves  in  amnionic  hydrate  and  m  nitric, 
citric,  and  acetic  acids  to  colorless  solutions ;  it  is  insoluble  in  sodic  and 
potassic  hydrates.  Hydrochloric  acid  changes  it  to  white  argentic  chlo- 
ride. 

The  test  is  interfered  with  by  the  presence  of  hydrochloric  acid  or  its 
salts,  and  also  by  organic  matter. 


374  ^   SYSTEM  OF  LEGAL  MEDLCINE. 

(b)  The  Ammonio-Cupric  Sulphate  Test. — This  reagent  is  formed  by  add- 
ing ammonia  to  a  solution  of  copper  sulphate  till  the  bluish-white  cupric 
hydrate  first  produced  is  almost  all  rcdissolved.  The  clear  liquid  is 
filtered  off  and  used.  An  excess  of  ammonia  will  spoil  this  test,  as  well 
as  the  former  one,  by  dissolving  the  precipitate. 

When  this  solution  is  added  to  a  solution  of  arsenious  oxide  it  pro- 
duces a  light  green  precipitate  of  cupric  arsenite  or  Scheele's  green,. 
CuHAsOy,  soluble  in  acids  and  ammonia,  but  not  in  potassic  or  sodic 
hydrates.  The  reagent  must  be  used  with  discretion,  or  its  blue  color 
will  hide  the  reaction.  If  the  arsenic  is  in  small  amounts  the  mixture 
must  be  allowed  to  stand  for  some  time,  when  the  precipitate  will  settle 
out. 

This  test  is  also  interfered  with  by  the  presence  of  organic  matter,  and 
is  about  as  delicate  as  the  preceding  one,  responding  to  about  1-1 0,000 
of  a  grain  of  arsenic. 

3.  Tests  used  for  Arsenic  in  Complex  Solutions. — (a)  Precipitation 
as  Sulphide. — Sulphureted  hydrogen  gas,  when  passed  for  some  hours 
through  a  warm  solution  of  arsenious  acid,  acidified  with  hydrochloric 
acid,  will  precipitate  the  arsenic  as  a  bright  yellow,  amorphous  precipi- 
tate of  arsenious  sulphide,  As2S3.  This  precipitate  dissolves  readily  to 
colorless  solutions  in  the  caustic  and  carbonated  alkalies,  and  in  the  sul- 
phides of  the  alkaline  metals.  It  is  insoluble  in  cold,  and  dissolves  but 
slightly  in  boiling,  concentrated  hydrochloric  acid.  It  is  oxidized  by  hot 
nitric  acid,  and  dissolves,  forming  arsenic  acid.  The  test  is  delicate,  re- 
acting (Wormley)  with  1-5000  of  a  grain  of  AsoOy,  dissolved  in  ten  grains 
of  acidified  water. 

Similar  yellow  precipitates  are  formed  by  the  sulphur  itself,  and  also 
by  the  sulphides  of  cadmium,  tin,  antimony,  and  selenium.  Hence  the 
precipitate  must  be  filtered  off,  dissolved  on  the  filter  in  a  few  drops 
of  ammonia,  and  this  solution  evaporated  to  dryness,  and  tested  for  arse- 
nic by  some  of  the  previous  tests,  or  by  Reinsch's  test,  described  below. 

This  test  may  also  be  used  for  quantitative  work.  The  sulphide, 
formed  with  great  care,  and  purified  as  much  as  possible,  is,  as -before, 
dissolved  from  a  filter  with  a  little  ammonia,  into  a  weighed  watch-glass, 
and  on  careful  evaporation  its  weight  is  determined.  It  cannot  be  too 
urgently  insisted  on  that  any  and  all  forms  of  the  poison,  isolated  in  this 
or  other  tests,  should  be  most  carefully  preserved,  and  presented  in  court 
for  inspection  and,  if  necessary,  subsequent  testing. 

It  has  been  satisfactorily  proven  that  the  sulphureted  hydrogen,  if 
well  washed,  cannot  introduce  arsenic,  even  when  made  from  impure 
materials,  into  the  suspected  solution. 

(b)  Reinscli's  Test, — If  an  arsenical  solution,  acidified  with  one  sixth 
or  one  eighth  of  its  bulk  of  pure  hydrocldoric  acid,  is  boiled  for  half  an 
hour  or  so  with  a  bright  strip  of  pure  copper  foil,  any  arsenic  present 
will  be  deposited  on  the  latter  as  a  dark  metallic  coating.  The  latter 
can  be,  and  must  be,  in  every  case  distinguished  from  similar  coatings 
formed  by  antimony,  mercury,  silver,  bismuth,  and  other  metals,  by  form- 
ing octahedral  crystals  of  arsenious  acid  when  heated  in  a  small  reduc- 
ing-tube.  The  sublimate  thus  formed  may  also  be  dissolved  out  of  the 
tube,  and  tested  as  before. 

The  limit  of  this  test,  with  ordinary  reduction-tubes,  is  about  1-10,000 
of  a  grain,  but  Wormley,  by  very  fine  tubes  and  minute  strips  of  foil, 


INORGANIC  POISONS. 


375 


obtained  the  crystals  from  1-50,000  of  a  grain.  The  test  is  inter- 
fered with  by  the  presence  of  nitric  acid,  potassic  chlorate,  manganese 
dioxide,  and  any  other  substances  which  would  cause  the  copper  to  dis- 
solve. 

Remsch's  test  has  been  much  abused  of  late  years,  but,  as  claimed  by 
Taylor,  Wormley,  and  other  excellent  authorities,  it  has  many  advan- 
tages, being  simple,  easily  made,  very  delicate,  and  requiiing  only  two 
pure  chemicals.  It  must  be  considered,  on  the  whole,  as  the  best  test 
to  be  used,  during  life,  for  examining  suspected  food,  drugs,  vomited 
matter,  urine,  or  faeces,  in  the  case  of  suspected  poisoning,  provided  the 
physician  or  chemist  who  makes  the  test  is  careful  to  prove  the  test  by 
forming  and  recognizing  the  octahedral  crystals. 

(c)  Marsh's  Test. — This  famous  test,  proposed  by  Mr.  Marsh  in  1836, 
depends  on  the  fact  that  when  hydrogen  is  set  free  in  an  arsenical  solu- 
tion it  liberates  the  arsenic  as  a  gas,  arseniureted  hydrogen,  which  can 
be  separately  examined. 

In  making  this  test  an  apparatus  like  that  shown  in  Fig.  77  is  usually 
employed.  In  the  flask  is  placed  some  pure  granulated  zinc,  previously 
coated  with  a  little  platinum  by  dipping  into  a  solution  of  platinic 
chloride,  and  this  is  covered  with  diluted,  pure  sulphuric  acid,  through 


Fig.  77.— Marsh's  apparatus. 


the  funnel  tube.  Hydrogen  gas  is  at  once  formed,  and  passing  through. 
a  drying-tube  filled  with  calcium  chloride,  and  then  through  an  ignition- 
tube  with  an  upturned  end,  is,  after  the  air  has  all  been  expelled,  ignited 
and  burns  with  a  pale  blue  flame. 

The  utmost  precaution  must  be  taken,  in  this  experiment,  to  have 
the  chemicals  perfectly  free  from  arsenic,  and  under  no  circumstances 
should  the  test  be  made  without  running  a  blank  experiment,  upon  the 
chemicals  alone,  using  the  same  time  and  the  same  tests  as  when  the 
suspected  solution  is  being  examined. 

It  has  been  proposed,  by  Bloxam  and  others,  to  evolve  hydrogen  by 
decomposing  water  in  a  U-tube  with  electricity.  (Quart.  Jour.  Ghem. 
Soc,  vol.  xiii.,  p.  14;  also  Doremus  and  Witthaus,  X  Y.  Ph>/s.  and 
Pharm.,  1879,  vol.  xii.,  p.  71.)  Unfortunately,  a  little  arsenic  is  always 
lost  by  combining  with  the  platinum  electrode. 

After  the  apparatus  has  been  properly  tested,  and  the  hydrogen  has 
been  ignited,  the  arsenical  solution  is  admitted  through  the  funnel-tube. 


37G  ^   SYSTEM  OF  LEGAL  MEDICINE. 

The  arseniureted  hydrogen  is  evolved  almost  immediately,  and  the  color 
of  the  ignited  gas  changes  to  bluish  white,  with  some  white  fumes  of 
arsenious  oxide. 

This  gas  can  be  tested  for  arsenic  in  three  different  ways : 

1.  By  Forming  Metallic  Mirrors  from  a  Burning  Jet. — If  a  piece  of 
cold  porcelain  is  placed  close  down  over  the  flame,  any  arsenic  present 
will  be  deposited  as  a  black,  or  brown,  stain  or  ring.  By  changing  the 
place  directly  a  good  spot  is  made  or  the  porcelain  gets  hot,  a  whole 
series  of  stains  can  be  made  from  minute  amounts,  1-5000  of  a  grain  or 
so  of  the  poison.  Wormley  states  that  the  amount  of  arsenic  in  a  good 
stain  may  not  be  over  1-80,000  of  a  grain. 

These  stains  can  be  distinguished  from  exactly  similar  deposits  made 
by  antimony  by  their  solubility  in  bleaching-powder  and  hypochlorite 
solutions  and  in  hot  nitric  acid ;  by  the  argentic  nitrate  test ;  and  by  dis- 
solving, though  with  difficulty,  in  yellow  ammonium  sulphide  solution, 
and  leaving,  on  evaporation,  a  film  of  yellow  arsenious  sulphide,  which 
dissolves  easily  in  ammonia,  but  is  insoluble  in  hydrochloric  acid.  The 
antimony  sulphide,  formed  in  this  last  way,  is  orange-red,  and,  while  dis- 
solving readily  in  concentrated  hydrochloric  acid,  is  insoluble  in  am- 
monia. 

2.  By  Depositing  Metallic  Arsenic  wit  en  Heated. — In  this  test,  proposed 
by  Berzelius,  an  ignition-tube  of  hard  glass  is  used,  drawn  out,  as  in 
Fig.  78,  into  two,  or  even  three,  very  narrow  constrictions.  By  strongly 
heating  the  tube,  protected  by  and  supported  on  wire  gauze,  if  neces- 

I 


Fig.  78.— Ignition-Tube,  for  Berzelius-Marsh  Test.    (Dragendorff.) 

sary,  in  front  of  these  places,  the  metallic  arsenic  will  be  deposited 
on  the  narrowed  parts  of  the  tube.  If  more  than  one  flame  is  used 
almost  all,  if  not  all,  the  metal  should  be  deposited  by  the  first  one, 
and  the  others  are  used  as  a  safeguard,  and  as  a  proof  that  no  poison  is 
escaping. 

The  deposit  can  be  distinguished  from  that  produced  by  antimony  by 
the  test  above  mentioned.  It  is  claimed  that  a  similar  deposit  can  be 
formed  from  the  presence  of  much  organic  matter  in  the  solution.  When 
properly  made  the  test  is  exceedingly  delicate,  giving  a  characteristic 
deposit  (Wormley)  with  1-50,000  of  a  grain  dissolved  in  one  hundred 
grains  of  liquid. 

It  can  be  used  as  a  quantitative  test  by  cutting  off  the  little  piece  of 
tubing  which  contains  the  mirror,  and  after  weighing  it  carefully,  dis- 
solving out  the  arsenic  and  weighing  it  again.  The  loss  of  weight  will 
be  due  to  the  metallic  arsenic,  while  the  solution  of  the  latter  can  be 
subjected  to  further  tests.  (For  full  description  see  Chittenden  and 
Donaldson,  Am.  Chem.  Jour.,  vol.  ii.,  p.  235.) 

When  the  quantities  of  metal  thus  deposited  are  too  small  to  be 
weighed  they  can  be  more  or  less  roughly  determined  by  comparison 
with  similar   deposits  made   under  similar   circumstances,  by  known 


INORGANIC  POISONS.  377 

amounts  of  the  poison.     (See  Fig.  79).     The  results  from  this  are  only 
partially  successful. 

3.  By  Decomposing  Silver  Nitrate  Solution. — If  the  gas,  instead  of 
being  ignited,  is  passed,  by  a  beut  tube,  into  a  weak  solution  of  argentic 
nitrate,  it  will  dissolve,  forming  arsenious  acid,  H3As03,  and  decompos- 


Mirror  from  1  mg  Arsenious  Acid. 


Mirror  from  0.1  mg  Arsenious  Acid. 


Mirror  from  0.05  mg  Arsenious  Acid. 


The  Glass  Tube  without  Arsenic. 
Fig.  79.—  Arsenic  Deposits  in  the  Berzelius-Marsh  Test.    (Robert.) 

ing  the  silver  salt  into  nitric  acid  and  metallic  silver.  The  latter  can 
be  filtered  off,  and  any  excess  of  silver  nitrate  removed  by  hydrochloric 
acid,  after  which  the  arsenic  in  solution  can  be  tested  for  and  isolated  as 
before. 

Both  sulphureted  and  phosphoreted  hydrogen  give  similar  black  de- 
posits, and  so,  under  similar  circumstances,  does  antimony.  The  latter, 
however,  is  itself  precipitated  as  argentic;  antimonide,  Ag3Sb,  and  hence, 
on  filtering  and  washing,  can  be  completely  separated  from  the  arsenic, 
which  remains  as  in  the  filtrate. 

Examination  of  Drugs,  Food,  Vomited  Material,  etc.,  for  Arsenic. 

— It  is  always  extremely  important  to  see  if  any  arsenic  is  present  in  a 
solid  state.  Hence  the  suspected  material  should  be  thoroughly  stirred 
and  mixed,  with  the  addition  of  water,  if  necessary,  and  then  allowed  to 
settle  in  a  conical  glass  or  tall  beaker.  From  this  the  liquid  and  the 
lighter  material  can  be  decanted,  but  any  heavy  sediment  should  be 
carefully  examined,  under  the  microscope,  if  necessary,  for  undissolved 
arsenic.  If  found  it  should  be  separated  as  completely  as  possible,  and 
with  a  minimum  of  agitation  and  solution,  for  special  testing. 

The  rest  of  the  material  should  be  filtered,  and  the  solid  matter  should 
be  boiled  thoroughly  with  hydrochloric  acid  until  thoroughly  disinte- 
grated, and  then  mixed  with  the  filtrate.  The  mixture  is  concentrated, 
if  necessary,  and  its  bulk  carefully  measured,  after  which  portions  of  it 
are  tested  for  arsenic  by  Reinsch's  or  Marsh's  test.  If  arsenic  is  present 
it  may  be  determined  quantitatively  as  described. 

Separation  of  Arsenic  from  the  Tissues. — The  above  method  will 
do  very  well  for  qualitative  tests.  It  is,  however,  universally  agreed, 
by  all  the  best  authorities,  that  when  small  amounts  of  arsenic  are  to  be 
quantitatively  determined  in  the  presence  of  large  quantities  of  organic 


378  ^   SYSTEM  OF  LEGAL  MEDICINE. 

matter,  the  latter  must  be  completely  removed  in  one  way  or  another,  or 
the  results  are  bound  to  be  untrustworthy.  Unfortunately,  this  is  no 
easy  task,  for  both  arsenic  itself  and  especially  arsenious  chloride  are 
volatile,  the  latter  at  quite  low  temperatures,  and  unless  care  is  taken 
the  arsenic  will  disappear  with  the  organic  matter. 

Dr.  Taylor  proposed  and  used  a  simple  method  of  obtaining  the 
arsenic  as  chloride,  in  a  comparatively  pure  condition,  by  distilling-  the 
dried  tissues  with  pure  hydrochloric  acid,  on  a  sand-bath,  and  condensing1 
the  fumes  in  a  receiver  containing  water.  The  chief  trouble  with  this 
process  is  the  fact  that  arsenious  sulphide  is  not  decomposed  by  it,  and 
hence  there  may  be  a  loss  of  arsenic. 

The  most  approved  methods,  nowadays,  of  preparing  the  tissues  for 
examination  depend  upon  oxidizing  the  organic  matter  either  with 
hydrochloric  acid  and  potassic  chlorate  (Uresenius  and  Babo)  or  by  the 
use  of  sulphuric  and  nitric  acid.  In  the  first,  which  is  most  commonly 
used,  the  tissues,  finely  cut,  are  boiled  in  hydrochloric  acid,  with  the  con- 
stant additions  of  chlorate,  until  they  dissolve  to  a  clear  yellow  solution. 
This  is  strained,  washed,  concentrated,  and  treated  with  sulphureted 
hydrogen  ;  and  the  arsenic  in  the  precipitate,  after  more  or  less  elaborate 
treatment  to  remove  other  metals  and  organic  matter,  is  determined  as 
sulphide  or  metallic  arsenic. 

Full  details  of  this  and  the  nitric  acid  method  have  been  carefully  de- 
scribed by  Wormley  (Mierocliemistnj  of  Poisons),  Doremus  and  Witthaus 
(X.  Y.  Fhys.  <iih1  Phartn.,  vol.  xii.,  p.  71),  Chittenden  and  Donaldson  (Am. 
Ghem.  Jour.,  vol.  ii.,  p.  235),  and  others. 

Distribution  of  Arsenic  in  the  Body. — In  all  cases  of  poisoning  it 
is  very  important  to  separate  that  contained  in  the  contents  of  the 
stomach  and  intestines,  whether  solid  or  in  solution,  from  that  absorbed 
in  the  tissues  themselves.  The  latter  represents  more  or  less  of  the  poison 
which  has  actually  produced  death,  while  the  former  is  simply  that  left 
over  and  which  has  had  no  part  in  killirg  the  individual. 

Unfortunately,  so  much  has  been  said  about  the  characteristic  effects 
of  arsenic  on  the  digestive  tract  that  it  is  common,  in  cases  of  suspected 
arsenic  and  other  poisoning,  for  the  coroner  and  his  staff  to  submit  to 
the  expert  for  analysis  the  stomach  by  itself,  or,  as  a  great  favor,  accom- 
panied with  some  of  the  intestines. 

Such  practice  is  distinctly  bad.  It  has  been  recognized  for  fifty  years 
that  most  of  the  absorbed  poison  will  be  found  in  the  liver,  and  after 
that,  in  the  kidneys,  spleen,  and  heart.  These  organs  will  contain  the 
poison  after  it  has  almost,  if  not  entirely,  disappeared  from  the  contents 
and  even  from  the  tissues  of  the  stomach  and  the  intestines. 

Of  late  years  much  work  has  been  done  upon  the  absorption  of  ar- 
senic in  the  tissues.  Some  stir  was  made  by  M.  Scolosoff  (Gompt.  Bend. 
Biol.,  1875,  part  ii.,  p.  304),  who  made  various  experiments  upon  dogs, 
poisoning  them  with  sodium  arsenite,  and  in  several  cases  found  three 
or  four  times  as  much  arsenic,  comparatively,  in  the  brain  and  spinal 
cord  as  in  the  liver,  and  some  thirty-five  or  forty  times  as  much  as  in 
the  muscles. 

These  experiments  raised  a  storm  of  contradiction  from  all  over  the 
world,  and  since  then  abundant  evidence  has  shown  that  the  liver  is.  in 
almost  every  case,  the  great  seat  of  the  absorbed  poison.  It  is,  however, 
believed  by  Chittenden  and  others  that  in  cases  of  poisoning  by  a  solu* 


INORGANIC  POISONS.  379 

l)le  and  diffusible  salt  of  arsenic  the  poison  will  be  found  in  quantities 
in  the  brain.  It  was,  indeed,  argued  on  these  lines  in  the  well-known 
<^ase  of  Jennie  Cramer,  where  some  of  the  not  excessive  amount  of  arsenic 
present  was  found  in  the  brain,  that  the  poison  must  have  been  adminis- 
tered in  such  a  form.  This  was  of  importance  in  the  trial,  for  it  helped 
the  hypothesis  of  the  State  that,  in  spite  of  the  absence  of  the  least  sign 
of  gastric  inflammation,  death  was  caused  by  arsenic  and  not  by  drown- 
ing, the  arsenic,  taken  in  a  soluble  form,  acting  rapidly,  with  cerebral  or 
narcotic  symptoms.    . 

Many  interesting  analyses,  those  of  Jennie  Cramer's  body  among  the 
number,  have  been  published  of  late  years,  showing  the  presence  of  arse- 
nic in  the  muscles,  and  in  many  cases  in  the  bones  of  the  body,  as  well 
as  in  the  organs.  This  was  done  with  the  utmost  care  by  Johnson  and 
Chittenden  {Am.  Client.  Jour.,  vol.  ii.,  No.  5)  in  the  case  of  a  Mrs.  Riddle, 
where  2.38  grains  of  white  arsenic  had  been  previously  found  in  the  in- 
ternal organs.  The  defense  claimed  that  this  was  not  necessarily  a  fatal 
dose,  and  accordingly  further  analyses  were  made  of  tissue  from  the 
arm,  thigh,  feet,  and  hand,  of  a  thigh  bone,  and  of  a  transverse  section 
of  the  body  itself — in  all,  over  twenty-one  pounds  of  material.  From 
this  analysis  it  was  calculated  that  the  whole  of  the  body  not  previously 
analyzed  contained  2.85  grains,  making  the  respectable  total  of  over  five 
grains. 

This  precaution,  it  will  be  remembered,  was  not  taken  in  the  May- 
brick  trial,  where  the  stomach,  intestines,  liver,  bile,  spleen,  and  kidneys 
were  the  only  portions  submitted  to  analysis,  and  where  the  only  weigh- 
able  amount  of  arsenic,  excepting  a  minute  quantity  in  the  intestines, 
was  found  in  the  liver,  which  contained  about  one  third  of  a  grain. 
Hence  the  defense  was  able  to  claim  that  death  had  not  been  caused  by 
arsenic,  because  a  fatal  dose  of  arsenic  was  not  extracted  from  the 
tissues. 

This  argument  is  a  thoroughly  misleading  one,  and,  as  will  be  shown, 
has  absolutely  no  basis  in  fact.  Arsenic  is  not  a  normal  constituent  of 
the  body,  and  when  once  absorbed  is  rapidly  eliminated  in  many  different 
ways.  And  more  than  one  case  is  on  record  where  death  has  undoubt- 
edly been  due  to  arsenic,  and  yet  not  a  trace  of  the  poison  has  remained 
in  the  principal  organs  of  the  body,  if  not  in  the  whole  body. 

In  chronic  arsenic  poisoning,  or  in  cases  where  death  has  been  delayed 
for  several  days,  or  even  weeks,  the  examination  of  the  body  outside  the 
principal  organs  is  still  more  important.  In  the  Havre  cases,  already 
discussed,  arsenic  was  discovered  in  the  skin,  nails,  and  hair  of  the  vic- 
tims. Careful  experiments  by  Dr.  Pouchet  {Ann.  d'Hyg.,  1889,  vol.  xxii., 
pp.  35G,  486)  tend  to  show  that,  when  administered  slowly,  arsenic  may 
be  detected  not  only  in  those  parts,  but  also  and  more  noticeably  in  the 
spongy  tissue  of  the  bones,  especially  in  the  vertebrae,  scapula,  and  bones 
of  the  cranium,  for  weeks  after  it  has  disappeared  from  the  liver  and  vis- 
cera, and  even  from  the  other  tissues  of  the  body. 

Amounts  of  Arsenic  Found  in  the  Body. — The  quantity  of  arsenic 
that  may  be  present  in  the  contents  of  the  stomach  and  intestines  is  very 
large.  Dr.  Pearson,  in  the  Cross  trial  in  Ireland,  in  1887,  testified  that 
over  two  ounces  had  been  so  found,  and  reports  of  one  ounce  and  over 
arc  not  uncommon. 

The  amount,  however,  actually  present  at  any  one  time  in  the  tissues 


380  A   SYSTEM  OF  LEGAL  MEDICINE. 

themselves  is  far  smaller,  and  in  perfectly  well  authenticated  cases  of 
arsenic  poisoning  they  have  diminished  to  the  vanishing-point. 

As  just  stated,  the  liver  is  the  main  source  of  the  poison,  and  yet  in 
the  liver  it  is  hard  to  find  it  in  any  great  quantity.  The  average  amount 
seems  to  be  from  one  third  to  two  thirds  of  a  grain.  Wormley,  an  excel- 
lent authority,  states  that  "  the  absolute  quantity  thus  found,  even  under 
the  most  favorable  circumstances,  rarely  exceeds  a  grain  in  weight."  In 
some  cases,  indeed,  the  presence  of  larger  quantities,  as,  for  instance,  in 
the  Cross  case,  where  1.28  grains  were  found,  has  been  made  a  ground 
for  disputing  the  analysis.  In  that  same  trial  the  learned  judge  was  so 
impressed  with  the  defense's  view  of  the  case  that  he  solemnly  charged 
the  jury  that  the  liver  was  like  a  sponge,  and  that  from  one  to  two  grains 
of  arsenic  was  its  total  capacity. 

His  honor,  however,  was  evidently  napping  on  this  occasion,  for  larger 
amounts  have  been  not  infrequently  reported.  Hayes,  for  instance  (Am. 
Chew.,  Dec,  1875),  found  3.86  grains  of  arsenic  in  the  liver  of  a  lady  who 
died  in  forty  hours  after  drinking  some  poisoned  tea  prepared  by  a  crazy 
servant.  While  the  largest  amount  of  arsenic  yet  found  was  reported  by 
Dr.  Barker  (Am.  Chem.,  1872,  vol.  ii.,  p.  441),  in  the  Lydia  Sherman  case, 
where  he  isolated  from  the  liver  of  Horatio  Sherman,  her  fourth  and  last 
husband,  arsenic  equivalent  to  nearly  five  grains  for  the  whole  liver;  and 
obtained  over  seven  grains  from  the  liver  of  Dennis  Hurlbert,  a  previous 
husband.  These  results  seemed  so  remarkable,  and  such  a  slur  had  been 
recently  cast  upon  expert  testimony  by  the  fiasco  in  the  famous  Wharton 
case,  that  Professor  Barker  was  particularly  careful  to  isolate  the  poison, 
to  bring  the  poison  itself  into  court,  and  to  preserve  it,  in  various  forms, 
for  future  reference. 

As  a  general  rule  the  amount  of  arsenic  found  in  any  of  the  other 
organs — the  kidneys,  spleen,  stomach,  intestines,  heart,  bladder,  and  brain 
— is  not  as  much  as  that  found  in  the  liver,  nor  does  the  total  amount 
often  exceed  five  grains.  To  illustrate  the  amounts  that  have  been  found 
in  different  portions  of  the  body,  we  give  here  two  famous  analyses,  made 
by  Johnson  and  Chittenden,  and  by  Chittenden  alone,  published  in  the 
Am.  Client.  Jour.  (vol.  ii.,  No.  5,  and  vol.  v.,  No.  1) : 

MRS.  RIDDLE    (A   CASE   OP   CHRONIC   ARSENIC   POISONING). 

Internal  Organs.  Arsenic  Found. 

Stomach  and  spleen 0 .  825  grain. 

Kidneys 0.103  " 

Liver 0.738  " 

One  lung  and  heart 0.235  " 

Intestines  and  uterus 0 .  388  " 

One  lung  and  liquid  from  thorax 0.091  " 

Urinary  bladder,  etc Distinct  trace 

Brain Unweighable  trace 

Total 2.380  grains. 

Other  Tissues.  Total  Weight.  Total  Arsenic. 

Arm 2  lb.  61  oz.  0.  Ill  gr. 

Leg 12"    4£  "  0.408    " 

Muscular  and  bony  tissue,  including 

transverse  section  of  body 6  "    7f  "  0.577    " 


Total 21  lb.  3    oz.  1.096grs. 


INORGANIC  POISONS.  381 

The  body,  exclusive  of  the  internal  organs,  weighed  880  ounces; 
hence  it  was  calculated  that  the  whole  amount  of  arsenious  acid  to  be 
found  in  it  was  2.846  grains,  which,  added  to  the  2.380  grains  found  in 
the  internal  organs,  amounted  to  5.226  grains  for  the  whole  body. 

JENNIE   CRAMER   (CLAIMED   TO   BE   A   CASE   OF   NARCOTIC   POISONING   FROM   A   SMALL 

DOSE   OF   DISSOLVED   ARSENIC). 

Internal  Organs.  Amount  of  As203  Found. 

Stomach  and  oesophagus 0. 158  grain. 

Liver  (1) 0.109       " 

Intestines 0.314       " 

Kidneys  0.029       " 

Heart  (i) 0.028       " 

Lungs  and  spleen  (f)   0.1146     " 

Brain  (£)  0.0255     " 

Trachea,  larynx,  and  tongue 0.081       " 

Diaphragm  ." 0.010       " 

Total  arsenic  found „ 0 .  8691  grain, 

Liver  (I) 0 .  109  grain. 

Heart  (£) 0.084       " 

Lungs  and  spleen  (i)  ...    0 .  0573     " 

Brain  (f) 0.050 


a 


Rest  of  arsenic  calculated 0.3003  grain 


>^j 


Total  arsenic  in  internal  organs 1 .  1694  grains. 

Muscular  and  Bony  Tissue.                 Total  Weight.                        Arsenic. 

Left  arm 2  lb.  Hi  oz.  0 .  094  grain. 

Right  leg,  except  thigh-bone 10"  4     "  0.118 

Thigh-bone 74  " 

Transverse  section  of  body 8"  15*  "  0.186       " 

Muscle  from  heart *. 1   "  2J-  "  0.098       " 

Muscle  from  back 1"  6     "  0.356       " 

Total 24  lb.   14i  oz.  0.852  grain. 

The  entire  body,  exclusive  of  the  internal  organs,  weighed  fifty-seven 
pounds.  Hence,  on  calculation,  the  amount  of  arsenic  in  the  body  was 
1.9498  grains,  which,  added  to  that  found  in  the  internal  organs,  gave  a 
total  of  3.1192  grains. 

The  body  of  Mrs.  Riddle  had  been  buried  for  a  year  and  a  half,  while 
that  of  Jennie  Cramer  was  analyzed  but  a  few  days  after  death. 

Amount  of  Arsenic  Necessary  to  Prove  Poisoning. — As  before  men- 
tioned, it  is  very  common  for  the  defense  to  insist  that,  in  a  case  of  sup- 
posed arsenic  poisoning,  unless  full  fatal  doses  of  arsenic  are  found  ab- 
sorbed in  the  system,  the  prosecution  has  failed  to  prove  the  cause  of 
death.  To  be  sure,  in  view  of  the  almost  universal  presence  of  traces  of 
arsenic  and  the  extraordinary  delicacy  of  the  tests,  it  is  generally  con- 
sidered improper  to  convict  of  poisoning  on  the  evidence  of  mere  traces, 
unless  overwhelmingly  corroborated  by  other  evidence. 

Orfila  himself  at  one  time  asserted  the  presence  of  minute  quantities 
of  arsenic  in  the  normal  human  body ;  and  yet,  but  a  few  years  after- 
ward, in  the  dramatic  case  of  Madame  Lafarge,  after  two  separate  sets 
of  chemists  had  failed  to  find  any  arsenic  in  the  body  of  her  husband, 


382  ^  SYSTEM  OF  LEGAL  MEDICINE. 

Orfila  obtained  her  conviction  by  finding,  with  Marsh's  test,  mere  un- 
weighable  stains,  amounting  all  told,  as  he  estimated,  to  not  over  1-100 
of  a  grain.  This  amount  is  to  be  considered  below  the  limit,  especially 
when,  as  came  out  in  a  subsequent  trial,  the  zinc  used  by  Orfila  in  his 
Marsh's  apparatus  on  that  occasion  had  not  itself  been  tested  for  arsenic. 
Another  case,  where  very  small  amounts  of  arsenic  formed  the  most 
conclusive  evidence  against  the  prisoner,  was  that  of  Margaret  Wishart, 
convicted  on  an  analysis,  by  Sir  R.  Christison,  showing  one  fortieth  of 
a  grain  in  the  linings  of  the  stomach. 

When,  however,  the  arsenic  extracted  is  in  weighable  quantities,  and 
in  such  a  form  that  it  can  be  isolated  and  shown  to  the  jury,  and  when 
the  care  shown  by  the  analyst  and  his  previous  reputation  make  it  rea- 
sonably certain  that  the  arsenic  in  question  came  from  the  cadaver,  it  is 
perfectly  proper  to  insist  that  quite  minute  quantities  of  the  poison  fur- 
nish very  strong  evidence  of  the  cause  of  death. 

Indeed,  the  best  experts  are  agreed  that  in  perfectly  well-defined  cases 
of  arsenic  poisoning  it  is  not  only  not  uncommon  to  find  but  small 
amounts  of  the  poison,  but  it  may  easily  happen  that  no  arsenic  at  all 
ma}^  remain  in  the  system.  The  case  of  Dr.  Alexander,  previously  men- 
tioned, is  one  often  quoted.  He  lived  sixteen  days  after  a  fatal  dose  of 
white  arsenic.  There  was  no  question  whatsoever  as  to  the  cause  of 
death,  and  yet  Dr.  Geoghegan,  professor  of  medical  jurisprudence  in  the 
Royal  Medical  College  in  Dublin,  and  an  expert  of  great  experience  and 
ability,  found  no  trace  of  arsenic  in  the  contents  of  the  stomach  nor  in 
the  viscera. 

Elimination  of  Arsenic. — When  arsenic  is  taken  into  the  system 
through  the  stomach,  but  a  short  time  elapses  before  nature  endeavors, 
by  constant  and  thorough  vomiting,  and  subsequently  by  purging,  to 
expel  the  poison  before  too  much  has  entered  the  circulation.  That  this 
is  frequently  successful  is  well  known  from  the  numerous  instances  of 
persons  who  have  taken  large  doses  and  recovered  without  special  treat- 
ment. The  poison  that  is  absorbed  enters  the  portal  circulation,  and  is 
stopped  by  the  liver,  which  retains  as  much  of  the  arsenic  as  possible. 

The  poison  begins  to  be  stored  up  in  the  liver  probably  in  a  few  min- 
utes, if  not  seconds,  after  it  is  absorbed,  and  gradually  increases  in  quan- 
tity for  some  fifteen  or  twenty  hours.  But  from  the  time  it  enters  the 
system  until  it  is  entirely  removed  or  death  intervenes,  active  agencies 
are  at  work  to  eliminate  it  from  the  body. 

The  most  important  of  these  is  the  kidneys,  which  begin  their  work 
almost  at  once.  Dr.  McLagan,  when  experimenting  on  arsenic  eating  in 
Styria,  found  arsenic  in  the  urine  three  quarters  of  an  hour  after  taking 
the  drug ;  while  in  a  case  fully  reported  by  Prof.  E.  S.  Wood  (Boston  Med. 
and  Surg.  Jour.,  1888,  vol.  xix.,  p.  435),  it  was  present  in  the  urine  within 
five  minutes  after  it  had  been  taken. 

Besides  this,  the  arsenic  is  excreted  through  the  bile,  the  skin,  and 
probably,  after  some  little  time,  at  least,  through  the  large  intestine.  So 
it  is  perfectly  evident  that  if  the  patient  does  not  die  for  some  time  the 
amount  of  arsenic  present  in  the  system  must  be  diminishing  every  day 
and  every  hour,  and  sooner  or  later  will  disappear  entirely. 

Opinions  differ  as  to  the  length  of  time  required  for  such  disappear- 
ance. All  the  older  authorities,  Orfila,  Christison,  Herapath,  Geoghegan, 
Taylor,  and  others,  agree  that  from  fifteen  to  twenty  days  would  suffice 


INORGANIC  POISONS.  383 

to  remove  all  traces  from  the  body.  These  writers,  however,  rarely  ex- 
amined more  than  the  main  viscera,  and  it  is  probable  that  a  careful 
examination  of  the  muscles,  and  especially  of  the  bones,  skin,  nails,  and 
hair  of  the  victim  might  have  shown  at  least  traces  of  the  poison  for 
much  longer  periods.  In  experiments  on  animals  Ludwig  found  arsenic, 
in  some  'quantities,  in  the  liver  of  a  dog  after  forty  days,  and  it  is  prob- 
able that  traces  of  arsenic  would  still  be  found  in  the  body,  if  carefully 
looked  for,  for  two  or  three  months  at  least  after  the  poison  had  been 
taken. 

Indeed,  if  we  are  to  believe  the  wonderful  stories  published  by  some 
of  the  Massachusetts  doctors,  exposure  to  infinitesimal  traces  of  arsenic 
is  liable  to  leave  evidences  of  that  poison  in  the  urine  not  only  for 
months,  but  for  years,  after  removal  from  the  contagion.  (See  Putnam, 
Boston  Med.  and  Surg.  Jour.,  vol.  cxix.,  p.  3,  and  others.) 

Detection  of  Arsenic  after  Long  Periods. — It  has  been  often  noticed, 
when  bodies  containing  arsenic  have  been  exhumed  after  some  months 
or  years,  that  the  tissues  are  unusually  well  preserved,  seemingly  in  pro- 
portion to  the  amount  of  poison  which  they  contained,  and  also  that  the 
stomach  and  intestines  are  often  lined  with  a  bright  yellow  deposit.  An 
excellent  example  of  this  is  shown  in  the  frontispiece  illustration  (Plate  I.) 
■of  this  volume. 

This  deposit  has  been  usually  considered  to  be  the  yellow  arsenious 
sulphide,  formed  by  sulphureted  hydrogen  coming  from  the  decomposi- 
tion of  the  tissues.  In  some  cases,  at  any  rate,  this  compound  contains 
no  arsenic  at  all,  but  consists  of  organic  compounds  probably  derived 
from  bile.  The  subject  is  thoroughly  discussed  by  Drs.  Brown  and 
Davies  (Lancet,  1884,  part  i.,  p.  421)  in  the  case  of  persons  poisoned  at 
Liverpool  by  fly-paper  solution  ;  and  also  by  Stevenson  (Brit.  Med.  Jour., 
1884,  part  i.,  p.  GOO),  who  insists  that  the  yellow  deposit  is  sometimes,  with- 
out question,  arsenious  sidphide,  and  proves  it  from  his  own  experience. 

Whether  it  is  due  to  the  formation  of  this  sulphide  or  of  some  other 
stable  compound,  it  is  quite  certain  that  after  a  body  has  once  been 
buried  no  great  loss  of  arsenic  occurs  either  by  volatilizing  or  leaching. 
Accordingly  mere  lapse  of  time  is  no  bar  to  the  detection  and  isolation 
of  arsenic.  Cases  are  on  record,  both  in  this  country  and  Europe,  where 
crimes  have  thus  been  traced,  and  the  murderers  convicted,  after  ten, 
fifteen,  and  even  twenty  years. 

Under  these  circumstances,  every  precaution  must  be  taken  to  satisfy 
the  jury  that  the  poison  could  not  have  come  from  the  earth,  coffin,  or 
coffin-lining,  clothes,  ornaments,  or  other  post-mortem  sources.  This,  in 
former  years,  presented  no  such  great  difficulty,  but  at  present,  in  tliis 
•country,  the  universal  habit  of  embalming  renders  it  almost  impossible, 
unless  strong  suspicions  have  been  aroused  before  death,  to  convict  of 
poisoning  not  years  and  months,  but  days  and  even  hours,  after  a  person 
has  died. 

Post=mortem  Imbibition  of  Arsenic. — The  possibility  of  the  inten- 
tional injection  of  arsenic  after  death,  so  as  to  throw  suspicion  on  sus- 
pected persons,  was  suggested  by  Orfila  in  1813,  and  has  been  referred 
to  since  by  most  of  the  authorities.  Only  two  cases,  however,  so  far  as 
•I  can  learn,  have  yet  reached  medical  literature. 

In  the  case  of  Mrs.  Bleazby  (Kidd,  Dublin  Quar.  Jour.,  1850,  vol.  x., 
p.  73),  the  defense  claimed,  from  post-mortem  appearances  and  other 


38-4  A    SYSTEM  OF  LEGAL   MEDICINE. 

reasons,  that  the  arsenic  found  in  stomach,  kidneys,  and  liver  had  been 
introduced  into  the  stomach  after  death.  In  this  case  the  chemist  for 
the  crown  swore  that  under  such  circumstances  it  could  not  possibly 
have  reached  the  liver  or  kidneys,  for  "  absorption  ceases  directly  after 
death."  A  second  case  (Reese,  Trans.  Coll.  Physicians,  Phila.,  1877,  vol.  iii.,. 
p.  23)  is  of  an  old  man  who  married  his  housekeeper,  and  before  death 
left  her  all  his  property.  There  was  constant  squabbling  over  the  will, 
and  finally,  three  or  four  years  afterward,  the  widow,  who  had  married 
again,  was  accused  of  poisoning  her  first  husband.  The  body  was  ex- 
humed and  arsenic  found  in  the  stomach  and  intestines,  though  not  in 
the  form  of  sulphides ;  but  the  case  was  dropped,  owing  to  the  strong 
suspicions  that  some  of  the  relatives  had  tampered  with  the  body. 

Since,  however,  arsenical  solutions  have  been  used  for  embalming 
purposes,  there  is  no  doubt  at  all  but  that  more  than  once  they  have 
been  used  to  conceal  crime.  This  possibility  was  first  pointed  out  in 
an  excellent  letter  of  Dr.  Hay  to  the  Medical  Times  (1876,  vol.  vi.,  p.  576), 
after,  at  the  request  of  an  undertaker,  he  had  analyzed  a  much  used  and 
highly  recommended  embalming  fluid,  and  found  it  a  strong  solution  of 
sodium  arsenate. 

This  possibility  was  soon  proved  to  be  a  fact,  for  not  long  afterward 
Vaughan  (Jour.  Amer.  Med.  Ass'n,  1883,  vol.  1.,  p.  115)  published  a  case 
where  a  husband  injected,  with  the  aid  of  his  brother  and  an  undertaker, 
some  arsenic  into  the  mouth  and  rectum  of  his  dead  wife,  to  "preserve 
her  body  till  he  could  get  a  handsome  casket  from  a  neighboring  city." 
The  body  after  one  hundred  and  five  days  was  exhumed,  and  arsenic  was 
found  in  the  stomach  and  liver,  although  not  in  the  brain  or  calves  of 
the  legs.  But  it  was  impossible  to  tell  whether  it  had  come  from  the 
injection  or  not. 

A  more  striking  case  was  reported  (Boston  Med.  and  Surg.  Jour.,  1890, 
vol.  cxxii.,  p.  544)  by  one  of  the  Massachusetts  medical  examiners,  who 
was  evidently  much  chagrined  by  the  facts  he  mentioned.  A  young 
married  woman  died  very  suddenly,  two  hours  after  luncheon,  with 
symptoms  of  violent  irritant  poison.  The  medical  examiner  was  sent 
for,  and  although  he  was  out  of  town  at  the  time,  he  reached  the  house 
at  about  eight  o'clock  that  night,  within  seven  hours  after  the  woman 
had  died.  But  already  an  undertaker  had  been  called  in,  and  the  body 
had  been  embalmed  with  an  arsenical  solution,  and  so,  although  there 
was  every  ground  for  suspicion  and  the  body  was  full  of  arsenic,  the  case 
had  to  be  dropped. 

The  most  remarkable  case  of  all,  however,  which  has  once  or  twice 
been  referred  to,  although  not  in  detail,  in  some  of  the  journals,  was  laid 
before  some  prominent  legal,  chemical,  and  medical  experts,  of  whom 
Professor  Chandler  was  one,  some  nine  years  ago.  As  I  write,  all  the 
documents  of  the  case  are  before  me. 

From  these  it  appears  that  the  wife  of  a  country  clergyman,  after  a 
year  or  two  of  married  life,  died,  in  a  country  village  in  this  State,  under 
somewhat  suspicious  circumstances.  Some  of  the  relatives  started  an 
investigation.  The  husband,  an  attractive,  intelligent-looking  old  gentle- 
man over  sixty  years  old,  had  come  to  New  York  soon  after  the  funeral, 
and  was,  at  the  time,  preaching  regularly  every  Sunday  afternoon  in  one 
of  the  most  prominent  Fifth  Avenue  churches. 

It  was  soon  found  that  he  had  had  at  least  six  wives.     Detectives,  ac- 


INORGANIC  POISONS.  385 

cordingly,  started  to  study  up  the  deaths  of  wives  numbers  five  and  four, 
as  well  as  of  the  last  one,  while  two  other  detectives,  one  of  them  living 
at  the  same  boarding-house  as  the  reverend  gentleman,  made  daily  re- 
ports as  to  his  life  and  occupation.  He  appeared,  indeed,  to  have  some- 
what recovered  from  the  recent  bereavement,  for,  besides  his  clerical 
work,  the  reports  showed  that  he  was  devoting  himself  assiduously  to 
one  of  the  fair  residents  at  the  boarding-house.  But  suddenly,  probably 
because  he  heard  of  the  investigations  going  on  in  the  country,  he  packed 
up  and  started  for  Europe.  He  was  heard  of  the  next  year,  with  wife 
number  seven,  in  charge  of  a  parish  in  New  Mexico. 

The  investigations,  which  are  most  interesting  reading,  show  that  he 
generally  selected  for  his  better  halves  old  maids,  with  some  property  of 
their  own,  living  in  country  villages.  Soon  after  marriage  he  would 
move  to  another  country  parish,  and,  almost  as  soon  as  he  had  settled 
there,  he  would  spread  reports  of  his  wife's  ill-health  and  poor  constitu- 
tion. The  wife  would  soon  be  taken  sick,  and,  treated  by  the  local 
country  doctor,  would  alternately  get  better  and  worse,  until  she  died. 
Before  death  she  would  have  made  a  will  leaving  her  devoted  husband 
all  her  property,  and  immediately  after  a  hasty  and  superficial  autopsy, 
at  which  he  himself  was  generally  present,  the  body  would  be  thoroughly 
embalmed  with  arsenic.  His  grief  would  be  so  great  that  he  would  be 
obliged  to  give  up  his  parish  and  leave  for  other  parts,  where  he  woidd 
console  himself  anew. 

As  can  easily  be  seen,  there  was  no  possibility  of  proving  anything  in 
such  a  case,  although  suspicious  circumstances  without  number  were 
brought  to  light.  The  experts  unanimously  advised  the  abandonment 
of  the  case,  and  the  worthy  clergyman,  if  his  former  good  health  has 
not  deserted  him,  by  this  time  has  probably  reached  wife  number  eight 
or  even  number  nine. 

Possibility  of  Distinguishing  Anti=mortem  from  Post=mortem 
Arsenic. — This  question  has  been  discussed  by  most  of  the  writers  on 
poisons,  and  numerous  experiments  have  been  made  on  it  in  connection 
with  the  different  cases  already  mentioned.  Orfila,  Dr.  Kidd,  and  Pro- 
fessors Reese  and  Vaughan  (he.  tit.)  all  have  published  experiments 
on  the  subject,  and,  as  a  rule,  agreed  that  while,  with  sufficient  length  of 
time,  arsenical  and  other  metallic  solutions  woidd  travel  far  and  wide 
through  the  body,  it  was  very  improbable,  to  say  the  least,  that  within 
any  moderate  length  of  time  such  compounds  could  enter  the  brain. 

The  whole  question,  however,  was  finally  settled,  once  for  all,  by 
some  experiments  made  by  Professor  Witthaus,  and  described  in  an  ex- 
cellent paper  in  the  first  volume  of  the  Researches  of  the  Loomis  Labor- 
atory, 1890.  Professor  Witthaus  was  engaged  by  the  State  to  examine 
the  body  of  a  certain  Mrs.  Ford,  supposed  to  have  been  poisoned  by 
arsenic.  The  corpse,  which  had  been  dead  fourteen  days,  had  been  em- 
balmed by  injecting  into  the  stomach  through  the  nostril  a  solution  of 
sodium  arsenate,  some  four  pounds  to  the  gallon.  The  undertaker 
stated,  by  the  way,  that,  excepting  in  very  cold  weather,  it  was  his  in- 
variable habit  to  do  this  embalming  as  soon  as  possible  after  death. 
Upon  analysis  arsenic  was  readily  found,  not  only  in  the  viscera,  but 
also  in  the  brain.  But  on  making  exactly  parallel  experiments  upon 
•  •adavers  by  injecting  similar  solutions  and  similar  amounts  in  the  same 
manner,  or  even  more  carefully,  it  was  found  that  within  fourteen  days 


386  ^   SYSTEM   OF  LEGAL  MEDLCINE. 

arsenic  had  penetrated  from  the  stomach  into  every  part  of  the  body,  in- 
cluding* the  muscles  of  the  feet  and  legs,  the  hands,  the  arms,  and,  finally, 
every  portion  of  the  brain.     The  case  accordingly  was  dropped. 

At  the  present  moment  it  would  seem  that,  if  once  the  undertaker  is 
allowed  to  enter  the  house,  there  is  no  chance  of  conviction,  in  arsenic 
poisoning.  This  means  that  arsenic,  instead  of  being  the  most  dangerous, 
is  now,  practically,  the  safest  agent  for  committing  murder.  And  also, 
that  unless  the  attending  physician  is  clever  enough  to  properly  diagnose 
the  case  during  life,  and  is  courageous  enough  to  risk  his  own  profes- 
sional career  by  calling  in  the  authorities  and  insisting  on  an  autopsy  at 
once,  there  is  practically  no  hope  of  conviction. 

(c)  Arsenic  Acid  and  Arsenates — H^AsOi. 

Arsenic  acid  is  formed  by  the  oxidation  of  arsenious  oxide  with  nitric 
acid  or  aqua  regia.  The  arsenic  oxide  thus  formed  has  a  formula  of 
Aso05,  but  it  absorbs  water  very  readily,  even  from  the  air,  thus  forming 
the  true  acid,  H;iAs04. 

The  latter  is  a  thick,  syrupy,  colorless  liquid,  with  a  sour,  metallic 
taste.  It  is  quite  caustic,  and  has  poisonous  properties  similar  in  every 
respect  to  those  of  arsenious  oxide.  It  has  been  largely  manufactured 
for  use  as  an  oxidizing  agent,  but  has  been  superseded  of  late,  in  the 
aniline  and  kindred  industries,  by  other  and  non-poisonous  compounds. 

The  tests  for  this  substance  are  like  those  for  arsenious  oxide.  It 
reacts  promptly  with  Marsh's  test,  the  nascent  hydrogen  reducing  it 
rapidly  to  the  lower  oxide,  and  then  to  arseniureted  hydrogen.  It  re- 
sponds to  Reinsch's  test,  but  not  as  well  as  white  arsenic.  Sulphureted 
hydrogen,  however,  precipitates  it  very  slowly,  if  at  all,  from  dilute  solu- 
tions, unless  it  has  been  first  reduced  to  arsenious  oxide. 

Characteristic  tests  for  it  are  with  argentic  nitrate,  which  gives  a 
brick-red  precipitate,  and  with  ammonio-magnesic  sulphate  (formed  by 
adding  amnionic  hydrate  to  magnesic  sulphate  till  the  white  precipitate 
is  redissolved),  which  gives  a  white,  crystalline  deposit  of  ammonio- 
magnesic  arsenate.  Cases  of  poisoning  are  extremely  rare,  and  when 
they  do  happen  present  about  the  same  characteristics  as  those  from 
white  arsenic. 

One  case  of  a  child  who  ate  some  "  pest  poison,"  consisting  of  arsen- 
ate of  soda,  was  published  by  Prof.  B.  Silliman,  in  an  interesting  paper 
read  before  the  New  York  Medico-Legal  Society,  October  3,  1883.  The 
child  died  in  about  nine  hours,  without  symptoms  of  any  gastric  or  in- 
testinal irritation,  but  with  such  strong  evidences  of  narcotic  poisoning 
that  the  poison  was  first  thought  to  be  an  alkaloid  of  the  belladonna 
type. 

(d)  Arseniureted  Hydrogen — Arsine — AsHs. 

This  gas,  as  already  mentioned,  is  produced  by  the  action  of  nascent 
hydrogen  upon  solutions  of  arsenic.  It  is  formed  in  laboratories  in 
making  Marsh's  test,  and  also  occasionally  is  produced  in  the  arts  when 
metals  contaminated  with  arsenic  are  treated  with  acid. 

It  is  a  colorless,  inflammable  gas,  with  a  garlic  odor.  It  burns  to 
water  and  arsenious  oxide,  deposits  metallic  arsenic  when  heated,  and 


INORGANIC  POISONS.  387 

precipitates  metallic  silver  when  passed  into  argentic  nitrate,  the  arsenic 
dissolving  in  the  nitric  acid  set  free. 

It  has  marked  poisonous  qualities,  not  only  producing  the  usual 
effects  of  arsenic,  but  also  having  a  specific  action  on  the  blood  and 
kidneys.  The  blood  becomes  dark  and  inky,  while  the  kidneys  become 
much  congested,  and  the  flow  of  urine,  which  is  dark  and  full  of  blood, 
is  much  diminished  and  even  stopped.  The  victims  also  suffer  usually 
from  jaundice. 

The  gas,  however,  is  not  nearly  as  poisonous  as  is  supposed,  for  it  is 
evolved  in  considerable  quantities  by  the  students  in  almost  every  quali- 
tative laboratory  in  the  world,  and  yet  it  is  extremely  rare  to  hear  of  any 
accidents  from  it.  Its  discoverer,  Gehlen,  was  poisoned  by  it  from  try- 
ing to  trace  a  leak  in  his  apparatus  by  smelliug  at  the  joints,  and  three 
or  four  similar  instances  are  reported  in  the  books  and  journals,  but  that 
is  all. 

Cases  have  occasionally  been  reported  where  accidents  have  happened 
from  it  in  the  arts.  In  one  case  (Coester,  Deutsch.  Med.Wochensch.,  1884, 
p.  119),  a  workman  in  an  aniline  factory  inhaled  some  hydrogen  contain- 
ing some  of  this  gas.  He  suffered  at  first  from  nausea,  giddiness,  and 
general  discomfort.  Then  he  had  jaundice,  and  passed  practically  no 
urine  after  the  first  day,  when  it  was  bloody,  dying,  in  spite  of  treatment, 
on  the  tenth  day. 

Similar  symptoms  were  reported  in  a  very  interesting  case  (Dr.  Frost, 
Vierteljahrsh.  fur  Geriehtl.  Med.,  1873,  vol.  xviii.,  part  ii.,  p.  6),  fully 
quoted  by  Sonnenschein,  Blyth,  and  others,  where  twelve  workmen,  three 
of  whom  died,  were  seriously  affected  by  fumes  from  treating  zinc  with 
hydrochloric  acid.  The  early  symptoms  were  followed  by  jaundice, 
bloody  urine,  and  narcotic  sleep,  while  in  the  fatal  cases  the  mine  was 
suppressed,  and  death  occurred  in  a  state  of  coma. 

In  all  these  cases  arsenic  was  found  in  all  parts  of  the  body. 


(e)  Sntyhides  of  Arsenic — Realgar,  As.,S2,  Orpiment,  As2S3. 

These  two  compounds,  the  red  sulphide  containing  seventy  percent, 
of  the  metal,  and  the  already  mentioned  yellow  or  arsenious  sulphide, 
containing  sixty-one  percent.,  occur  in  small  quantities  in  nature,  and 
are  manufactured  for  use  in  the  arts. 

Their  toxic  effects,  tests,  etc.,  are  practically  the  same  as  those  of 
white  arsenic. 

(/)  Soluble  Salts  of  Arsenic. 

These  usually  consist  of  the  arsenites  and  the  arsenates  of  the  alka- 
line metals.  An  example  of  these  is  the  officinal  Fowler's  solution,  which 
contains  arsenic  to  the  amount  of  one  percent.,  dissolved  in  a  solution  of 
potassic  carbonate. 

The  poisonous  effects  of  these  salts  are  much  the  same  as  those  of 
white  arsenic,  excepting  that.,  being  soluble  and  easily  diffused,  they  usu- 
ally act  more  rapidly,  penetrate  the  brain  and  nerve  tissue  sooner  and  in 
greater  abundance,  and  produce  symptoms  rather  of  the  narcotic  or  cere- 
bral type. 


388  ^   SYSTEM  OF  LEGAL   MEDICINE. 


(g)  Paris  Green — Schweinfurth  Green. 

This  compound,  an  aceto-arsenite  of  copper,  containing  some  58.4 
percent,  of  arsenious  oxide,  has  of  late  years  come  into  common  use  as 
a  poison  for  potato-bugs  and  similar  insects,  and,  especially  in  country 
districts,  has  been  frequently  used  as  a  means  of  suicide.  Accidents 
from  its  use  are  occasionally  met  with,  but  are  rare. 

Internally  its  symptoms  are  the  same  as  those  produced  by  white 
arsenic,  excepting-  that  it  is  still  more  difficult  to  wash  it  out  of  the  stom- 
ach. Externally  it  occasionally  produces  rashes  and  similar  surface  dis- 
turbances upon  workmen  engaged  in  its  manufacture,  and  upon  farm 
hands  who  use  it  carelessly,  especially  if  their  fingers  or  arms  are  at  all 
sore.     But  it  is  rare  that  these  results  have  any  serious  consequences. 


(h)  Arsenic  in  Wall-paper  anil  Other  Fairies. 

For  a  great  many  years  there  has  been  a  feeling,  expressed  not  only 
by  the  laity  but  also  by  many  physicians  and  toxicologists  of  excellent 
standing,  that  there  was  more  or  less  real  danger  in  the  free  use  of 
arsenical  pigments,  like  Paris  or  Scheele's  greens,  for  instance,  in  the 
manufacture  of  wall-paper,  and  also  of  various  articles  of  household  use 
— dresses,  carpets,  book  covers,  water-color  paints,  toys,  and  the  like. 

With  regard  to  some  of  the  latter  the  feeling  was  undoubtedly  cor- 
rect. To  color  children's  toys,  or  pigments,  or  confectionery,  or,  in  many 
cases,  book  covers,  with  Paris  green,  is  simply  to  invite  accidents.  With 
regard  to  dress  materials,  carpets,  and  the  like,  there  is  more  cause  for 
doubt,  although  a  light  tarletan,  full  of  Paris  green  which  can  be  shaken 
off  as  a  fine  dust  by  the  mere  exercise  of  dancing,  may  be  not  unjustly 
considered  as  needlessly  dangerous. 

For  some  reason,  however,  the  cry  was  concentrated  against  wall- 
papers, which,  even  when  made  fluffy  and  velvety,  as  was  the  custom, 
and  full  of  loosely  adhering  arsenical  pigment,  are,  owing  to  their  station- 
ary position,  far  less  liable  to  give  rise  to  accidents  than  the  articles  just 
mentioned.  Indeed,  it  is  more  than  doubtful  wThether  a  single  case  of 
fatal,  or  even  dangerous,  arsenical  poisoning  has  ever  been  caused  by 
wrall-paper,  although  minor  accidents  may  occasionally  have  occurred. 
For  instance  (Lancet,  1879,  part  i.,  p.  686),  two  children  are  reported  to 
have  been  seized  one  morning  with  vomiting,  cramps,  and  diarrhoea,  after 
amusing  themselves  with  repainting  the  walls  of  their  room.  They  used 
their  fingers  as  paint-brushes,  and  would  lick  them  to  get  them  wet,  and 
then  rub  off  green  paint  from  one  part  of  the  wall  to  put  it  on  another. 

At  any  rate,  in  obedience  to  the  wishes  of  the  consumers,  manufact- 
urers have  practically  ceased  to  use  arsenical  pigments  in  any  quantity, 
not  only  on  toys  and  the  like,  but  also  on  wall-papers.  The  latter  are, 
as  a  rule,  thin  and  lightly  painted,  and  the  pigment  is  firmly  fastened 
on  with  size  and  generally  glaze,  and  now,  instead  of  finding  from  fifty 
to  several  hundred  grains  of  arsenic  to  the  square  yard,  it  is  quite  rare 
to  find  a  paper  with  more  than  one  or  two.  The  presence  of  the  latter, 
too,  is  almost  always  accidental,  and  results  from  the  impossibility  of 
getting  paper,  sizing,  paints',  and  so  on,  absolutely  pure  from  arsenic. 


INORGANIC  POISONS.  yycj 

Nevertheless  the  same  old  cry  against  arsenical  wall-paper,  which  now 
has  absolutely  no  basis,  still  goes  on,  and  has  risen  in  the  fine  old  State 
of  Massachusetts,  during-  the  last  ten  years,  to  an  actual  craze,  an  "  arse- 
nic fad,"  as  some  outsiders  have  dared  to  call  it. 

The  excitement  culminated  in  two  different  attempts  to  pass  legisla- 
tion forbidding,  under  heavy  penalties,  the  presence  in  wall-paper,  and, 
to  a  less  extent,  in  other  fabrics,  of  more  than  a  minute  fraction  of  a 
grain  to  the  square  yard.  The  evidence,  which  is  given  in  great  detail 
by  Professor  Wood  {Report  Mass.  State  Board  of  Health,  1885)  and  by  Pro- 
fessor Lyon,  Professor  Hill,  and  many  of  their  friends  and  colleagues,  in 
the  Arsenical  Wall-paper  Hearing,  House  Bill  No.  417,  1886,  and  in  the 
Hearing  before  the  Committee  of  Public  Health,  Senate  Bill  No.  215, 
1891,  is  exceedingly  interesting  and  entertaining,  and  deserves  a  brief 
review. 

The  susceptibility  of  the  victims  was  extraordinary.  Professor  Lyon 
(Senate  Hearing,  p.  121)  stated  that  a  member  of  his  family  was  seriously 
affected  (sleeplessness,  repeated  colds,  tenderness  in  throat,  skin  and  nerv- 
ous symptoms)  by  the  mere  presence  in  the  room  of  a  lounge  containing, 
all  told,  in  its  coverings  and  linings,  about  1.8  grains  of  arsenic.  Pro- 
fessor Wood,  too,  gives  a  case  (No.  31)  of  obstinate  eczema  of  the  hands, 
from  using  playing-cards  containing  on  their  backs  one  eighth  of  a  grain 
of  arsenic  apiece.  And  in  another  case  [Senate,  p.  14),  fever  was  caused 
b}'  the  mere  presence  in  the  room  of  a  red-and-yellow  comforter,  which, 
on  analysis,  showed  a  little  arsenic. 

The  climax,  perhaps,  was  reached  in  the  much-quoted  case  of  a  child 
(Senate,  p.  19)  whose  father,  a  physician,  stated  that  severe  symptoms  of 
Bright's  disease  had  been  produced  (a)  from  a  plush  seat  in  an  arm-chair ; 
(b)  from  a  slightly  arsenical  border  in  a  room ;  (c )  from  some  arsenical 
paints  frescoed  on  a  ceiling;  and  finally,  by  the  presence  of  some  green 
glazed  paper  boxes  in  a  closet  of  a  neighboring  room.  In  this,  as  in  the 
previous  cases,  arsenic  was  found  in  the  urine. 

The  symptoms,  too,  are  interesting,  for  they  include  those  of  practi- 
cally every  slight  affection  and  almost  any  grave  disease  that  flesh  is  heir 
to,  and  vary  from  a  cold  in  the  head  to  almost  complete  paralysis ;  the 
latter,  by  the  way  (Professor  Wood,  case  19),  occurring  within  two  hours 
after  exposure  to  the  poison.  In  one  famous  case,  that  of  ex-Mayor 
Cobb,  of  Boston,  the  long,  tedious  illness  and  final  death  were  confidently 
ascribed  to  arsenical  wall-paper.  On  autopsy  it  appeared  that  the  victim 
had  been  suffering  all  along  from  a  cancer  of  the  stomach. 

Nor  did  "  age  stale  or  custom  wither  their  infinite  variety,"  for  papers 
winch  had  been  on  walls  twenty-five  years  and  more,  and  were  in  good 
condition  at  the  end  of  that  time,  were  still  quoted  as  the  cause  of  disease. 

The  most  extraordinary  claim  of  all,  however,  was  that  paper,  covered 
over  by  a  non-arsenical  one,  could  still  produce  disease.  Thus  (Senate, 
p.  108),  irritation  of  the  air-passages,  tonsillitis,  and  other  diseases  were 
caused  by  an  arsenical  paper  completely  covered  by  one  free  from  any 
trace  of  the  poison.  A  still  more  striking  case  is  told  yearly  to  his  stu- 
dents by  a  well-known  professor  of  chemistry,  as  an  illustration  of  this 
subtle  and  deadly  wall-paper  poisoning.  Some  persons  were  taken  sick, 
and  the  wall-paper  was  examined,  but  found  free  from  arsenic.  This 
was  scraped  off  and  the  underneath  one  examined,  but  also  found  non- 
.arsenical.     Not  content  with  this,  a  third  paper  was  uncovered,  and,  to 


390  A   SYSTEM  OF  LEGAL  MEDLCINE. 

the  good  professor's  huge  delight,  traces  of  arsenic  were  found  in  some 
flowers  with  which  it  was  decorated.  This  paper,  number  three,  is  now 
triumphantly  exhibited  to  his  classes  as  an  example  of  a  physician's  abil- 
ity and  a  chemist's  perseverance  ! 

It  will  be  seen  at  once  that  these  results  could  not  have  been  sup- 
posed, by  the  greatest  enthusiast,  to  have  been  the  work  of  ordinary 
Paris  green,  mechanically  dislodged  from  the  walls.  So  a  theory  was 
propounded,  based  on  papers  by  Fleck  {Zeitsch.  f.  Biol,  vol.  viii.,  p.  444) 
and  Hamburg  (Pharm.  Jour,  and  Trans.,  August  1,  1874),  that,  by  the 
action  of  microbes,  arseniureted  hydrogen  was  constantly  being  evolved 
from  arsenical  pigments  and  dye-stuffs. 

Sad  to  say,  Prof.  C.  F.  Chandler,  called  on  from  New  York  to  testify 
on  the  subject,  demolished  this  whole  story  in  very  short  order.  He 
explained  how,  when  president  of  the  New  York  Board  of  Health,  he 
had,  years  before,  thoroughly  investigated  the  whole  subject  and  found 
there  was  nothing  to  it.  Deaths  and  illness  from  wall-paper  poisoning 
did  not  exist  in  either  New  York  or  Philadelphia,  and  the  best  physicians 
and  health  authorities  in  both  cities  agreed  in  calling  it  a  humbug.  He 
then,  after  pointing  out  the  general  absurdity  of  the  claims,  attacked 
their  evidence  on  two  lines :  first,  that  their  tests  for  arsenic  were  un- 
trustworthy ;  and  second,  that  arseniureted  hydrogen  or  other  poisonous 
gases  were  not  set  free  from  arsenical  pigments,  as  stated. 

It  so  happened  that  the  Boston  chemists  had  determined  the  presence 
of  arsenic  by  the  simple  formation  of  a  dark  or  black  deposit  with  the 
Berzelius-Marsh  test,  and  when  occasionally  they  took  the  trouble  to 
further  test  this  deposit  to  see  if  it  was  arsenic  or  not,  they  simply  broke 
the  tube  and  smelled  of  it,  to  see  if  it  had  a  garlic  odor.  This  careless 
method  of  testing  made  all  their  results  entirely  unreliable. 

About  the  exhalation  theory  Professor  Chandler  not  only  quoted 
Hoffman,  Henry  Watts,  Professor  Galloway,  and  others  in  favor  of  his 
views,  but  described  some  experiments  of  his  own,  never  before  pub- 
lished, which  were  made  in  1880  while  studying  the  matter  for  the  Board 
of  Health.  The  claim  had  been  made  that  in  the  decomposition  of  the 
starch  paste  enough  hydrogen  was  produced  to  form  arseniureted 
hydrogen.  Two  of  his  assistants,  under  his  direction,  mixed  Paris  green 
with  fresh  paste,  and  with  paste  in  an  active  state  of  decomposition,  and 
they  also  spread  Paris  green  and  paste  thickly  on  a  sheet  of  paper.  But 
although  they  passed  air  for  hours  and  hours  over  these  surfaces  and 
mixtures,  not  a  trace  of  arsenic  could  be  found  to  have  volatilized.  It  is 
interesting  to  know  that  this  testimony  of  Professor  Chandler,  seconded 
once  by  that  of  Professor  Henry  Morton  of  Stevens  Institute,  Hoboken, 
was  enough  to  nip  the  proposed  legislation  in  the  bud  on  both  occasions. 

This  subject  has  been  discussed  somewhat  at  length,  partly  because 
the  discussions,  in  which  both  sides  of  the  question  were  very  fully 
covered,  are  not  readily  accessible  to  the  public ;  but  also  because  some 
of  the  results  published  of  late  years  in  the  Massachusetts  journals  about 
the  presence  of  arsenic  in  urine  from  cases  of  wall-paper  poisoning,  will 
undoubtedly  be  quoted  to  the  discomfiture  of  experts  unless  they  can  also 
have  access  to  some  of  the  reasons  why  those  results  are  to  be  considered 
unreliable. 


INORGANIC  POISONS.  391 


VII.      LEAD,   PB. 


Metallic  lead  has  been  known  and  used  by  man  from  the  early  histor- 
ical ages,  and  to  this  day  we  can  see,  notably  in  England,  not  only  the 
traces  of  the  ancient  mines,  but  also  the  old  pigs  and  weights  of  lead, 
stamped  with  the  mark  of  the  old  smelting- works,  and  the  remains  of  the 
original  lead  pipes  used  by  the  Romans  to  conduct  water  to  their  baths. 

It  occurs  in  nature  principally  as  the  sulphide,  galena,  and  can  be 
readily  extracted  by  smelting  with  coal  and,  sometimes,  iron. 
.  Properties. — It  is  a  soft,  lustrous,  heavy  metal,  with  a  bluish-white 
color,  melting  at  about  315°  C.  It  dissolves  readily  in  dilute  nitric  acid, 
and  with  difficulty  in  hot  concentrated  sulphuric  acid.  It  is,  however, 
insoluble  in  cold  sulphuric  acid,  and  practically  so  in  hydrochloric  acid. 
In  pure  water  it  is  not  dissolved ;  but  if  the  water  is  or  has  been  exposed 
to  the  air  the  lead  oxidizes,  and  then  becomes  converted  into  a  hydrated 
carbonate,  a  white  compound,  a  little  of  which  dissolves  in  the  water, 
while  the  rest  forms  scales  and  incrustations,  which  settle  to  the  bottom, 
or  may,  in  fine  particles,  be  carried  along  with  the  liquid.  This  action 
of  water  is  supposed  to  be  assisted  by  the  presence  of  nitrates  and  also, 
to  some  extent,  of  chlorides,  while  even  small  quantities  of  sulphates  and 
phosphates,  or  of  carbonates,  protect  lead  from  corrosion  by  forming 
insoluble  coatings  upon  its  surface. 

As  a  Poison. — Metallic  lead  dissolves  but  slowly  in  the  fluids  of  the 
body,  and  hence  has  been  known  to  remain  in  the  body  for  years,  as,  for 
instance,  in  the  case  of  bullet  wounds,  without  causing  serious  incon- 
venience. If,  however,  it  enters  the  circulation,  as  has  been  known  to 
happen  in  those  very  cases  after  doses  of  potassium  iodide,  it  will,  even  in 
small  quantities,  give  rise  to  characteristic  symptoms  of  poisoning. 

Cases  of  acute  lead  poisoning  may  occur  from  taking  considerable 
quantities  of  the  soluble  salts,  plumbic  acetate,  or,  more  rarely,  plumbic 
nitrate.  These  cases,  however,  are  very  rare,  and  form  but  a  minute 
fraction  of  the  whole.  By  far  the  greater  bulk  of  the  victims  of  lead 
poisoning  have  absorbed  the  metal,  purely  by  accident,  in  minute  quan- 
tities, day  by  day,  for  considerable  periods.  The  number  of  these  cases 
is  extraordinary ;  for,  as  will  be  seen  on  reference  to  the  tables  on  pages 
351  and  352,  deaths  from  lead  poisoning  rank,  at  least  in  this  country  and 
England,  next  to  those  from  opium  and  its  compounds,  forming  some 
twenty  percent,  of  the  whole  number ;  while  these  figures  represent  but 
a  small  part  of  the  cases  more  or  less  permanently  injured  by  its  action. 

How  Introduced  into  the  System. — Chronic  lead  poisoning  is  most 
common  among  those  constantly  at  work  with  the  metal  or  its  com- 
pounds, as,  for  instance,  plumbers,  painters,  type  founders  and  setters, 
shot-makers,  and  the  like.  In  lead  works  and  paint  factories  it  is  so 
frequent  that  special  precautions  have  to  be  taken  to  protect  the  work- 
men :  the  ventilation  is  looked  after,  white  lead  and  other  powders  are 
ground  in  water,  while  stringent  rules  have  to  be  made  and  enforced, 
insisting  on  great  personal  cleanliness,  and  the  eating  of  all  food  outside 
the  gates  of  the  factory.  In  many  cases,  as  I  have  myself  seen,  sul- 
phuric acid  lemonade  is  furnished  freely  as  a  prophylactic  drink,  and 
employees  who  complain  of  any  trouble  from  constipation  are  given 
doses  of  Glauber's  or  Epsom  salts. 


392  A   SYSTEM  OF  LEGAL  MEDICINE. 

Food. — Innumerable  cases  of  lead  poisoning  have  also  been  caused 
by  the  presence  of  the  metal  in  ordinary  foods,  drugs,  and  drinks.  Many 
people  have  been  poisoned  by  the  presence  of  lead  compounds  in  flour 
and  bread,  in  one  case  (Stourbridge)  from  accidentally  mixing  lead  acetate 
with  the  flour,  but  in  most  of  the  other  cases  by  the  careless  use  of  white 
lead  in  repairing  the  grindstones.  Foods  cooked  in  lead-glazed  pots, 
beer  and  cider  drawn  through  lead  pipes,  wine  sweetened  with  litharge 
or  lead  acetate,  or  kept  in  bottles  carelessly  cleaned  with  shot,  sweet- 
meats and  the  like  packed  in  tin-foil,  fruits  and  vegetables  canned  with 
the  use  of  lead  solder,  have  all  contributed  their  share  of  victims. 

Hair-dyes. — Another  very  important  source  of  poisoning  is  the  use 
of  cosmetics,  hair-restorers,  and  hair-dyes  made  of  lead  salts.  The  latter 
aim  to  reproduce  the  original  brown  or  black  color  of  the  hair  by  im- 
pregnating it  with  lead  sulphide,  and  hence  usually  consist  of  two  solu- 
tions, one  of  lead  acetate,  to  be  well  rubbed  into  the  hair,  and  the  other 
of  alkaline  sulphide,  to  be  applied  later.  In  a  report  on  dangerous 
cosmetics  made  to  the  New  York  Board  of  Health  in  1870,  Professor 
Ohandler  gave  analyses  of  most  of  the  face  and  hair  preparations  sold 
at  the  time  in  the  city,  and  showed  that  they  almost  invariably  contained 
large  amounts  of  lead ;  while  a  similar  state  of  affairs  was  shown  a  few 
years  later  by  Dr.  Benjamin  {New  Remedies,  November,  1878). 

Water. — The  most  common  source  of  lead  poisoning,  to  the  com- 
munity at  large,  lies  in  the  use  of  drinking-water  conveyed  through  lead 
pipes  or  kept  in  lead-lined  tanks.  The  amount  of  lead  necessary  to 
make  a  water  poisonous  need  not  be  large.  Thus  in  the  well-known 
case  of  the  Orleans  family,  who,  after  their  expulsion  from  France  in 
1848,  settled  at  Claremont  in  England,  the  use  for  five  or  six  months  of 
water  containing  about  eight  tenths  of  a  grain  of  lead  to  the  (United 
States)  gallon,  produced  distinct  symptoms  of  chronic  poisoning.  As 
alread}^  noticed,  the  purer  the  water,  and  the  more  free  it  is  from  sul- 
phates, phosphates,  and  carbonates,  the  more  liable  it  is  to  attack  the 
lead. 

These  evil  effects  were  well  known  to  Vitruvius  (B.C.  50),  Galen 
(a.d.  130),  and  other  of  the  earliest  authorities,  and  the  use  of  lead  pipe 
for  conducting  drinking-water  was  forbidden,  in  early  days,  under  severe 
penalties.  But  it  is  so  cheap  and  so  convenient  for  this  purpose  that  its 
use  has  never  been  superseded.  Lead  tanks  are  always  dangerous,  and 
should  invariably  be  replaced  by  copper,  zinc,  or,  better,  block-tin.  If 
lead  pipes  are  used  the  precaution  should  always  be  taken  of  letting  the 
water  run  freely  before  drawing  any  to  drink.  Many  cases  are  on 
record,  in  this  city  as  well  as  elsewhere,  of  lead  poisoning  from  using 
drinking-water  that  has  stood  overnight  in  the  pipes. 

Effects  of  Lead  on  the  System — (a)  Acute  Poisoning. — This  occurs 
but  rarely,  and  then  usually  from  taking  plumbic  acetate,  sugar  of  lead, 
in  considerable  quantities.  This  compound  is  a  white  crystalline  sub- 
stance, with  a  sweet  metallic  taste,  and  readily  soluble  in  water.  Unlike 
most  poisons,  it  is  less  dangerous  in  one  large  dose  than  when  the  same 
quantity  is  taken  divided  into  many  smaller  doses.  Nor  can  it  be  con- 
sidered as  a  very  active  poison,  for  it  is  given  medicinally  as  an  astrin- 
gent, and  to  stop  bleeding  from  the  bowels,  in  doses  of  from  two  to  five 
grains,  and  in  quantities  running  up  to  fifteen  and  twenty,  or  even  thirty 
and  forty  grains  a  day,  without  injury.     Indeed,  the  fatal  dose  of  it  is 


INORGANIC  POISONS.  393 

not  known,  for  recovery  has  taken  place  in  very  few  days,  and  with 
simple  treatment,  after  taking  in  solution  an  ounce  and  more  of  the 
compound. 

Symptoms. — In  the  few  fatal  cases  of  plumbic  acetate  poisoning  that 
have  been  reported,  the  patient,  as  a  rule,  notices  at  once  a  metallic 
taste,  and  burning  and  sense  of  dryness  in  the  throat  and  mouth.  This 
is  followed  by  vomiting  and  retching,  with  pain  in  the  stomach  and 
abdomen,  sometimes  relieved  by  pressure.  Sometimes  there  is  severe 
purging,  with  passage  of  blood,  bat  usually  there  is  obstinate  constipa- 
tion, and  any  material  passed  is  dry  and  colored  black,  probably  from 
the  presence  of  lead  sulphide.  The  urine  is  diminished,  the  breath  is 
foul,  and  the  tongue  coated.  There  is  a  quick,  weak  pulse  and  great 
prostration. 

Time  of  Death. — If  the  dose  proves  fatal  the  patients  usually  die  in 
three  or  four  days  from  prostration.  After  the  first  few  days  they  are 
apt  to  suffer  from  the  various  nervous  symptoms  of  chronic  lead  poison- 
ing, and  after  surviving  the  acute  attack  they  may  remain  in  wretched 
health  for  a  long  time. 

Treatment. — The  proper  antidotes  to  lead  salts  of  all  kinds  are  the 
two  saline  emetics,  Glauber's  salts  and  Epsom  salts,  the  sulphates  of 
sodium  and  of  magnesium.  These  not  only  counteract  the  constipating 
effects  of  lead  and  help  to  remove  it  from  the  body,  but  also  convert  any 
of  its  salts  as  yet  unabsorbed  into  the  insoluble  plumbic  sidphate.  The 
stomach  should  be  well  washed  out,  and  the  vomiting  and  prostration 
controlled  as  far  as  possible  by  opium,  and  by  stimulants. 

After  lead  has  once  been  absorbed  into  the  system,  as,  for  instance, 
in  chronic  cases,  it  is  possible  to  remove  it  by  doses  of  potassium  iodide. 
These,  however,  should  be  administered  with  care,  or  else,  by  suddenly 
throwing  large  amounts  of  lead  into  the  circulation,  the  chronic  symp- 
toms may  be  changed  into  acute. 

Post-mortem  Appearances. — It  is  usual  to  find  after  death  evidences 
of  more  or  less  severe  inflammation  of  the  stomach  or  intestines.  The 
liver  and  kidneys  are  also  affected  if  death  has  been  delayed  for  some 
days. 

(b)  Chronic  Lead  Poisoning. — This  is  far  more  common  than  any 
other  kind,  and  indeed  presents  such  a  variety  of  symptoms  that  prob- 
ably many  cases  of  it  are  entirely  overlooked.  There  is  much  difference 
among  individuals  with  regard  to  their  susceptibility  to  small  doses  of 
lead.  As  a  ride  it  attacks  the  weaker  ones  first,  and  especially  if  they 
are  predisposed  to  gout.  On  the  other  hand,  as,  for  instance,  in  the  case 
of  the  Orleans  family  mentioned  above,  young  children  are  sometimes 
not  affected. 

The  poison  is  usually  absorbed  through  the  stomach,  but  it  can  pen- 
etrate through  the  skin  or  the  lungs  without  much  difficulty,  under  the 
proper  exposure.  The  length  of  time  necessary  to  produce  the  poison- 
ing varies,  of  course,  with  the  amount  of  lead  that  reaches  the  system. 
Thus  the  characteristic  symptoms  may  appear  in  a  few  weeks  or  even 
days,  or  they  may  not  be  noticed  until  exposure  has  lasted  for  years. 
Indeed,  lead  is  considered  to  be  a  poison  which  slowly  accumulates  in 
the  body  until  the  poisonous  limit  is  reached,  or  until  the  body,  becom- 
ing  weakened  from  one  cause  or  another,  gives  way  to  influences  which 
it  formerly  resisted  with  success. 


394:  A   SYSTEM  OF   LEGAL    MEDICINE. 

Occasionally  there  seems  to  be  some  local  action  of  the  lead.  Thus 
plumbers  and  painters  are  usually  first  paralyzed  in  the  hands,  right  or 
left  as  the  case  may  be,  with  which  they  work  the  most.  This,  however, 
precedes  the  lesion  on  the  other  side  by  only  a  few  days  at  the  most,  and 
it  is  generally  believed  that  the  poison  is  first  absorbed  into  the  general 
circulation,  and  then  selects  the  particular  organs  or  parts  for  attack. 

Symptoms. — [a)  General  Nutrition. — As  a  rule,  before  developing  any 
characteristic  lesions  the  patient  feels  generally  run  down  and  wretched. 
His  appetite  fails,  his  digestion  and  nutrition  are  poor,  and  he  feels 
feeble,  and  becomes  more  or  less  emaciated.  This  is  generally  accom- 
panied with  anamiia,  more  or  less  severe,  in  which,  it  is  claimed,  the 
red  blood-cells  diminish  in  quantity  and  increase  in  size  at  the  same  time. 

The  liver  is  often  affected,  and  the  kidney  is  very  commonly  diseased, 
undergoing  a  parenchymatous  inflammation,  and  finally  becoming  hard 
and  granular,  with  diminished  excretion  of  urea.  Indeed,  many  of  the 
later  nervous  symptoms  have  been  referred,  by  many  good  authorities, 
largely  to  uraemia  caused  by  the  kidney  lesions.  Abortions  are  extremely 
common  in  the  case  of  pregnant  women,  and  the  children  of  chronic  lead 
patients,  as  a  rule,  die  at  childbirth  or  a  few  years  afterward. 

Blue  Line  on  Gums. — Quite  early  in  the  course  a  peculiar  bluish-black 
line  can  be  observed  on  the  gums,  usually  where  they  join  the  teeth. 
This  is  formed  by  the  deposition  of  plumbic  sulphide,  and  has  been 
noticed  in  twenty-four  hours  after  taking,  medicinally,  twenty  grains  of 
plumbic  acetate,  and  for  four  years  after  exposure  to  lead  had  ceased. 
It  can  be  traced  first  on  the  projections  of  the  gum  between  the  teeth, 
and  in  some  cases,  especially  where  the  teeth  have  been  very  carefully 
attended  to,  it  may  appear  there  only.  In  a  few  instances  it  has  not 
been  observed  at  all,  and  it  has  once  or  twice  been  observed  in  mercury 
and  silver  poisoning;  but,  as  a  rule,  it  is  the  characteristic  and  distinctive 
mark  produced  by  lead. 

Intestinal  Pains,  "  Collect  TietorwmP — Soon  after  this  the  patient  suf- 
fers from  obstinate  constipation,  accompanied  by  acute  paroxysms  of 
pain  in  the  abdomen.  This  pain  is  probably  produced  by  the  action  of 
lead  on  the  sympathetic  ganglia  of  the  intestines,  and  not  by  any  in- 
flammation of  the  intestinal  walls.  It  can  often  be  relieved  by  pressure, 
and  is  situated  mostly  around  the  umbilicus. 

(6)  Nervous  Symptoms. — Besides  the  affections  of  the  nervous  system 
shown  by  the  colic  and  by  pains  in  various  joints  and  muscles  of  the 
body,  there  are  some  characteristic  nerve  lesions  due  to  a  progressive 
peripheral  neuritis.  This  sometimes  produces  an  atrophy  of  the  muscle 
along  with  a  loss  of  power,  but  as  a  rule  the  parts  affected  are  first 
partially  or  wholly  paralyzed,  and  do  not  waste  for  some  little  time. 
This  paralysis  does  not  often  attack  a  whole  group  of  muscles,  but  picks 
out  one  or  two  here  and  there. 

The  muscles  most  affected  are  the  extensors  of  the  fingers  and  wrists, 
causing  thereby  a  characteristic  hanging  of  the  wrist  known  as  the 
"  wrist  drop."  The  corresponding  leg  muscles  are  occasionally  affected, 
but  almost  always  after  the  upper  extremities,  while  the  paralysis  may 
spread  to  the  upper  arm  and  even  attack  muscles  of  the  trunk.  If  the 
muscles  are  only  paralyzed  and  not  much  atrophied,  it  is  possible  to 
make  a  complete  cure  by  the  aid  of  electricity  and  similar  nerve  stimu- 
lants, although  relapses  are  common  from  even  very  slight  exposures. 


INORGANIC  POISONS.  395 

But  when  atrophy  and  paralysis  occur  together,  recovery  is  very  slow,  if 
indeed  possible  at  all. 

Along-  with  this  paralysis  there  may  occur  more  or  less  tremor,  some- 
times fine,  like  that  of  old  age,  and  often  very  marked,  like  that  of  paral- 
ysis agitans,  only  of  wider  range  and  increased  after  motion  or  exertion. 
Sometimes  this  tremor  affects  the  lips  and  tongue,  and  is  much  like  that 
of  mercury. 

(c)  Cerebral  Symptoms. — Again,  the  poison  may  affect  the  brain,  caus- 
ing at  first  light  symptoms  of  giddiness,  headache,  insomnia,  disturbed 
sight  and  hearing,  and  the  like,  which  may  develop  into  delirium  or  into 
stupor,  with  coma  and  sometimes  convulsions,  especially  before  death. 
Sometimes  the  cerebral  symptoms  may  result  in  attacks  resembling  those 
of  epilepsy. 

The  disturbances  of  sight  are  quite  common,  and  seem  to  depend  upon 
an  optical  neuritis  produced  by  the  lead,  as  well  as  upon  retinitis  that 
may  result  from  the  kidney  disturbances.  The  eyesight  may  be  affected 
after  only  a  few  days'  exposure. 

Beside  these  there  may  be  mental  disturbances,  melancholia,  for  in- 
stance, and  hallucinations  and  delusions,  generally  mild,  but  sometimes 
acute.  Occasionally  there  is  mental  failure,  while,  especially  in  France, 
there  have  been  described  cases  of  plumbic  hysteria  which  counterfeited 
many  of  the  most  severe  forms  of  nervous  lead  symptoms. 

Cause  of  Death. — Death,  as  a  rule,  results  from  the  general  anaemia 
and  malnutrition  produced  by  the  poison,  and  especially  from  its  action 
upon  the  kidneys.  Sometimes,  however,  the  patients  die  in  an  acute 
cerebral  attack,  and  occasionally  from  a  paralysis  of  respiration  or  circu- 
lation. The  treatment  is  the  same  as  that  already  described  under  acute 
poisoning. 

Location  of  the  Poison  in  the  Tissues. — The  amount  of  lead  found 
in  the  body  after  death  is  generally  extremely  small.  It  has  been  found 
chiefly  in  the  liver  and  kidneys,  though  small  quantities  have  been  traced 
in  the  brain,  stomach,  spleen,  and  lungs,  in  man,  and  in  the  bones  and 
muscles  also,  in  a  dog. 

Excretion  of  Lead. — The  poison  absorbed  into  the  system  is  undoubt- 
edly excreted  chiefly  by  the  kidneys,  although  the  actual  amount  of  lead 
present  in  the  urine  is  usually  very  small.  Excretion  is  helped  by  the  in- 
gestion of  potassium  iodide,  which  tends  to  dissolve  the  lead.  It  is  prob- 
ably also  excreted  by  the  bile,  and  perhaps  by  the  skin  and  intestines. 
The  elimination  is,  as  a  rule,  extremely  slow. 

Tests  for  Lead. — (a)  Sulphureted  Hydrogen. — This  gas  when  passed 
through  an  alkaline,  neutral,  or  moderately  acid  solution  of  lead  will  give 
a  black  (or,  when  the  amount  of  metal  is  extremely  minute,  a  brown)  pre- 
cipitate of  plumbic  sulphide.  This  precipitate  can  be  reduced  to  metallic 
lead  by  heating  on  charcoal  with  the  blow-pipe.  It  is  soluble  in  dilute 
nitric  acid  and  also  in  hot  concentrated  hydrochloric  acid,  which  changes 
it  into  lead  chloride.  If  other  metals  are  present  the  mixed  sulphides 
can  be  separated  from  each  other  by  dissolving  the  arsenious  sulphide 
with  ammonia,  and  the  antimonious  sulphide  with  sodium  sulphide.  If 
the  residue  is  treated  with  hot,  strong  hydrochloric  acid,  the  lead  will  be 
dissolved  and  the  copper  or  mercury  compound  remain  behind.  The 
lead  chloride  thus  obtained,  if  in  any  abundance,  will  precipitate,  on  cool- 
ing and  diluting  with  water,  in  the  form  of  white  crystals. 


39G  ^   SYSTEM  OF  LEGAL   MEDICINE. 

The  test  is  extremely  delicate,  and,  according  to  Worinley,  will  give 
a  distinct  brownish  tinge  to  ten  grains  of  solution  containing,  in  all, 
1-25,000  of  a  grain  of  plumbic  oxide. 

(&)  Sulphuric  Acid. — A  solution  of  lead  is  readily  precipitated  by  dilute 
sulphuric  acid,  or  by  a  soluble  sulphate,  in  the  form  of  white,  needle- 
shaped  crystals  of  plumbic  sulphate.  This  precipitate  is  soluble  in  a 
large  amount  of  alkali,  and  also  in  hot  concentrated  hydrochloric  acid. 

(c)  Potassium  Iodide. — This  reagent  gives  a  yellow  precipitate  of 
plumbic  iodide,  soluble  in  caustic  potash  and  in  strong  hydrochloric 
acid;  it  also  dissolves  in  boiling  water,  and  will  be  deposited  from  this 
solution  in  the  form  of  yellow  hexagonal  plates,  quite  similar  to  crystals 
of  iodoform. 

(d)  Potassic  Bichromate. — This  will  precipitate  the  lead  as  yellow  plum- 
bic chromate,  soluble  in  potash  and  in  strong  hydrochloric  acid. 

Separation  of  Lead  from  the  Tissues. — If  lead  alone  is  being  looked 
for,  it  is  generally  best  to  extract  it  from  the  organic  material  by  re- 
peated treatment  with  concentrated  nitric  acid.  As  a  rule,  however,  the 
tissues  are  oxidized,  as  in  the  case  of  the  other  metals,  with  hydrochloric 
acid  and  potassic  chlorate,  and  the  mixed  sulphides  are  precipitated  from 
the  acid  solution  by  sulphureted  gas.  The  lead  sulphide  can  be  extracted 
by  hydrochloric  acid  and  reprecipitated  by  sodic  sulphate  in  the  form  of 
plumbic  sulphate,  which  can  be  separated  and  weighed.  To  prove  this 
to  be  lead  it  is  possible  to  dissolve  the  sulphate  in  an  alkaline  carbonate 
and  reprecipitate  it  by  sulphureted  hydrogen. 

It  is  important  to  remember  that  lead,  in  minute  quantities,  has  fre- 
quently been  found  in  the  body  when  there  has  been  no  suspicion  of 
either  acute  or  chronic  lead  poisoning;  so  that,  unless  the  quantity 
found  is  comparatively  large,  or  some  at  least  of  the  characteristic  symp- 
toms have  been  present,  it  is  not  right  to  lay  too  much  stress  upon  the 
analysis  alone. 

VIII.      MERCURY,   HG. 

Mercury  is  occasionally  found  free  in  nature,  but  is  generally  extracted 
by  reducing  and  subliming  the  red  sulphide,  cinnabar.  It  is,  at  ordinary 
temperatures,  a  bright,  metallic,  heavy  liquid,  freezing  at  —39.9°  C,  and 
boiling  at  about  350°  C.  It  is  volatile  at  all  temperatures,  to  a  greater  or 
less  extent.  It  dissolves  readily  in  hot  concentrated  sulphuric  acid,  and 
in  cold  nitric  acid. 

Physiological  Effects. — Metallic  mercury,  when  taken  in  single  large 
doses,  is,  as  a  rule,  quite  harmless.  Cases  are  on  record  where  as  much 
as  two  pounds  have  been  administered,  either  at  once  or  in  the  course 
of  one  or  two  days,  and  no  toxic  symptoms  have  resulted.  On  the  other 
hand,  in  one  or  two  cases  where  large  doses  were  taken,  enough  of  the 
metal  has  been  absorbed  to  produce  slight  but  distinct  marks  of  poi- 
soning. 

When  administered  in  minute  doses  for  a  considerable  length  of  time 
the  mercury  becomes  absorbed  into  the  system,  and  then  produces  its 
characteristic  effects.  This  is  equally  the  case  when  given  by  the  stom- 
ach or  through  the  skin,  or  when  inhaled  as  a  vapor. 

When  the  doses  are  very  minute  mercury  seems  to  act  as  a  tonic  to 
the  blood,  and  thus  to  the  general  system.     In  somewhat  larger  quanti- 


INORGANIC  POISONS.  397 

ties  it  acts  as  a  mild  purgative  by  stimulating  the  flow  of  bile  from  the 
liver,  and  is  much  used,  along  with  calomel,  for  this  purpose.  Besides 
this  it  has  a  well-known  specific  effect  in  the  early  stages  of  syphilis, 
counteracting  both  the  specific  lesions  and  also  the  general  depressing 
effect,  anaemia,  weakness,  and  the  like,  of  the  disease. 

Poisonous  Effects. — [a)  Month  Symptoms. — The  first  signs  that  the 
drug  has  been  pushed  to  its  limit  as  a  medicine  consist  of  a  slight  red- 
ness about  the  gums,  a  smell  to  the  breath,  and  a  slight  gray  deposit  at 
the  base  of  one  or  more  teeth.  The  teeth  feel  long,  and  are  tender  when 
tapped  or  struck,  and  there  is  a  slight  excess  of  saliva. 

If  the  mercury  is  pushed  still  further  true  poisonous  symptoms  set  in. 
The  gums  and  tongue  are  swollen  and  sore,  and  bleed  very  freely.  The 
teeth  get  loose,  the  saliva  is  enormously  increased  in  quantity  and  be- 
comes thick  and  ropy,  and  the  breath  is  excessively  offensive.  The  sali- 
vary glands  become  inflamed,  and  the  soft  parts  of  the  jaw  may  even 
become  ulcerated,  and  bleed  more  or  less  constantly.  In  some  cases 
there  is  a  necrosis  of  the  jaw  itself ;  and  in  all  cases  the  general  discom- 
fort, sleeplessness,  loss  of  blood,  and  bad  condition  of  the  tissues  produce 
great  weakness  and  emaciation,  and  sometimes  may  even  cause  death. 

(b)  General  Symptoms. — These  large  doses  of  mercury  always  impair 
the  general  health  and  nutrition  of  the  body.  The  patient  becomes 
anaemic,  loses  appetite,  becomes  emaciated  and  weak,  and  often  develops 
ulcers,  bed-sores,  and  the  like  upon  various  parts  of  the  body.  This  has 
been  called  mercurial  cachexia.  The  kidneys,  also,  are  apt  to  become  in- 
flamed, although  not  as  severely  as  in  acute  poisoning. 

(c)  Xervous  Symptoms. — Very  important  effects  are  produced  upon  the 
nervous  system,  especially  when  the  mercury  has  been  absorbed  slowly 
through  the  lungs.  Cases  of  this  are  very  common  in  persons  working 
in  mercury  mines,  in  the  manufacture  of  barometers  and  thermometers, 
in  plating  looking-glass,  in  furriers  and  hatters  working  in  fur  preserved 
by  mercurial  solutions,  and  others.  These  nervous  symptoms  sometimes 
occur  without  salivation,  and  occasionally  after  all  exposure  to  the  poison 
has  ceased. 

The  most  common  and  characteristic  symptom  is  the  mercurial 
tremor,  which  usually  comes  on  slowly  and  gradually,  although  occasion- 
ally it  may  appear  all  at  once,  as  after  a  fit  of  rage.  It  at  first  affects  the 
face  and  tongue,  though  but  slightly.  Then  it  attacks  the  arms,  espe- 
cially the  forearms,  and  finally  the  legs.  At  first  it  is  only  occasional, 
coming  on  most  markedly  after  exertion,  or  when  excited  for  any  cause. 
The  patient  is  not  quite  sure  of  his  hands.  They  move  by  jerks,  and 
not  slowly  and  steadily.  When  he  tries  to  drink  he  spills  the  water  and 
is  apt  to  miss  his  mouth,  while  after  he  has  once  taken  hold  of  anything 
it  is  hard  to  let  it  go. 

Then  his  legs  fail  to  serve  him  well ;  it  is  hard  to  walk  without  assist- 
ance, and  his  limbs  tremble  and  move  without  his  control.  His  tongue 
is  tremulous  and  his  speech  is  jerky,  hard  to  articulate  and  hard  to 
understand.  When  once  excited  the  tremor  is  hard  to  stop,  and  finally 
may  continue  all  the  time,  only  lessening,  though  not  stopping  entirely, 
during  sleep.  The  muscles  become  weak,  although  not  losing  their 
power  of  reacting  with  electricity.  These  motor  disturbances  may  in- 
crease to  partial  paralysis. 

Along  with  this,  or  sometimes  before  it,  there  are  some  psychical 


398  A   SYSTEM  OF  LEGAL  MEDICINE. 

symptoms,  i.e.,  the  patients  become  irritable  and  sleepless,  and  find  it 
hard  to  fix  their  attention  on  anything.  They  may  even  develop  symp- 
toms of  mental  disorder;  sometimes  they  have  hallucinations,  or  even 
outbreaks,  as  in  mild  forms  of  mania;  other  cases  become  extremely 
stupid,  almost  idiotic. 

The  sensation,  also,  is  almost  always  more  or  less  disturbed.  Some- 
times there  is  a  tickling  feeling  on  the  limbs,  even  marked  neuralgia. 
At  other  times  there  is  more  or  less  anaesthesia,  sometimes  over  half  the 
body,  but  generally  in  patches. 

The  eyes  are  very  commonly  affected,  and  there  is  occasionally  more 
or  less  deafness,  and  even  aphasia.  Sometimes  the  disturbances  are 
confined  to  some  part  of  the  body,  one  arm,  or  a  foot,  for  instance,  spe- 
cially exposed  to  the  metal.     This,  however,  is  rare. 

Cases  of  Chronic  Mercurial  Poisoning. — A  remarkable  and  often 
quoted  instance  of  this  chronic  poisoning  on  a  large  scale  is  that  of  the 
British  man-of-war,  the  Triumph,  which,  off  Cadiz  in  1810,  stowed  in  her 
hold  one  hundred  and  thirty  tons  of  quicksilver  saved  from  a  wreck. 
The  packages  broke,  and,  as  the  weather  was  hot,  the  ship  was  permeated 
with  the  vapor  of  mercury.  In  three  weeks  over  two  hundred  men  were 
ill  with  salivation,  ulceration  of  the  mouth,  diarrhoea,  and  partial  paral- 
ysis. Two  men  died  of  gangrene  of  the  jaw  and  mouth,  and  three 
others  of  consumption,  although  they  had  not  previously  been  suffering 
from  that  disease ;  while  others  lost  teeth  and  pieces  of  the  jaw,  or  suffered 
fi'om  more  or  less  chronic  nervous  symptoms.  Almost  all  the  stock  on 
the  vessel  died,  cats,  mice,  a  dog,  and  even  a  canary  bird. 

An  interesting  account  is  given  by  Dr.  Adler  {Med.  News,  1891,  vol.  lix., 
p.  186)  of  five  cases  of  chronic  poisoning  among  workmen  in  a  hat 
factory.  One  of  these,  a  man  of  forty-five  years,  had  worked  for  nine 
years  in  the  factory  and  had  been  sick  for  over  a  year.  He  first  noticed 
the  usual  signs  of  salivation,  which,  however,  did  not  become  very  severe. 
Then  his  hands  became  tremulous  and  unsteady,  so  that  he  could  not 
read  his  newspaper.  His  eyes,  too,  began  to  trouble  him  ;  black  spots 
would  dance  before  him,  and  they  would  keep  twitching.  His  gait  was 
next  affected ;  he  was  unsteady  on  his  feet  and  staggered  as  though  in- 
toxicated. Then  his  appetite  failed ;  he  lost  his  sexual  power ;  he  became 
emaciated,  losing  twenty-five  pounds  or  so  in  six  months,  and  he  had 
occasional  vertigo.     There  was  a  blue  line  on  his  gums. 

Another  of  these  patients  was  a  boy  of  fourteen  years,  who  had  been 
in  the  shop  one  year  and  had  not  been  affected  until  about  foxu'  months 
before.  He  then  began  to  lose  his  memory  and  to  suffer  from  headaches  ; 
his  breath  was  affected,  and  he  had  symptoms  of  salivation.  In  about  a 
month's  time  he  found  it  hard  to  walk ;  his  feet  felt  heavy,  like  lumps  of 
lead.  He  then  found  it  hard  to  pick  up  things  from  the  ground,  was 
slow  to  drop  a  pencil  when  he  held  it,  and  so  on.  When  he  came  under 
treatment  there  was  a  marked  tremor,  and  much  ataxia,  especially  in  Ins 
arms  and  shoulders. 

In  another  case  (Dr.  Thiroloix,  Gaz.  des  Hop.,  1891,  vol.  lxiv.,  p.  417) 
similar  symptoms  were  produced,  in  an  attendant  in  a  shooting-gallery, 
by  the  fumes  of  the  fulminate  of  mercury  used  in  the  cartridges.  They 
are  believed,  also,  to  have  been  caused  (Dr.  Buckley,  Jour.  A.  Y.  Med. 
Ass'n.,  1884,  vol.  i.,  p.  127)  by  the  use  of  rubber  teeth-plates  colored  with 
cinnabar. 


INORGANIC  POISONS.  399 

Nerve  Lesions. — Some  authors  claim  that  the  above  nervous  symp- 
toms are  due  to  the  action  of  mercury  upon  the  brain  and  cord.  On  the 
other  hand,  Letulle  {Archie,  de  Physiol.,  1887,  pp.  301,  437)  has  observed 
degenerations  of  the  sheaths  of  the  peripheral  nerves,  although  he  claims 
that  the  axis  cylinders  remain  intact.  This  would  correspond  with  the 
action  of  other  poisons,  alcohol,  arsenic,  and  lead,  and  would  show  that 
the  effects  are  due  to  a  progressive  peripheral  neuritis. 

Mercurial  Hysteria. — It  is  only  proper  to  say,  in  this  connection, 
that  prominent  neurologists  of  the  Paris  school  claim  that  in  many  cases 
the  nervrms  symptoms  of  chronic  mercury,  and  also  of  lead,  poisoning, 
are  exaggerations  of  previously  existing  hysteria,  and  that,  having  pro- 
duced no  true  nerve  lesions,  they  may  be  cured  by  suggestion.  They 
give  instances  not  oidy  of  tremor,  but  also  of  mercurial  hemiplegia, 
hemianaesthesia,  amblyopia,  and  even  of  apoplexy,  which,  they  state,  are 
•of  an  hysterical  character,  and,  while  not  producing  death,  are  often  very 
hard  to  cure  by  ordinary  treatment.  They  carefully  distinguish  these 
from  other  cases  of  severe  nervous  disease,  which  rapidly  leads  to  paral- 
ysis and  death,  and  which  results  from  exposure,  as  in  the  mercury  mines, 
to  large  amounts  of  mercury  vapor. 

A  curious  case  of  this  sort  is  given,  in  great  detail,  by  Dr.  Letulle 
{France  MM.,  1888,  part  ii.,  pp.  1578,  1589),  of  a  workman  who  was  ex- 
posed to  mercury  fumes  for  ten  years,  aud  at  last  came  down  with  mod- 
erately severe  palsy  in  his  arms.  He  returned  to  his  work  partially  cured, 
after  a  six- weeks  treatment  at  the  hospital  with  the  ordinary  remedies, 
and  kept  on  for  five  years  more  without  much  trouble.  ,  Finally,  while 
at  work,  he  was  seized  with  violent  tremors  of  all  four  extremities,  fell 
down,  found  that  he  could  not  raise  himself,  and  was  carried  out  and 
driven  to  the  hospital. 

He  presented  very  marked  features  of  mercurial  palsy,  violent  tremors 
in  both  arms  and  legs,  anaesthesia  in  part  of  his  arm,  teeth  blackened  and 
striated  (a  symptom  noted  by  many  French  authors),  left  e}*e  somewhat 
affected.  He  was  unable  to  walk  without  the  greatest  effort,  and  after 
such  exertion  his  whole  body  was  set  trembling.  But  he  was  cured  of 
.all  his  nervous  symptoms  in  four  days,  on  the  application  by  Dr.  Letulle, 
with  a  certain  amount  of  formality,  of  a  tight  rubber  bandage  round  one 
arm,  followed  on  the  next  day  and  the  day  after  by  the  placing  of  a 
magnet  upon  his  shoulder,  and  again  on  his  thigh. 

Besides  the  above  reference,  the  reader  is  directed  to  another  paper 
by  Dr.  Letulle  (Soc.  Med.  des  Hop.,  1887,  vol.  iv.,  p.  370),  where  numerous 
examples  are  given  and  references  are  made  to  papers  by  Charcot,  Jean, 
and  others,  on  the  same  subject. 

Treatment. — In  other  countries  chronic  mercury  poisoning  is  treated 
by  less  striking  methods.  In  the  first  place,  the  patient  must  be  pre- 
vented from  absorbing  more  of  the  poison.  The  mouth  symptoms,  sali- 
vation and  the  like,  are  controlled  by  washes  of  potassic  chlorate,  and 
by  small  doses  of  the  same  salt  taken  internally.  The  nervous  symptoms 
are,  as  a  rule,  much  improved  and  in  many  cases  cured  by  galvanic  elec- 
tricity, while  the  mercury  in  the  system  is  removed  by  small  doses,  from 
two  to  three  grains,  of  potassium  iodide.  This  salt,  in  some  obscure  way, 
seems  to  dissolve  out  the  mercury  and  eliminate  it  through  the  kidneys ; 
but,  if  done  too  rapidly,  it  may,  by  throwing  large  quantities  of  poison 
into  the  blood,  aggravate  the  symptoms. 


400  A   SYSTEM  OF  LEGAL   MEDLCLNE. 

Elimination  of  Mercury. — This  is  done  principally  by  the  kidneys, 
and  also  largely  through  the  large  intestine  and  the  saliva.  Mercury  has 
been  found,  however,  in  the  sweat,  milk,  bile,  and,  in  fact,  all  the  secre- 
tions of  the  body.  It  has  been  found  in  the  urine  half  an  hour  after  a 
hypodermic  injection,  and  two  hours  after  a  dose  of  mercuric  chloride, 
taken  through  the  mouth. 

Experiments  on  animals  tend  to  show  that  when  a  single  dose  of  a 
mercury  salt  has  been  administered,  it  will  be  eliminated  from  the  body 
in  a  few  days.  When,  however,  a  patient  has  been  absorbing  mercury 
for  some  time,  it  may  remain  in  the  system  for  months  if  not  for  years. 

Calomel — Mercurous  Chloride — Hg2 Cl2. 

This  is  formed  by  subliming  mercurous  sulphate  with  common  salt. 
It  occurs  in  commerce  as  a  heavy  white  powder,  insoluble  in  cold  water. 
It  is  largely  used  in  medicine,  generally  in  small  but  occasionally  in  huge 
doses,  as  a  purgative  and  liver  tonic,  and  also  as  a  diuretic. 

As  a  rule  it  is  too  insoluble  to  produce  any  severe  effects,  and  doses 
of  an  ounce  and  more  act  no  more  powerfully  than  those  of  a  few  grains. 
Occasionally,  however,  whether  from  some  idiosyncrasy  in  the  patient, 
some  impurity  in  the  medicine,  or  some  change  in  its  composition  set  up 
inside  the  body,  quite  small  amounts  of  calomel,  five  or  six  grains,  in 
some  cases,  have  produced  marked  salivation  and  even  death. 

Corrosive  Sublimate — Mercuric  Chloride — Bichloride  of  Mercury — HgCl. 

This  is  the  most  powerful  and  most  important  of  the  corrosive  salts 
of  mercury,  among  which  are  included  other  mercuric  compounds,  the 
nitrate,  sulphate,  and  the  like,  and  also  " turpeth-mineral "  and  "white 
precipitate."  These  compounds,  when  taken  in  small  doses  for  some  time, 
will  set  up  the  constitutional  effects  of  mercury  described  above.  But 
when  administered  in  any  quantity,  they  have  an  irritant  and  even  cor- 
rosive action  both  upon  the  mucous  membranes  with  which  they  come 
in  contact,  and  also  upon  the  organs  through  which  they  are  excreted. 

Corrosive  sublimate  occurs  in  commerce  as  a  white  crystalline  solid 
or  powder,  with  a  peculiar  metallic  taste,  and  soluble  in  sixteen  parts  of 
cold,  and  three  parts  of  boiling,  water.  It  can  readily  be  distinguished 
from  other  salts,  by  forming  a  brilliant  scarlet  precipitate  with  potassium 
iodide ;  and  even  minute  quantities  can  be  identified  by  heating  them  in 
a  small  reduction-tube  and  moistening  the  white  sublimate  with  a  little 
iodide. 

Symptoms,  when  taken  Internally. — When  swallowed  in  any  quan- 
tity the  patient  notices  at  once  the  characteristic  taste,  and  a  sense  of  con- 
striction about  the  throat.  The  throat  and  mouth  become  very  sore  and 
painful,  and  the  mucous  membranes  look  white  and  shriveled.  This  is 
soon  followed  by  pain  in  the  stomach,  and  then  by  nausea  and  violent 
vomiting,  the  vomited  matter  being  frequently  stained  with  blood.  There 
is  severe  purging,  often  of  blood}'  material,  and  the  abdomen  becomes 
painful  to  the  touch.  Sometimes  there  is  profuse  hemorrhage  from  the 
bowels,  or,  occasionally,  from  the  stomach. 

Along  with  these  symptoms  come  those  of  marked  collapse,  a  feeble. 


INORGANIC  POISONS.  401 

rapid  pulse,  cold  sweat,  difficult  breathing',  faintness,  stupor,  and  the  like. 
There  are  often  cramps  in  the  extremities,  thirst  is  intense,  and  the  urine 
is  scanty  or  even  suppressed. 

Time  of  Death. — Death  may  come  on  very  rapidly  from  suffocation, 
owing  to  corrosion  of  the  trachea  and  oedema  of  the  glottis.  As  a  rule, 
it  results  from  collapse,  in  a  state  of  coma,  or  preceded  sometimes  by 
convulsions,  in  the  course  of  from  one  to  three  days.  After  this  time  the 
symptoms  are  more  like  those  of  dysentery,  i.e.,  frequent  bloody  stools 
containing  often  shreds  of  bloody  mucus,  and  accompanied  with  much 
straining.  The  kidneys  are  much  affected,  while  the  case  is  apt  to  be 
complicated  with  salivation,  and  even  by  the  nervous  symptoms  due  to 
mercury. 

The  shortest  period  of  death  in  the  case  of  an  adult  is  given  by  Tay- 
lor as  half  an  hour.  He  also  quotes  another  case  of  death  in  three  and  a 
half  hours.  Protracted  cases  of  six,  eight,  and  ten  days,  or  even  of  some 
weeks,  are  not  rare. 

Fatal  Dose. — Not  a  few  cases  have  been  reported  where  adults  have 
died  from  doses  varying  from  five  to  ten  grains,  and  Taylor  states  that, 
under  favorable  circumstances,  death  might  result  from  doses  of  from 
three  to  five  grains. 

On  the  other  hand,  with  proper  treatment,  patients  have  recovered 
from  much  larger  doses.  For  instance,  Dr.  Lodge  {Brit  Med.  Jour.,  1888, 
part  ii.,  p.  720)  tells  of  a  man  who  ran  into  his  office  ten  minutes  after 
drinking  a  solution  of  one  hundred  grains  of  bichloride.  He  had  already 
drunk  a  pint  of  milk,  and  the  doctor,  after  washing  out  his  stomach  with 
warm  water  and  an  emetic,  and  giving  egg  albumen,  had  him  put  to  bed 
in  hot  blankets.  He  suffered  from  a  slight  collapse,  and  next  day  from 
dysenteric  symptoms,  but  was  all  well  in  a  fortnight. 

Treatment. — Mercury  forms  insoluble  compounds  with  albuminous 
bodies,  and  hence  the  best  antidotes  are  milk  and  white  of  eggs.  The 
stomach,  of  course,  must  be  well  washed  out,  and  the  symptoms,  as  they 
occur,  treated  with  soothing  drinks,  morphine,  and  stimulants.  It  not 
infrequently  happens  that  the  symptoms  improve  for  a  while  only  to  re- 
turn with  greater  violence. 

Post=mortem  Appearances. — These  show  evidences  of  inflammation 
of  the  digestive  tract,  although  not  always  of  the  same  part.  Usually 
signs  of  softening,  congestion,  and  even  corrosion  of  the  mucous  mem- 
branes are  found  in  the  mouth,  throat,  and  stomach,  and  in  the  few  cases 
where  these  are  found  nearly  normal,  the  intestines,  and  especially  the 
large  intestine,  are  much  involved.  After  a  few  days  the  kidneys  become 
large  and  much  congested,  and  the  bladder  is  usually  contracted  and 
almost  or  quite  empty.  The  liver  is  not  affected  as  much  as  by  some 
other  poisons. 

Other  Irritant  Mercurial  Compounds. — Similar  effects  have  been 
produced  by  somewhat  larger  doses  of  other  salts  of  mercury,  as,  for  in- 
stance, mercuric  nitrate,  white  precipitate,  and  turpeth-mineral. 

Mercuric  nitrate  has  poisonous  qualities,  whether  taken  internally  or 
externally,  but  little  inferior  to  those  of  corrosive  sublimate.  It  has,  in- 
deed, been  used  as  a  means  of  attempted  poisoning. 

The  white  precipitate,  mercury-ammonium  chloride,  NHL,HgCl,  is 
largely  used  as  an  ointment,  and  as  such  is  a  mild  and  easy  form  of  ad- 
ministering mercury.     Internally,  however,  it  acts  as  an  irritant,  as,  for 


402  ^   SYSTEM   OF  LEGAL  MEDICINE. 

instance,  in  a  case  {Brit.  Med.  Jour.,  1885,  part  ii.,  p.  15)  where  a  drunken 
man,  drinking  forty  grains  of  it  in  water,  was  taken  violently  ill  in  half 
an  hour,  with  great  pain,  vomiting  blood  freely,  and  passing  bloody  stoolsr 
and,  in  spite  of  treatment,  died  of  collapse  in  five  hours.  A  case  of  re- 
covery from  twenty  grains,  where  the  early  symptoms  of  an  irritant  poi- 
son were  complicated  in  two-days  time  by  acute  mercurial  symptoms,  is 
given  by  Dr.  Sandberg  {Brit.  Med.  Jour.,  1889,  part  i.,  p.  709). 

Turpeth-mineral,  a  basic  sulphate  of  mercury,  HgS042HgO,  has  also 
been  the  cause  of  many  accidents,  especially  when  given  to  croupy  chil- 
dren as  an  emetic.  Cases  have  been  reported  {Med.  and  >Snr<j.  Rep.,  1884,. 
vol.  1.,  p.  93)  where  one  dose  of  three  grains  caused  severe  intestinal  symp- 
toms, and  two  similar  doses  produced  death.  Death  in  an  adult  has  been 
caused  by  forty  grains. 

External  Poisoning  by  Mercuric  Chloride. — It  has  long  been  known 
and  quoted  in  the  text-books  that  strong  solutions  or  mixtures,  ointments 
and  the  like,  of  corrosive  sublimate  might  cause  severe  illness,  and  even 
death,  if  freely  rubbed  into  a  raw  surface.  The  symptoms,  too,  in  these 
cases  much  resembled  those  when  the  poison  was  swallowed. 

Of  late  years,  however,  the  bichloride  has  been  used  very  largely  as 
an  antiseptic  dressing,  in  solutions  containing  from  one  to  ten  parts  in 
ten  thousand ;  and,  much  to  the  surprise  of  the  operators,  it  has  been 
found  that  even  such  extremely  diluted  solutions  are  liable  to  cause  seri- 
ous and  fatal  illnesses,  unless  used  with  considerable  care. 

The  most  marked  symptoms  are  an  obstinate  diarrhoea,  not  readily 
yielding  to  treatment,  and  in  severe  cases  followed  by  dysentery,  with 
severe  straining,  passing  of  blood  and  bloody  mucus,  and  the  like,  and 
by  death.  Along  with  these  are  usually  some  signs  of  salivation  and 
other  mouth  symptoms,  and  also,  to  a  marked  degree,  of  inflammation  of 
the  kidneys.  On  post-mortem  examination  there  is  found  in  the  large 
intestine  a  peculiar  diphtheritic  inflammation,  and  the  kidneys  are  much 
congested. 

These  cases  were  early  recognized  in  this  country  by  Dr.  Peabody, 
who  {Med.  Bee,  1885,  vol.  xxvii.,  p.  290)  gave  statistics  of  eleven  cases  of 
such  poisoning  which  had  occurred  in  the  previous  eighteen  months  at 
the  New  York  Hospital.  Seven  of  these  cases  were  fatal.  The  poison- 
ing is  also  quite  common  in  obstetrical  cases,  wherever  bichloride  solu- 
tions are  used  to  wash  out  the  uterus,  and  in  Obstetrical  Transactions 
(188G,  vol.  xxviii.,  p.  281,  and  1888,  vol.  xxx.,  p.  315)  are  to  be  found  de- 
tails of  numerous  cases,  and  also  some  interesting  discussions  on  the 
subject. 

It  is  generally  agreed,  at  present,  that  when  bichloride  irrigations  are 
used  they  must  not  be  too  strong,  and  the  parts  bathed  must  be  well 
drained.  They  should  never  be  given  when  the  kidneys  are  at  all  af- 
fected at  the  start.  They  must  be  stopped  directly  any  mouth  or  intes- 
tinal symptoms  are  noticed ;  and  the  bowels  should  be  kept  open  as 
freely  as  possible,  so  as  to  promote  the  excretion  of  the  mercury  by  means 
of  the  large  intestine. 

Tests  for  Mercury. — {a)  Sublimation  of  Metallic  Mercury. — If  a  sub- 
stance containing  mercury  or  one  of  its  salts  is  dried,  mixed  with  dry 
sodic  carbonate,  placed  in  a  reduction-tube,  and  heated  gently,  there  will 
form  a  ring  of  metallic  mercury  upon  a  cool  part  of  the  glass.  This  ring 
differs  from  the  similar  sublimates  of  arsenic  and  bismuth  by  being 


INORGANIC  POISONS.  403 

composed  of  small,  spherical,  bright  globules.  If  the  quantity  of  mer- 
cury is  very  small  it  is  best  to  do  this  sublimation  in  a  little  subliming 
cell,  and  to  condense  the  metal  upon  a  flat  cover-glass,  when  it  can  be 
more  easily  studied  under  the  microscope. 

If  a  crystal  of  iodine  be  placed  in  the  reduction-tube  or  the  subliming- 
cell  after  the  sublimate  has  formed,  the  latter  will  slowly  turn  yellow,  and 
then  scarlet,  from  the  formation  of  mercuric  iodide. 

(b)  Reinserts  Test. — If  the  metal  is  in  solution,  it  is  most  easily  ex- 
tracted by  adding  hydrochloric  acid  to  it  and  boiling  it  with  a  strip  of 
bright  copper.  The  gray  deposit  thus  formed  must  be  washed,  dried, 
and  heated  in  a  small  reduction-tube,  and  the  sublimate  of  metallic  mer- 
cury recognized,  as  before,  by  consisting  of  globules  and  turning  red 
with  iodine. 

By  careful  manipulation  Wormley  has  recognized,  in  this  way,  the 
presence  of  1-500,000  of  a  grain  of  corrosive  sublimate. 

(e)  Gold  Test. — This  test  may  be  modified  by  using  a  strip  of  gold  in- 
stead of  copper.  This  will  form  an  amalgam  with  the  mercury,  and  the 
amount  of  the  latter  may  be  easily  obtained  by  drying  and  weighing  the 
amalgam,  and  then,  after  driving  off  the  mercury  by  heat,  weighing  the 
gold. 

(d)  Sulphureted  Hydrogen. — This  gas  will  give  a  deposit  of  mercuric 
sulphide,  a  black  powder,  insoluble  in  caustic  alkalies,  alkaline  sulphides, 
and  hot  or  cold  nitric  or  hydrochloric  acids.  It  dissolves  readily  in 
aqua  regia,  with  separation  of  the  sulphur  as  a  yellow,  sticky  mass. 

This  sulphide,  dried  at  110°  C,  and  weighed  in  a  filter  of  known 
weight,  is  a  convenient  form  for  determining  the  quantity  of  mercury. 

Tests  for  Mercuric  Chloride.— If  it  is  desired  to  test  for  corrosive 
sublimate  it  is  best  to  boil  the  suspected  substance  well  with  water,  and 
strain  and  filter  it;  and  then  to  shake  the  filtrate  with  ether,  in  which 
the  bichloride  is  soluble,  and  the  common  alkaline  chlorides  are  not.  The 
ether  can  then  be  allowed  to  evaporate,  and  the  chlorine  in  the  residue 
determined  with  argentic  nitrate.  It  is  possible,  also,  to  recognize  the 
crystals  of  the  bichloride  under  the  microscope. 

Separation  from  the  Tissues.— This  is  best  done,  as  in  the  case  of 
the  other  metals,  by  disintegrating  the  tissues  with  hydrochloric  acid  and 
chlorate  of  potash,  and  precipitating  the  metal  as  sulphide.  This  can  be 
tested,  as  before,  for  mercury,  or  may  be  dissolved  in  aqua  regia,  evapo- 
rated to  dryness,  taken  up  with  water  and  hydrochloric  acid,  and  repre- 
cipitated  with  sulphureted  hydrogen  and  weighed. 

It  should  be  remembered  in  this  connection,  that  mercury,  in  acute 
cases,  leaves  the  body  quite  rapidly  by  means  of  the  kidneys,  liver,  mouth, 
and  intestines,  and,  according  to  some  of  the  best  authorities,  may  be 
absent  from  the  body  in  the  course  of  four  or  five  days.  It  would  prob- 
ably be  found  in  the  liver  and  kidneys  after  it  had  disappeared  from  the 
stomach  and  even  the  intestines. 

Nor,  on  the  other  hand,  should  the  presence  of  mercury  in  a  body  be 
considered  of  much  importance  unless  strong  evidence  could  be  obtained 
that  the  metal  had  not  been  administered  as  a  drug  for,  at  any  rate, 
several  days,  if  not  several  weeks  or  months,  before.  It  is  not  uncommon 
to  find  mercury  present  in  cadavers,  and  it  is  not  known  how  long  after 
a  prolonged  course  of  mercury  traces  of  it  may  still  remain  in  the  system. 


404  ^   SYSTEM   OF  LEGAL   MEDICINE. 


IX.      COPPER,   CU. 

The  above  element,  in  a  more  or  less  pure  state,  was  probably  the 
first  metal  ever  made  nse  of  by  man. 

Occurrence. — It  occurs,  sometimes  in  large  quantities,  native,  but  is 
usually  extracted  from  its  ores,  carbonates  and  oxides,  and  especially  the 
more  or  less  impure  sulphides,  of  copper.  In  small  quantities  it  is  very 
widely  distributed  in  the  mineral  kingdom,  being  found  in  many  miner- 
als, rocks,  and  soils,  and  also  in  many  natural  waters.  From  these  it  gets 
into  plants,  and  has  been  found,  sometimes  in  considerable  quantities, 
in  certain  special  varieties  of  flowers  grown  on  soils  in  copper  regions, 
and  in  minute  traces,  in  most  common  vegetables  and  cereals. 

It  has  been  often  found  in  wheat,  barley,  etc.,  and  hence  in  bread, 
and  also  in  roots  like  turnips,  mangels,  and  the  like,  as  well  as  in  the 
leaves  and  stems  of  these  and  many  other  plants.  It  has  been  recog- 
nized, too,  in  drugs,  such  as  quinine,  and  in  quite  large  amounts  (Gautier) 
in  the  inferior  grades  of  chocolate  and  cocoa.  Hence  it  is  absorbed  into 
animals,  and  besides  being  constantly  present  in  the  blood  of  lower  ani- 
mals, it  is  frequently,  if  not  always,  present  in  the  flesh  and  organs  of 
ordinary  food  animals  and  of  man.  Taylor  tells  of  finding  copper  in  a 
mutton  chop  bought  at  random  at  a  butcher's  shop,  and  Dupre,  Bergeron, 
and  others  have  found  it,  generally  in  weighable  quantities  (one  thirtieth 
of  a  grain  or  so),  in  the  livers,  as  well  as  the  kidneys,  of  many  human 
corpses  which  they  examined. 

Properties. — Copper  is  a  reddish,  heavy  metal,  melting  at  a  high 
temperature,  soft,  malleable,  and  ductile.  It  has  a  metallic  taste,  and 
some  odor.  In  moist  air  it  slowly  tarnishes,  becoming  covered  with 
oxide.  It  dissolves  in  hot  sulphuric  acid,  forming  cupric  sulphate  or 
blue  vitriol,  and  sulphurous  oxide.  It  is  easily  soluble  in  nitric  acid,  and 
although  more  slowly,  in  hydrochloric  acid  aud  ammonia,  especially  if 
air  be  present. 

Toxicology. — From  the  earliest  ages  metallic  copper  has  been  used 
for  making  pots  and  kettles  in  which  articles  of  food  were  to  be  pre- 
pared. Homer,  for  instance,  describes  the  great  copper  bowls  offered  as 
prizes  to  the  Grecian  heroes  in  their  games.  And  in  the  Bible  there  are 
not  only,  in  Exodus,  descriptions  of  the  sacred  u  vessels  of  the  altar,  the 
pots,  and  the  shovels,  and  the  basins,  and  the  flesh-hooks  and  the  fire- 
pans "  being  made  of  "  brass,"  but  also,  in  the  Book  of  Leviticus,  directions 
are  given  about  meat  "  sodden  in  vessels  of  brass." 

Nor  was  any  objection  made  either  then,  or  by  the  Greeks  and 
Romans,  or  through  the  long  middle  ages,  to  any  poisonous  properties 
of  the  metal  thus  used  until  the  eighteenth  century,  when  in  1722  one 
Sehulze  published  a  book  about  it.  His  arguments  were  attacked  and 
refuted  by  Dr.  Eller,  a  very  prominent  physician,  some  thirty  years  later, 
but  soon  afterward  were  repeated,  with  embellishments,  by  J.  J.  Rousseau, 
the  half -crazy,  egotistical  "philosopher  of  reason,"  who  was  at  the  height 
of  fashion  in  France  at  the  time.  Thanks  to  him,  a  battery  of  iron  cook- 
ing-utensils was  made  for  the  royal  family,  and  this  example  was  followed 
by  many  prominent  members  of  the  court. 

In  England  the  fashion  of  objecting  to  copper  cooking-utensils  dates 
from  1774,  when  Dr.  Falconer,  a  well-known  physician,  published  a  book 


INORGANIC  POISONS.  405 

on  the  subject  in  London.  Ever  since  the  beginning  of  the  century  copper 
has  been  under  a  ban.  Almost  all  the  prominent  authorities  on  the  sub- 
ject of  poisons,  from  Orfila  and  Tardieu  to  Taylor  and  Wormley,  in  eveiy 
country,  have  accepted  the  statements  of  Rousseau,  Falconer,  and  the  rest 
as  true,  and  have  added  further  evidence.  In  some  countries  legislation 
has  been  invoked  occasionally  against  the  use  of  copper  saucepans  and 
the  like  without  tinning,  and  frequently  against  the  preparation  and  sale 
of  vegetables,  and  other  articles  of  food,  containing  perceptible  traces  of 
the  metal. 

This  last  matter  has  proved  extremely  serious  in  France,  where  enor- 
mous quantities  of  small  vegetables  are  put  up  in  cans  and  glass,  and 
where  for  a  long  time  the  manufacturers  have  been  accustomed  to  obtain 
the  fine  green  color,  resembling  the  natural  appearance,  by  the  use  of 
small  amounts  of  copper.  Accordingly  the  subject  has  been  thoroughly 
investigated  of  late  years,  and  proof  has  been  presented,  both  by  French 
and  Belgian  scientific  men,  that  the  toxic  effects  of  copper  have  been 
enormously  exaggerated,  and  that  neither  copper  itself  nor  its  com- 
pounds are  to  be  considered  as  poisonous,  except  when  in  very  large 
doses. 

Among  the  most  interesting  papers  on  this  subject  are  those  bv  Dr. 
Galippe  [Ann.  d'Hyg.,  1878,  vol.  1.,  p.  426 ;  Compt.  Rend.  8oc.  de  Biol, 
1884,  p.  718)  and  by  Professor  du  Moulin,  in  the  discussions  on  the 
poisonous  properties  of  copper  (Bull.  Acad,  de  Med.  Belgique,  1885, 
vol.  xix.,  pp.  753,  813,  859).  Dr.  Galippe  made  experiments,  first  on  him- 
self and  later  on  his  family  and  friends,  for  fourteen  months,  using  in  his 
kitchen  nothing  but  copper  utensils.  He  not  only  prepared  fish  and 
other  salty  food,  and  even  acid  foods  like  sauerkraut,  in  copper  sauce- 
pans, but  let  them  cool  in  them,  exposed  to  the  air,  and  partook  of  the 
results.  In  one  case  he  prepared  a  sort  of  custard,  made  of  sour  milk 
and  eggs,  after  a  recipe  furnished  by  an  American  doctor  who  reported 
a  case  of  poisoning  from  it,  and  ate  that. 

In  no  single  instance  did  he  or  any  member  of  his  family  suffer  any 
effects,  although,  as  in  the  last-mentioned  experiment,  the  food  often 
looked  and  tasted  strongly  of  copper.  Indeed,  he  states  that  the  taste 
of  copper  would  make  the  food  extremely  unpalatable  long  before  it 
would  give  symptoms  of  even  nausea. 

Dr.  du  Moulin  thoroughly  corroborates  Dr.  Galippe,  having  made 
experiments  not  only  on  himself  and  family,  but  also  upon  dogs  and  rab- 
bits. Indeed,  from  these  last  experiments  he  states  that  it  was  impossi- 
ble to  kill  dogs  even  with  very  large  doses  of  copper  salts,  and  that  he 
doubts  if  copper  or  its  salts  can,  under  any  circumstances,  be  considered 
as  a  poison. 

A  still  more  interesting  view  of  the  subject  is  given  (Jour.  d'Hi/ij.. 
1879,  vol.  iv.,  pp.  160,  170)  by  Dr.  Houles,  who  studied  thoroughly  the 
conditions  of  life  in  a  whole  village  full  of  copper-workers.  The  latter, 
descendants  of  English  marauders,  have  for  nearly  five  hundred  years 
been  engaged,  from  father  to  son,  in  rolling,  hammering,  and  polishing 
copper  boilers,  kettles,  and  the  like.  They  have  long  hours  of  work, 
eleven  to  thirteen  hours  a  day,  year  in  and  year  out,  during  which  they 
are  breathing  an  atmosphere  full  of  particles  of  copper  oxide.  They  have 
greenish  lines  on  their  teeth,  green  color  in  their  hair,  a  green  tinge  on 
their  forearms.     Copper  is  found  in  their  secretions,  and  even  after  death 


406  A   SYSTEM  OF  LEGAL  MEDICINE. 

their  bones  can  be  distinguished  from  those  of  the  farming  community 
near  them  by  the  green  coloration. 

Nevertheless,  although  not  robust-looking  they  are  strong  and  tough, 
suffer  from  no  special  diseases,  and  are  unusually  long-lived.  Of  three 
hundred  and  forty  deaths  occurring  in  the  last  hundred  years  among  the 
copper  workers,  the  average  life  was  nearly  sixty  years  (59.63),  and  forty 
died  over  eighty  years  old.  The  only  peculiarities  noticed  were  that  they 
were  almost  all  deaf,  probably  from  the  incessant  noise  of  hammering ; 
that  those  with  weak  lungs  were  apt  to  be  troubled  by  asthma  in  the 
winter  time,  when  the  shops  are  badly  ventilated ;  and  that  when  the 
boys  begin  to  work,  at  twelve  or  thirteen  years  old,  there  is  apt  to  be  a 
little  vomiting,  which  wears  off  in  a  day  or  two.  If  they  begin  late  in 
life  they  may  have  to  give  up  work  on  account  of  the  nausea  and  vomit- 
ing.    This,  however,  is  rare. 

As  a  result  of  the  discussion  and  investigation  of  the  subject,  the 
French  Government,  in  1889,  revoked  the  laws  about  coloring  peas  and 
other  vegetables  by  boiling  them  in  copper  vessels.  And,  in  short,  with 
all  due  respect  to  the  many  authorities  who  have  claimed  the  contrary, 
it  would  seem  as  though  it  has  been  fairly  proved  that  the  absorption  of 
small  amounts  of  copper  is  not  to  be  considered  as  dangerous,  and  cer- 
tainly not  as  a  cause  of  death.  (For  a  case  of  this  sort  based  on  very 
slender  evidence,  see  Taylor,  Gwfs  Hospital  Reports,  1866,  p.  329.) 


Cupric  Sulphate — Blue  Vitriol — CuSOi. 

This  is  the  salt  of  copper  most  commonly  met  with  in  the  arts  and  in 
medicine,  and  occurs  as  blue  transparent  crystals  or  crystalline  frag- 
ments, slightly  efflorescent,  and  readily  soluble  in  water. 

Symptoms. — Externally  the  compound  acts  as  a  mild  stimulant  or 
irritant.  Internally,  in  doses  from  ten  to  fifteen  grains,  it  acts  promptly 
and  rapidly,  as  a  rule  as  an  irritant  emetic.  In  still  larger  quantities  it 
acts  as  an  irritant  poison,  producing  in  a  short  time  nausea,  vomiting, 
and  purging,  with  bluish  or  greenish  vomit  and  excreta  and  considerable 
pain  and  colic. 

There  are  often  quite  marked  nervous  symptoms,  convulsions,  delir- 
ium, paralysis,  and  the  like,  or  disturbances  of  sensation,  while  among 
later  symptoms  are  apt  to  occur  inflammation  of  the  liver  and  kidneys. 

The  blood  occasionally  is  very  much  affected,  as,  for  instance,  in  a  very 
striking  case  reported  by  Dr.  Starr  (Med.  Rec,  1882,  vol.  xxi.,  p.  564).  A 
healthy  woman,  forty-six  years  old,  took  about  an  ounce  of  the  salt 
dissolved  in  tea,  for  suicide.  Almost  at  once  she  felt  burning  pains  in 
her  stomach  and  all  over  her  body,  and  in  a  few  minutes  vomited  and 
became  very  weak,  with  severe  pains  and  cramps.  She  was  given  stim- 
ulants and  emetics,  and  in  two  hours  was  taken  fo  the  hospital.  She 
was  then  unable  to  walk  or  stand  from  weakness.  Her  pulse  and  respi- 
ration were  good,  her  skin  cool  and  dry ;  she  complained  of  weakness  and 
cramps  in  the  stomach. 

She  was  treated  with  stomach-pump,  antidotes,  purgatives,  and  milk 
diet,  and  improved  next  day.  By  the  second  day  her  stomach  seemed  in 
good  condition,  though  the  intestines  were  still  inflamed,  but  she  began 
to  pass  considerable  amounts  of  dark  inky  urine  containing  much  ha?mo- 


INORGANIC  POISONS.  407 

globin  and  black  granular  matter,  some  in  the  form  of  casts,  with  epi- 
thelial casts,  kidney  cells,  and  albumen.  The  third  day  she  became- 
jaundiced,  and  her  urine  remained  the  same,  although  in  other  respects 
the  patient  was  better.  But  on  the  fourth  day  she  was  worse,  became 
stupid,  sleepy,  with,  later,  general  paresis,  and  after  lying  for  several 
hours  in  a  comatose  condition  died  in  four  and  a  quarter  days  from  the 
fatal  dose. 

Post-mortem  examination  showed  that  the  blood,  all  over  the  body, 
was  firmly  coagulated,  and  of  a  chocolate  color.  There  was  only  a  little 
congestion  in  the  stomach  and  upper  part  of  the  intestines,  but  the  ileum 
and  large  intestine  were  considerably  ulcerated  and  inflamed.  The  liver 
was  fatty,  and  the  kidneys  were  somewhat  swollen,  with  tubules  filled 
with  altered  blood.  It  was  thought  that  death,  and  possibly  the  jaun- 
dice, had  been  caused  by  the  alteration  of  the  haemoglobin. 

This  post-mortem  appearance  differs  from  those  usually  reported,  not 
only  in  the  condition  of  the  blood,  but  also  in  the  absence  of  more  marked 
stomach  lesions.  This  was  probably  due  to  the  prompt  and  thorough 
treatment  in  the  hospital. 

Verdigris. 

This,  an  impure  sub-acetate  of  copper,  is  largely  manufactured  for 
paint,  and  is  often  formed  in  small  quantities  when  sour  or  decomposing 
food  is  cooked  or  allowed  to  stand  in  copper  vessels.  Its  effects  are 
similar  to,  though  less  marked  than,  those  of  cupric  sulphate  just  de- 
scribed.    It  is  partly  soluble  in  water,  and  wholly  so  in  the  mineral  acids. 

Antidotes  and  treatment. — A  very  excellent  antidote,  if  it  can  be 
obtained  pure,  is  the  yellow  prussiate,  or  ferrocyanide,  of  potash,  which 
forms  a  brown,  inert  precipitate  with  copper.  The  metal  is  also  de- 
posited, in  a  more  or  less  insoluble  form,  by  milk,  white  of  egg,  and  other 
albuminous  solutions.     The  treatment  must  be  directed  at  the  symptoms. 

Dangerous  and  Fatal  Doses. — These  have  not  been  accurately  deter- 
mined, and,  as  a  rule,  must  be  considered  large,  probably  from  half  an 
ounce  to  an  ounce.  Medicinally,  doses  of  from  sixty  to  one  hundred 
grains  of  the  sulphate  have  been  given  to  children,  three  to  six  years  old, 
in  cases  of  croup  and  the  like,  in  the  course  of  five  or  six  days,  without 
any  evil  effects  beyond  some  vomiting  and  nausea,  or  perhaps  a  slight 
purging. 

The  shortest  time  of  death  yet  reported  is  in  the  case  of  a  child  six- 
teen months  old,  who  amused  herself  by  chewing  a  piece  of  blue  vitriol, 
given  her  to  play  with.  She  was  violently  sick  in  fifteen  minutes,  and 
died  in  four  hours  without  purging  and  without  convulsions. 

Tests  for  Copper. — It  is  very  easy  to  recognize  the  presence  of  cop- 
per, either  free  or  in  combination.  The  metal  is  easily  dissolved  by 
nitric  acid,  forming  a  blue  solution,  while  the  soluble  salts  are  all  either 
blue  or  green,  and  with  the  reducing-flame  of  the  blow-pipe  give  fine 
green  color  to  the  flame. 

(a)  Amnionic  Hydrate  in  excess  changes  these  salts  into  a  deep  blue 
solution  of  cupric  hydrate  in  ammonia.  This  reaction,  in  (dear  and  not 
highly  colored  solutions,  is  very  marked,  and  will  serve  to  recognize  very 
minute  amounts  of  copper  (1-10,000  of  a  grain  of  cupric  sulphate — 
Wormley).     Salts  of  nickel  give  the  same  reaction. 


408  ^   SYSTEM   OF  LEGAL  MEDICINE. 

(b)  Ferrocyanide  of  Potash  forms,  with  solutions  of  copper,  a  reddish- 
brown  precipitate ;  or,  if  the  amount  of  metal  is  very  minute,  will  give  a 
reddish-brown  color  to  the  liquid.  This  precipitate  is  insoluble  in  acetic 
and  hydrochloric  acids,  but  dissolves  to  a  pale  green  liquid  in  ammonia. 
This  test  is  extremely  delicate,  even  more  so  than  the  former  one. 

(c)  Iron  Test. — Simpler,  and  in  some  respects  more  satisfactory,  than 
either  of  the  above  tests,  is  that  made  by  placing  a  piece  of  bright  iron 
or  steel  in  a  slightly  acid  solution  of  copper.  The  metal  will  then  be  de- 
posited in  a  brownish  or  reddish  film  upon  the  iron,  while  the  latter  will 
be  dissolved  in  corresponding  quantities.  In  very  dilute  solutions  the 
piece  of  iron  should  be  very  small,  a  needle,  for  instance,  and  in  all  cases 
the  deposit  should  be  tested,  as,  for  instance,  by  immersing  it  in  ammonia 
and  exposing  it  to  the  air,  and  seeing  if  it  gives  a  blue  solution.  The 
advantage  of  this  test  is  that  the  copper  is  extracted  in  a  metallic  state. 

(d)  Zinc  Test,  or  Galvanic  Test. — If  the  solution  containing  copper  be 
placed  in  a  bright  platinum  dish  and  a  piece  of  bright  zinc  immersed  in 
it  so  as  to  touch  the  bottom  of  the  dish,  a  spot  of  red  metallic  copper  will 
be  deposited  on  the  platinum. 

Or,  instead  of  that,  if  a  platinum  electrode  be  placed  in  it  and  con- 
nected with  the  copper  side  of  a  battery,  and  the  wire  from  the  zinc  side 
be  connected  with  the  dish,  the  copper  in  the  solution  will  be  deposited, 
in  the  course  of  twelve  or  twenty-four  hours,  upon  the  dish.  If  the  dish 
containing  this  deposit  be  carefully  washed,  dried,  and  weighed,  and, 
after  dissolving  out  the  copper  with  nitric  acid,  the  platinum  dish  is 
again  weighed  by  itself,  the  actual  amount  of  the  copper  can  be  readily 
determined. 

(e)  Sulphureted  Hydrogen  will  produce,  in  acid  solutions,  a  brownish 
or  brownish-black  precipitate  of  cupric  sulphide,  which  dissolves  readily 
in  hot  nitric  acid,  and  also,  to  some  extent,  in  hydrochloric  acid.  It  is 
slightly  soluble  in  an  excess  of  ammonium  sulphide,  but  is  insoluble  in 
the  fixed  alkaline  sulphides  and  in  the  caustic  alkalies. 

Hence,  if  present  in  the  precipitate  from  passing  the  gas  through 
solutions  of  arsenic  or  antimony,  it  can  be  separated  by  treating  them 
first  with  amnionic  hydrate,  to  dissolve  the  arsenious  sulphide,  and  then 
with  potassic  hydrate,  to  dissolve  the  antimonious  sulphide.  The  cupric 
sulphide  remaining  can  be  dissolved  in  nitric  acid  and  reprecipitated  by 
sodic  or  potassic  hydrate  as  cupric  hydrate,  which  can  be  washed,  ignited, 
and  weighed. 

Or  else  the  hydrate  can  be  dissolved  in  dilute  hydrochloric  acid,  and 
the  copper  precipitated,  and  weighed  as  metal,  by  the  galvanic  method 
above  described. 

Extraction  from  the  Tissues. — Under  these  circumstances  the  or- 
ganic matter  should  be  thoroughly  destroyed  by  boiling  with  strong 
nitric  acid  and  potassic  chlorate,  and  then  by  extracting,  if  necessary 
with  repeated  evaporations,  with  nitric  acid.  The  excess  of  acid  should 
be  evaporated  off,  and  the  residues,  which  should  no  longer  be  black, 
should  be  dissolved  in  some  hot  water,  containing,  if  necessary,  a  drop 
or  two  of  acid.     This  solution  can  then  be  tested  as  ah'eady  described. 


INORGANIC  POISONS.  4Q9 


X.     ZINC,  Rn. 

Metallic  zinc,  and  also  the  oxide  of  zinc,  seem  to  have  but  slight  if 
any  effects  upon  the  human  system,  and  so  our  attention  will  be  directed 
solely  to  the  sulphate  of  zinc,  or  white  vitriol,  and  to  zinc  chloride. 

Zinc  Sulphate— White  Vitriol— Zn  SO  ±. 

This  compound,  which  occurs,  when  pure,  in  large,  colorless  ciystals, 
easily  soluble  in  water,  and  with  a  peculiar,  styptic  taste,  is  quite  largely 
used  in  medicine.  In  weak  solutions  it  acts  as  a  mild  astringent,  and  in 
strong  solutions  as  a  mild  irritant.  Its  chief  value,  however,  depends 
upon  the  fact  that,  in  doses  of  twenty  or  thirty  grains,  it  acts  promptly 
and  efficiently  as  an  emetic,  without  much  depression. 

When  taken  in  large  quantities,  half  an  ounce  to  an  ounce,  it  may 
produce  serious  and  even,  on  rare  occasions,  fatal  results.  As  a  ride, 
the  symptoms  are  those  of  an  irritant  poison,  and  consist,  chiefly,  of 
violent  and  severe  vomiting  and  purging,  followed  by  prostration. 
Usually  the  poison  is  rejected  so  promptly  by  the  stomach  that  fatal 
results  do  not  occur,  and  recovery  has  taken  place  when  an  ounce  and 
more  of  the  salt  has  been  swallowed ;  while  if  death  does  result,  it  is 
almost  always  after  the  lapse  of  some  days,  from  the  exhaustion  pro- 
duced by  the  inflamed  condition  of  stomach  and  bowels. 

Occasionally,  however,  a  case  is  reported  where  the  drug  acts  upon  the 
central  nervous  system  directly.  Thus  Dr.  Penfold  {Austral.  Med.  Jour., 
1883,  vol.  v.,  p.  340)  tells  of  a  girl,  twenty-one  years  old,  who  on  going 
to  bed  took  a  dose  of  zinc  sulphate  to  produce  abortion.  Her  mother 
was  wakened  in  about  three  hours  and  a  half  by  the  girl's  groans  and 
screams,  and  started  to  get  her  some  water,  but  in  a  few  minutes  the 
girl  was  dead.     There  was  no  evidence  of  vomiting  or  purging. 

On  post-mortem  examination  all  the  organs,  heart,  lungs,  liver,  brain, 
kidneys,  and  spleen,  were  found  congested.  The  stomach  contained  half 
a  teacupful  of  yellowish  pasty  material,  which  proved  full  of  zinc,  while 
the  mucous  membrane  of  the  stomach  was  much  congested,  with  large 
patches  colored  brownish  black. 

As  an  antidote  to  zinc  it  is  well  to  give  infusions  of  tannin,  green  tea, 
and  the  like,  and  also  milk  and  solutions  of  albumen.  Emesis  should 
be  assisted  as  much  as  possible  by  flooding  the  stomach  with  warm 
water,  and  by  the  use  of  the  stomach-pump  if  necessary. 

Zinc  Chloride,  ZnCl2. 

Chloride  of  zinc  is  a  soft,  deliquescent  salt,  very  soluble  in  water, 
alcohol,  and  ether.  When  concentrated  it  is  a  powerful  caustic,  burning 
the  tissues  and  leaving  a  white,  odorless  scar.  Its  solutions  decompose 
rather  readily,  but  are  largely  used,  especially  in  England,  as  disinfect- 
ants, Burnett's  fluid,  one  of  the  best  known  of  these  solutions,  contain- 
ing over  fifty  percent,  of  the  dry  salt. 

In  medicine  it  is  largely  used  as  a  local  caustic,  for  destroying 
tumors,  cancers,  and  the  like,  and  is  considered  to  be  more  easily  con- 


410  ^   SYSTEM  OF  LEGAL   MEDICINE. 

trolled  than  potash,  and  far  less  dangerous  than  the  different  arsenical 
compounds.  Occasionally,  however,  enough  has  been  absorbed,  in  such 
a  way,  to  cause  death.  Thus,  iu  a  case  related  by  Dr.  Blyth,  a  woman 
died  after  an  application  to  a  cancerous  breast,  and  zinc  was  found  in 
the  liver. 

Another  case  is  recorded  by  Dr.  Fiiield  (Xeiv  York  Med.  Jour.,  188G, 
vol.  xliii.,  p.  442),  where  a  healthy  farmer  employed  a  neighboring  "  cancer 
doctor  "  to  burn  out  a  small  cancer  on  his  lip  with  a  zinc  chloride  paste. 
Two  hours  afterwards  the  farmer  became  extremely  drowsy  and  stupid, 
and  had  a  slight  epileptiform  convulsion.  Later  he  became  comatose, 
and  when  seen  in  about  four  hours  was  lying  on  the  bed  unconscious, 
with  complete  anaesthesia,  even  of  the  eyeballs,  with  one  pupil  contracted 
and  the  other  dilated.  He  was  unable  to  swallow,  and  what  treatment 
they  could  give  him  seemed  of  no  avail.  He  died,  still  unconscious,  in 
about  eight  hours  after  the  application  of  the  caustic.  Nothing  of  any 
consequence  could  be  observed  on  autopsy. 

Internal  Administration. — When  taken  internallv,  zinc  chloride,  if 
concentrated,  acts  as  a  caustic.  In  less  powerful  doses  it  produces  acute 
inflammation  of  the  digestive  tract,  and  also  certain  nervous  symptoms, 
twitchings,  cramps,  convulsions,  affections  of  the  eyesight,  aphonia,  and 
the  like.  Generally  the  symptoms  much  resemble  those  of  acute  min- 
eral-acid poisoning,  with  intense  pain  in  throat,  stomach,  and  abdomen, 
violent  and  often  bloody  vomiting  and,  later,  purging,  and  great  pros- 
tration. 

The  patients  die  usually  from  collapse,  as  a  rule  in  the  coarse  of  one 
or  two  days,  bat  occasionally  in  two  or  three  hours.  Iu  other  cases  the 
patients  recover  at  first,  but  die  later  from  secondary  complications,  strict- 
ure of  the  oesophagus,  duodenum,  and  the  like. 

In  one  very  curious  case  {Brit.  Med.  Jour.,  1887,  part  i.,  p.  1387)  a 
drunken  laborer  took  for  suicide  three  or  four  ounces  of  a  saturated  zinc 
chloride  solution.  He  suffered  terribly  at  first  from  pain  and  burning  in 
throat  and  stomach,  and  with  convulsions  and  epileptiform  fits  for  the 
first  two  days,  but  gradually  seemed  to  improve.  He  was  fed  for  some 
six  weeks  by  enemata,  but  then  was  able  to  take  quite  large  quantities  of 
milk  and  beef-tea,  and  from  that  time  up  to  the  tenth  week  he  increased 
in  weight  and  strength,  although  still  suffering  pain  under  the  sternum. 
Then  he  grew  weaker,  and  died  of  collapse  at  the  end  of  eleven  weeks. 

Post-mortem  examination  showed  that  his  stomach  had  been  entirely 
destroyed,  and  had  been  replaced,  for  the  few  inches  between  the  end 
of  the  oesophagus  and  the  beginning  of  the  duodenum,  by  an  "irregular, 
sausage-shaped  mass  of  organized,  inflammatory,  peritoneal  adhesions," 
composed  of  a  "  matting  of  the  gastro-hepatic  omentum  and  the  great 
omentum."  It  was  some  five  inches  long,  and  four  inches  in  circumfer- 
ence, and  the  walls  were  in  places  very  thin,  and  in  other  parts  a  half  or 
three  quarters  of  an  inch  thick. 

In  most  instances  the  fatal  cases  reported  have  been  due  to  persons 
accidentally  drinking  Burnett's  fluid,  or  some  other  solution  of  the  salt, 
and  thereby  taking  from  fifty  grains  to  an  ounce  or  so  of  dry  zinc  chlo- 
ride. According  to  Blyth,  death  has  been  caused  after  several  weeks' 
illness  by  six  grains.  The  treatment  would  consist  of  the  free  use  of 
emetics  and  of  mild  alkalies,  and- also  of  milk  and  albumen  solutions. 
The  collapse  would  be  treated  by  stimulants  and  heat. 


INORGANIC  POISONS.  411 

Post=mortem  Appearance. — The  principal  lesions  noticed  are  those 
resulting  from  the  inflammation  of  the  oesophagus,  stomach,  and  intes- 
tines. The  mucous  membranes  are  usually  much  congested  and  inflamed, 
and  may  be  ulcerated  or  corroded,  or  even  perforated.  Sometimes  the 
membrane  is  much  thickened  and  corrugated,  aud  may  have  a  yellowish 
color  instead  of  red  or  black.  In  long-continued  cases  there  is  apt  to  be 
some  thickening  and  constriction  of  the  duodenum  or  pylorus. 

Zinc  Chloride  in  Canned  Vegetables. — A  solution  of  zinc  in  hydro- 
chloric acid  is  not  infrequently  used  instead  of  borax  as  a  soldering  fluid, 
and,  when  carelessly  used  in  soldering  the  heads  on  cans  of  preserved 
vegetables  and  fruit,  it  is  not  impossible  that  it  may  cause  harm. 

An  interesting  case  of  this  sort,  which  actually  came  into  court,  is 
described  by  Dr.  Johnson  in  the  Sanitarian  (1884,  vol.  xii.,  p.  477),  and 
discussed  by  him  and  Dr.  Hammond  with  some  vigor  in  the  New  York 
Medical  Journal  (188G,  vol.  xliii.,  pp.  370,  471).  A  family  was  taken 
sick,  soon  after  eating  a  can  of  tomatoes,  with  severe  gastro-intestmal 
trouble,  which  became  very  serious  in  the  case  of  two  members  of  the 
family,  and  caused  chronic  intestinal  obstruction  in  the  eldest  daughter. 
The  tomatoes  were  not  spoiled,  nor  was  the  can  a  "  sweller,"  i.e.,  one 
that  had  fermented,  and  had  been  repunched  to  let  out  the  gas,  reboiled, 
and  then  resoldered.  On  looking  the  question  up,  however,  it  was  found 
that  the  heads  had  been  soldered,  with  the  use  of  zinc  chloride,  by  a  boy 
of  thirteen  years,  with  practically  no  experience. 

Suit  was  brought  against  the  wholesale  grocers  supplying  the  vegeta- 
bles, but  it  fell  through,  because  the  Brooklyn  Board  of  Health,  who  had 
taken  charge  of  the  case  at  the  time,  had  never  analyzed  either  the 
secretions  of  the  patients  or  the  remainder  of  the  tomatoes,  and  had 
thrown  the  tin  and  its  contents  away. 

Tests  for  Zinc. — Blow-pipe. — A  zinc  compound,  heated  on  charcoal 
with  the  oxidizing  blow-pipe  flame,  will,  after  the  moisture  has  been 
driven  off,  form  a  white  coating  on  the  coal,  and,  unless  heated  too  long, 
leave  a  yellowish- white  residue.  The  latter,  when  heated  with  a  drop  of 
cobaltic  nitrate  b}*  the  reducing-flame,  will,  when  cool,  turn  green. 

Sulphureted  Hydrogen. — When  this  gas  is  passed  through  an  alkaline 
or  neutral  solution  of  zinc,  it  will  form  a  white  precipitate  of  zinc  sul- 
phide, ZnS,  which  is  insoluble  in  alkalies  and  their  sulphides,  and  also  in 
acetic  acid,  but  dissolves  readily  in  the  mineral  acids.  The  same  precip- 
itate is  produced  by  ammonium  sulphide. 

To  prove  the  presence  of  zinc  in  the  precipitate  it  is  possible  to  dis- 
solve it  in  nitric  acid,  and  to  add  caustic  potash  in  excess  to  this  solution. 
The  resulting  precipitate  of  zinc  hydrate,  if  melted  on  platinum  foil  with 
a  drop  of  cobaltic  nitrate,  will  give  the  green  color  as  above. 

The  quantity  of  zinc  can  be  determined  by  dissolving  the  sulphide  in 
acid  and  precipitating  it  with  sodic  carbonate,  boiling  it  thoroughly  after 
the  precipitate  is  formed.  The  zinc  hydrate  is  then  filtered,  washed, 
dried,  ignited,  and  weighed  as  zinc  oxide,  ZnO. 

XI.     silver — Ag. 

Metallic  silver  seems  to  have  no  effect  upon  the  human  body,  but  one 
of  its  salts,  argentic  nitrate,  or  lunar  caustic,  as  it  is  frequently  called, 
is  a  violent  poison. 


412  J.   SYSTEM  OF  LEGAL  MEDICINE. 

Argentic  Nitrate. — This  compound  crystallizes  in  the  form  of  color- 
less, shining,  rhombic  plates,  which  have  an  astringent,  metallic  taste 
and  dissolve  freely  in  water.  Either  dry  or  dissolved,  it  turns  black  in 
the  light  when  in  the  presence  of  organic  matter.  Its  solutions  are  de- 
composed by  hydrochloric  acid  or  soluble  chlorides  into  argentic  chloride, 
a  white,  curdy  precipitate,  which  dissolves  in  ammonia  and  turns  dark 
in  the  sunlight. 

Externally  it  acts  as  a  rapid  but  superficial  corrosive,  turning  the 
tissues  first  white  and  then  black. 

Internally  it  has  an  irritant,  and  even  corrosive,  effect  upon  the  di- 
gestive tract,  and  besides,  acts  directly  upon  the  central  nervous  system, 
producing  convulsions,  vertigo,  coma,  paralysis,  and,  above  all,  marked 
disturbances  in  respiration.  The  latter  may  be  so  severe  as  to  cause 
death  \>y  asphyxia.  If  the  patient  survives  for  a  few  days  there  will  be 
set  up  inflammation  of  the  liver  and  kidneys. 

Only  three  or  four  deaths  have  been  reported  in  human  beings  from 
the  action  of  this  poison.  From  these  it  would  seem  that  death  has 
occurred  from  thirty  grains ;  and  in  another  case  from  fifty  grains,  in 
divided  doses,  in  a  woman  aged  fifty-one  years.  A  child  (fifteen  months) 
died  of  convulsions  in  six  hours,  after  swallowing  a  three-quarter-inch 
piece  of  a  stick  of  lunar  caustic. 

As  an  antidote  it  is  proper  to  give  large  quantities  of  salt  and  water, 
and  also  milk  and  albumen  solution,  to  precipitate  the  silver.  The 
symptoms  must  be  treated  as  they  occur. 

An  interesting  case,  where  a  valuable  horse  was  poisoned  by  this 
compound,  was  investigated  by  Dr.  Mott  {N.  Y.  Med.  Leg.  Jour.,  1883-84, 
vol.  i.,  p.  82),  who  isolated  from  the  contents  of  the  stomach  the  equivalent 
of  nearly  sixty  grains,  and  from  the  liver,  of  thirty  and  a  half  grains,  of 
argentic  nitrate.  The  horse  died  quite  suddenly,  having,  before  death, 
"  complete  paralysis  of  the  hind  quarters,  including  the  rectum  and  bladder." 
and  on  autopsy  the  stomach  was  found  "  highly  corroded,  and  perfectly 
white  on  its  inner  surface,"  while  the  liver  was  a  very  dark,  brown  color. 

Chronic  Poisoning. — When  small  doses  of  this  salt  are  taken  inter- 
nally for  some  length  of  time,  until  from  one  half  to  three  quarters  of  an 
ounce  of  argentic  nitrate  have  been  absorbed,  there  is  liable  to  result 
a  peculiar  bluish-black  discoloration,  first  of  the  face,  and  later  of  the 
whole  body.  This  is  not  necessarily  accompanied  by  other  symptoms, 
but  is  a  very  decided  drawback  to  the  free  use  of  the  salt  for  medicinal 
purposes.  It  is  almost,  if  not  quite,  impossible  to  take  away  this  color 
when  once  it  has  been  produced. 

Tests. — The  use  of  nitrate  of  silver  can  usually  be  recognized  bv  the 
white  and  then  black  stains  upon  the  mouth,  gums,  skin,  and  clothing 
of  the  patient,  without  the  deep  corrosions  of  sulphuric  acid.  If  the 
silver  is  in  solution  it  is  easy  to  precipitate  and  weigh  it  as  chloride,  by 
the  addition  of  hydrochloric  acid  or  common  salt. 

In  the  tissues,  however,  it  usually  exists  as  a  chloride,  and  for  that 
reason  it  is  necessary,  after  destroying  the  organic  matter  with  nitric 
acid  and  potassic  chlorate,  to  extract  with  a  solution  of  potassium  cyan- 
ide and  a  little  ammonia.  This  dissolves  the  silver,  which  can  then  be 
precipitated  as  chloride  by  an  excess  of  hydrochloric  acid.  This  chloride 
can  be  easily  reduced  to  metallic  silver  by  heating  on  charcoal  with  a 
blow-pipe,  or  by  touching  it  with  a  piece  of  metallic  zinc. 


INORGANIC  POISONS.  413 


XII.    IRON — FE. 


Although  solutions  of  iron  are  constantly  employed  in  medicine  in 
considerable  quantities,  and  are  considered  harmless,  it  is  worth  remem- 
bering that  two  of  its  salts,  ferric  chloride  and  ferrous  sulphate,  may,  on 
occasions,  act  as  severe  poisons,  and  have  even  been  used  for  murder. 

Ferric  Chloride,  FeL,Cl,;. — This  compound  is  a  brown  deliquescent 
substance  extremely  soluble  in  water,  and  only  met  witli  dissolved  in 
water  or  alcohol.  Careful  experiments  have  been  made  with  it  upon 
animals,  in  connection  with  a  famous  trial  in  Martinique  (Berenger- 
Ferraud  and  Porte,  Ann.  d'Hi/g.,  1879,  pp.  312,  508),  from  which  it  would 
seem  that,  given  with  the  food,  it  is  practically  harmless,  but  upon  an 
empty  stomach,  and  especially  when  dissolved  in  alcohol,  it  is  an  active 
poison.  The  symptoms  noticed  were  those  of  gastric  and  intestinal  in- 
flammation, with  suppression  of  urine,  sometimes  paralysis,  and  death 
generally  in  convulsions. 

Effects  upon  Man. — The  tincture  of  ferric  chloride  has  occasionally 
been  taken  in  large  amounts  by  accident,  and  produced  serious  conse- 
quences. But  in  the  case  mentioned  above  it  was  used  for  murder,  and 
actually  killed  four  people.  The  victims  were  all  French  Creoles  living 
in  Martinique,  and  successively  devoted  to  a  fair  Creole  widow ;  while,  in 
three  of  the  cases,  the  symptoms  of  poisoning  occurred  shortly  after 
drinking  a  glass  of  punch  given  them  by  the  widow's  son.  The  poison 
was,  in  each  of  these  three  cases,  taken  on  an  empty  stomach,  and  produced 
violent  pains  in  the  abdomen,  with  either  diarrhoea  or  constipation,  with 
tenesmus,  and  with  suppression  of  the  urine.  One  of  the  patients  died 
in  about  thirteen  hours,  and  the  other  two  in  about  sixty-five  hours, 
while  the  fourth  one,  whose  death  was  not  as  thoroughly  traced  as  the 
rest,  survived  nearly  four  days. 

Post=mortem  Appearances. — The  most  noticeable  appearance  after 
death,  in  both  animals  and  these  men,  was  the  blackish  coating  left  on  the 
mucous  membrane  of  the  mouth,  throat,  and  stomach.  The  liver  and 
kidneys  were  swollen  and  congested,  and  the  brain  and  meninges  were 
hypera?mic,  and  engorged  with  blood. 

Fatal  Dose. — The  dose  given  in  these  cases  could  not  be  ascertained, 
but  from  other  cases  it  is  known  that  an  ounce  or  so  of  the  tincture, 
containing  one  and  a  third  percent,  of  the  dry  salt,  will  produce,  under 
proper  conditions,  quite  serious  symptoms  on  the  stomach  and  kidneys. 
It  is  excreted  through  the  urine,  and  probably  also  through  the  intestines, 
for  the  fa?ces  are  usually  stained  black. 

Ferrous  Sulphate — Green  Vitriol — FeS04. — This  salt  occurs  in 
■  •niiimerce  in  the  form  of  large,  green,  transparent  crystals,  with  an  as- 
tringent taste,  and  readily  soluble  in  water.  It  is  frequently  used,  in 
common  with  ferric  chloride,  as  an  abortive,  and  has  occasionally  been 
taken  in  dangerous  or  even  fatal  amounts  by  accident,  and  also,  in  rare 
cases,  for  suicide.  An  interesting  example  of  this  last  is  reported  by 
Dr.  Lucy  M.  Hall  (Jf.T.Med. Jomt.,  1883,  vol.  xxxviii.,  p.  401), whereawoman 
prisoner  chewed  and  swallowed,  on  an  empty  stomach,  about  two  ounces 
of  the  crystals.  She  soon  became  partially  blind  and  deaf,  she  was 
dizzy,  and  her  legs  were  partly  paralyzed,  so  that  she  walked  with  diffi- 
culty.    In  four  days  she  was  brought  to  the  infirmary  suffering  from 


414  A   SYSTEM  OF  LEGAL  MEDICINE. 

diarrhoea  and  severe  pain  in  the  abdomen,  especially  over  the  sigmoid 
flexure.  Her  stools  were  watery,  greenish  in  color,  and  without  any 
faecal  odor,  her  tongue  was  furred,  her  pulse  was  weak  and  irregular,  her 
temperature  low. 

The  intestinal  trouble  increased  for  two  or  three  weeks,  and  developed, 
in  some  twenty-five  days,  into  an  exceedingly  severe  inflammation  of  the 
stomach  as  well  as  of  the  intestines.  This  nearly  caused  the  death  of 
the  patient,  but  was  finally  subdued  by  injecting  fifty-percent,  solutions 
of  plumbic  acetate,  containing  some  morphine,  in  four-  and  five-ounce 
doses,  and  keeping  them  in  the  intestines,  by  pressure,  for  two  hours  at 
a  time.  Under  this  somewhat  heroic  treatment  the  inflammation  was 
finally  controlled,  and  after  two  months  the  patient  gradually  began  to 
improve. 

In  this  case,  as  will  be  noticed,  there  was  no  particular  effect  upon 
the  kidneys,  and  after  the  first  few  days  the  lesions  were  confined  to  the 
digestive  tract. 

Tests  for  Iron. — It  must  be  remembered  that  iron  is  a  normal  constit- 
uent of  the  blood  and  the  red  muscles  of  the  body,  forming  an  essential 
part  of  the  haemoglobin.  Accordingly  it  is  extremely  difficult  to  distin- 
guish, on  chemical  analysis,  between  the  natural  and  the  foreign  iron. 

According  to  Orfila — and  his  example  has  been  followed  by  chemists 
since — the  foreign  metal  can  be  dissolved  by  steeping  the  finely  cut  tis- 
sues, as  well  as  the  contents  of  the  stomach  and  intestines,  in  cold  acetic 
acid,  which,  it  is  claimed,  has  little  or  no  effect  on  the  iron  in  the  haemo- 
globin. The  iron  in  the  filtrate  can  be  separated  by  amnionic  sulphide, 
in  the  form  of  black,  ferrous  sulphide,  and  after  dissolving  in  hydro- 
chloric and  nitric  acids,  may  be  reprecipitated  by  ammonia  as  brown  fer- 
ric hydrate.  The  solution  may  also  be  tested  with  potassic  ferrocyanide, 
which  will  form  a  blue  precipitate,  or,  after  nearly  neutralizing,  by  add- 
ing amnionic  sulphocyanide,  which  will  turn  the  solution  a  deep  red. 

It  would  probably  be  easier  and  more  satisfactory  to  obtain  a  good 
test  for  iron  in  the  faeces,  or  especially,  after  death,  from  the  black  depos- 
its on  the  mucous  membranes  of  the  stomach  and  intestines,  than  from 
the  tissues  themselves.  Any  stains  upon  the  bedclothes  or  garments  of 
the  patient  should  also  be  carefully  examined  for  iron. 


Plate    VIII. 


No.  1.  Atropiue  with  Vitali's  Test. 


No.  2.  Morphine  with  Nitric  Acid. 


No.  3.  Morphine  with  Ferric  Chloride. 


No.  4.  Morphine  with  Sulpho-Molybdic  Acid. 


No. 

5. 

Strychnine 

with 

Sulphuric 

Acid  and  Potassium 

Bichromate. 

No.  6.  Veratrine  with  Sulphuric  Acid 


Painted  by Df. /? SDOans. 


COLOR  REACTIONS  OF  ALKALOIDS. 


ALKALOIDAL  AND   OTHER  ORGANIC  POISONS. 

BY 

walter  s.  haines,  a.m.,  m.d. 

1.    Alkaloidal  Poisons. 

The  term  alkaloid  is  used  with  somewhat  varying  significance  by  dif- 
ferent authorities ;  but  as  commonly  employed  it  refers  to  the  bases  or 
alkali-like  bodies  found  in  many  plants,  to  which  the  latter  as  a  rule  owe 
their  physiological  effects.  They  are  often  spoken  of  as  plant  bases.  The 
total  number  known  is  large,  and  embraces  some  of  our  most  valuable 
remedial  agents,  and  not  a  few  of  our  most  active  poisons.  There  are 
many  properties  common  to  all,  or  to  nearly  all,  of  the  different  mem- 
bers of  the  class,  and  these  may  advantageously  be  considered  together 
before  taking  up  the  individual  substances. 

Composition. — All  alkaloids  contain  carbon,  hydrogen,  and  nitrogen, 
and  all  but  a  few  contain  oxygen  also.  The  major  portion  of  them, 
therefore,  do  not  differ  from  one  another  in  the  elements  of  which  they 
are  composed,  but  only  in  the  relative  proportion  of  these  elements. 

The  chemical  formulas  of  a  few  of  the  most  important  toxic  alkaloids 
are  as  follows : 

Aconitine C3:iH+:,N012 

Atropine C,  7H.23N03 

Cocaine Ci  7H21N04 

Colchicine C,  7H!  9N05 

Coniine CSH,7N 

Gelsemine C12H14N02 

Morphine C17H19N03 

Nicotine C10H14N2 

Strychnine C2 ,  H2  2N.202 

Veratrine C3  7H5  ;!NOi : 

Physical  and  Chemical  Properties. — Alkaloids  containing  oxygen 
are  fixed  solids,  while  those  containing  no  oxygen  are  volatile  liquids. 
They  are  generally  crystalline,  devoid  of  color,  and  are  usually  possessed 
of  a  bitter  or  pungent  taste.  The  volatile  alkaloids  have  a  pronounced 
odor,  but  those  that  are  fixed  are  odorless  ;  they  are  generally  of  alkaline 
reaction  to  litmus,  and  combine  with  acids,  neutralizing  them  and  pro- 
ducing salts. 

The  free  alkaloids  are,  as  a  rule,  either  insoluble  or  difficultly  soluble 
in  water,  but  they  generally  dissolve  with  readiness  in  alcohol,  ethei-, 
chloroform,  and  benzine,  and  in  many  other  organic  liquids.  Their  salts, 
•on  the  other  hand,  are  usually  readily  soluble  in  water,  especially  when 

415 


416  A    SYSTEM   OF  LEGAL   MEDICINE. 

slightly  acidulated,  and  also  in  alcohol,  but  ordinarily  they  do  not  dis- 
solve in  ether,  chloroform,  or  benzine.  These  differences  in  the  solubility 
of  the  free  alkaloids  and  their  salts  are  taken  advantage  of,  as  we  shall 
see  later,  in  the  extraction  of  alkaloids  from  complex  organic  mixtures. 

Like  the  majority  of  organic  substances,  most  of  the  alkaloids  are 
unstable  bodies,  undergoing  complete  or  partial  decomposition  under  a 
great  variety  of  conditions.  All  of  them  when  heated  considerably  above 
the  boiling-point  of  water,  and  sometimes  at  a  much  lower  tempera- 
ture, are  prone  to  undergo  change ;  as  a  rule,  strong  acids  and  alkalies 
and  active  oxidizing  agents  decompose  them ;  and  they  all  appear  under 
suitable  conditions  to  be  acted  on  by  micro-organisms,  which  eventually 
cause  their  complete  decomposition.  For  these  reasons  it  is  highly  nec- 
essary in  extracting  alkaloids  not  to  subject  the  materials  under  examina- 
tion to  too  high  a  degree  of  heat,  nor,  as  a  rule,  to  bring  them  in  contact 
with  strong  acids,  alkalies,  oxidizing  agents,  or  other  powerful  chemicals. 
Failure  to  observe  these  precautions  can  easily  lead  to  negative  results, 
even  though  an  alkaloid  be  present  in  the  suspected  substance. 

For  the  same  reason,  after  death  by  poisoning  by  an  alkaloid  the  lat- 
ter sooner  or  later  disappears  from  the  body  by  decomposition.  This  is 
probably  brought  about  chiefly  through  the  agency  of  micro-organisms, 
which  swarm  in  the  decomposing  body.  It  is  very  important,  therefore,, 
to  examine  for  alkaloidal  poisons  as  soon  after  death  as  possible ;  the 
longer  the  examination  is  put  off,  the  smaller  the  chance  of  detecting  the 
poison. 

Most  alkaloids  when  in  solution  are  rendered  insoluble  and  precipi- 
tated by  a  number  of  chemical  compounds,  which  are  known,  conse- 
quently, as  general  precipitants  or  reagents  for  alkaloids.  The  most 
important  of  these  are  tannic  acid,  picric  acid  (Wormley's  reagent),  phos- 
phomolybdic  acid  (Sonnenschein's  reagent),  iodine  dissolved  in  a  solu- 
tion of  potassium  iodide  (Wagner's  reagent),  and  potassio-mercuric 
iodide  (Mayer's  reagent).  The  last  two  are  usually  the  most  valuable,, 
and  both  are  of  great  service  as  general  tests  for  the  presence  of  an 
alkaloid.  If  neither  of  these  reagents  produces  a  precipitate  in  a.  sus- 
pected solution,  we  generally  say  with  great  certainty  that  no  alkaloid  is 
present ;  if,  however,  they  do  occasion  a  precipitate,  the  presence  of  an 
alkaloid  may  be  suspected,  although  not  positively  demonstrated,  as  sev- 
eral other  substances  are  precipitated  in  a  similar  manner.  These  tests, 
therefore,  have  chiefly  a  negative  value,  but  this  is  frequently  of  great 
importance.  Wagner's  reagent  may  conveniently  be  prepared  by  dis- 
solving one  part  of  iodine  and  two  parts  of  potassium  iodide  in  ninety- 
seven  parts  of  water,  and  Mayer's  reagent  for  qualitative  purposes  may 
be  similarly  made  by  dissolving  one  part  of  mercuric  iodide  and  two 
•  parts  of  potassium  iodide  in  ninety-seven  parts  of  water.  The  precipi- 
tates given  by  Wagner's  reagent  are  reddish  or  reddish  brown,  while 
those  produced  by  Mayer's  reagent  are  generally  yellowish  white. 

Many  of  the  alkaloids  when  subjected  under  appropriate  conditions 
to  certain  chemical  agents  produce  characteristic  colors,  and  advantage 
is  extensively  taken  of  this  fact  in  the  recognition  of  a  large  number  of 
the  alkaloids.  Such  reactions  are  known  as  color  tests.  For  example, 
if  strychnine  is  treated  with  strong  sulphuric  acid,  and  a  crystal  of  potas- 
sium bichromate,  or  other  oxidizing  agent,  is  drawn  through  the  mixture, 
a  very  brilliant  play  of  colors  ensues,  beginning  with  blue  and  ending 


ALKALOID AL   AND   OTHER   ORGANIC  POISONS.  417 

with  red.  Similarly  morphine,  colchicine,  atropine,  and  many  other 
alkaloids  develop  more  or  less  characteristic  colors  when  treated  with 
different  chemical  reagents,  especially  those  of  an  oxidizing  character. 
As  before  stated,  extensive  advantage  is  taken  of  these  color  reactions 
in  testing  for  the  presence  of  alkaloids,  and  they  are  of  the  greatest  util- 
ity in  toxicological  investigations.  When  properly  conducted  they  are 
entirety  reliable,  and  may  be  depended  upon  with  great  certainty ;  but  if 
not  performed  with  skill,  or  if  the  observer  is  decidedly  color-blind,  they 
may  be  worse  than  useless,  and  may  lead  to  most  unreliable  results.  In 
connection  with  the  several  alkaloids,  hereafter  to  be  considered  sepa- 
rately, the  color  tests  for  each  will  be  described,  and  the  precautions  to 
be  observed  in  obtaining  them  dwelt  upon. 

Symptoms  Produced  in  Case  of  Poisoning. — The  alkaloids  as  a  ride 
produce  their  poisonous  effects  rapidly ;  sometimes  the  symptoms  begin 
immediately  after  their  administration,  and  they  are  rarely  delayed  for 
any  considerable  length  of  time.  After  the  toxic  symptoms  begin  to 
show  themselves  they  generally  progress  rapidly,  with  increasing  vio- 
lence, and  unless  relief  is  obtained  death  promptly  ensues.  There  are 
many  marked  exceptions  to  this  ride,  especially  in  connection  with  mor- 
phine, whose  effects  are  often  slow  in  manifesting  themselves,  and  some- 
times persist  many  hours  before  leading  to  a  fatal  termination.  Rapid- 
ity of  action  is  somewhat  characteristic  of  the  alkaloids,  and  in  a  general 
way  distinguishes  them  from  most  of  the  mineral  poisons,  which  usually 
are  slower  in  producing  their  effects.  The  poisonous  alkaloids  as  a  rule 
exert  their  chief  influence  upon  the  nervous  centers,  and  the  symptoms, 
therefore,  in  the  main,  are  those  referable  to  the  nervous  system.  Per- 
verted action  of  the  heart  and  of  the  respiratory  organs,  disorders  of 
vision,  perverted  sensation,  convulsions,  paralyses,  and  coma  are  among 
the  most  common  symptoms  shown.  With  a  few  exceptions,  chiefly  in 
connection  with  colclncine  and  veratrine,  violent  vomiting  and  purging 
are  not  usually  seen,  and  in  this  respect  alkaloidal  poisoning  differs  from 
the  toxic  effects  of  most  of  the  mineral  poisons,  which  as  a  rule  occasion 
pronounced  emesis  and  diarrhoea.  As  the  effects  of  the  poisonous  alka- 
loids are  chiefly  directed  to  the  nervous  system,  the  diseases  with  which 
they  are  likely  to  be  confounded  are  naturally  those  in  which  the  nerve- 
centers  are  involved,  such  as  tetanus,  epilepsy,  apoplexy,  hysteria,  etc. 

Treatment. — Since  the  alkaloids  generally  act  rapidly,  prompt  treat- 
ment must  be  resorted  to  if  favorable  results  are  to  be  secured.  As  in 
all  other  cases  of  poisoning,  the  stomach  should  be  evacuated,  either  by 
emetics,  or  by  the  stomach-pump  or  stomach-tube,  and  the  organ  thor- 
oughly washed  out  with  tepid  water.  In  the  absence  of  means  of  evacu- 
ating the  stomach  promptly,  or  even  in  connection  with  such  means,  sub- 
stances should  be  given  which  will  render  the  alkaloid  less  soluble,  and 
•consequently  retard  its  absorption.  The  most  valuable  of  these  are  tan- 
nic acid,  and  iodine  dissolved  in  potassium  iodide  (the  official  compound 
solution  of  iodine  of  the  pharmacopoeia).  Finely  pulverized  charcoal 
has  also  been  highly  recommended,  and  it  undoubtedly  may  sometimes 
be  usefid  by  mechanically  uniting  with  the  poison  and  slowing  its  ab- 
sorption. It  has  at  least  the  merit  of  being  harmless.  After  removing 
from  the  stomach  whatever  portion  of  the  poison  is  still  there,  the  treat- 
ment should  be  addressed  to  the  constitutional  symptoms;  and  as  these 
are  commonly  produced  through  perverted  action  of  the  nervous  system, 


418  ^   SYSTEM   OF  LEGAL  MEDICINE. 

the  remedies  employed  are  usually  those  that  exert  an  influence  upon 
the  nerve-centers,  such  as  chloroform,  chloral,  ammonia,  caffeine,  alcohol, 
nitroglycerine,  atropine,  electricity,  etc.,  according  to  the  poison  taken 
and  the  indications  presented. 

Post=mortem  Appearances. — These  are  rarely,  or  perhaps  never,  en- 
tirety characteristic,  although  they  are  sometimes  of  considerable  utility 
in  enabling  us  to  form  an  opinion  as  to  the  cause  of  death,  when  taken 
in  connection  with  the  symptoms,  the  results  of  chemical  analysis,  etc. 
As  the  alkaloids  generally  produce  their  effects  chiefly  upon  the  nerve- 
centers,  it  might  be  supposed  that  characteristic  post-mortem  appearances- 
would  be  found  in  the  brain  and  spinal  cord ;  this,  however,  is  not  often 
the  case,  for  death  usually  ensues  before  definitely  marked  structural 
changes  visible  to  the  unaided  eye,  or  even  discoverable  by  the  microscope,, 
can  be  produced.  As  a  rule  it  is  the  absence  of  marked  post-mortem 
appearances,  rather  than  their  presence,  that  points  to  death  by  toxic 
alkaloids. 

Detection. — The  discovery  of  inorganic  poisons  in  the  stomach  or 
other  part  of  the  body  is,  with  few  exceptions,  generally  one  of  mathe- 
matical certainty,  owing  to  their  unalterable  character,  their  ease  of  puri- 
fication, and  their  definiteness  of  reaction.  Such,  however,  is  not  the 
case  with  the  alkaloids,  as  a  rule.  They  are  all  more  or  less  unstable, 
and  their  complete  purification,  especially  when  present  in  but  small 
amount,  is  frequently  difficult,  and  their  recognition  therefore  by  estab- 
lished tests  is  always  laborious,  and  sometimes  impossible ;  only  by  the 
use  of  skill  and  care  at  every  step  can  positive  results  be  gained.  It 
should  be  stated,  however,  that  one  of  the  alkaloids,  strychnine,  in  unal- 
terability  and  definiteness  of  reaction  approaches  somewhat  the  inor- 
ganic poisons. 

Many  methods  have  been  devised  for  the  extraction  of  alkaloids 
from  complex  mixtures,  such  as  articles  of  food,  parts  of  the  body, 
etc.,  but  they  are  all  based  upon  the  method  first  suggested  in  1851 
by  the  eminent  chemist,  Stas,  of  Brussels.  They  all  depend  upon  the 
fact  that  the  salts  of  the  alkaloids  are  soluble  in  water,  but  are  decom- 
posed in  aqueous  solution  upon  the  addition  of  an  alkaline  substance 
which  abstracts  their  acid  and  liberates  the  alkaloid ;  the  latter  is  then 
precipitated,  but  may  be  removed  by  shaking  with  an  immiscible  solvent,, 
such  as  ether,  chloroform,  benzine,  or  some  other  similar  fluid,  which  ex- 
tracts them  from  the  watery  mixture  and  retains  them  in  solution.  By 
evaporation  of  the  liquid  the  alkaloid  is  left  behind  in  a  condition  for 
further  purification,  and  ultimately  for  testing.  The  various  methods 
suggested  for  the  extraction  of  alkaloids  differ  chiefly  in  minor  details,  and 
especially  in  the  use  of  different  immiscible  solvents.  In  Stas's  original 
method  ether  is  used,  in  that  of  Rogers  and  Gird  wood  chloroform  is 
employed,  while  in  the  method  of  Uslar  and  Erdmann  amyl  alcohol  is 
the  solvent  recommended.  In  all  cases,  however,  practically  the  same 
general  method  is  pursued,  which  in  its  greatest  simplicity  is  as  follows : 

The  substance  to  be  tested  is  finely  comminuted  and  made  into  a  thin 
paste  with  water,  and  an  acid  added  in  sufficient  amount  to  impart  de- 
cided acidity  to  the  mixture.  Acetic  or  tartaric  acid  is  the  one  generally 
to  be  chosen  when  operating  on  the  contents  of  a  stomach,  articles  of 
food  or  vomited  matter,  but  when  examining  tissues,  such  as  the  liver, 
kidneys,  or  brain,  dilute  sulphuric  acid  is  sometimes  preferable.     The 


ALKALOIDAL  AND   OTHER   ORGANIC  POISONS.  419 

acidulated  mixture  is  gently  heated  on  the  water-bath  one  or  two  hours, 
with  frequent  stirring,  and  the  occasional  addition  of  a  little  water  to  re- 
place what  is  lost  by  evaporation.  By  this  treatment  any  alkaloid  that 
may  be  present  is  converted  into  a  soluble  salt  and  passes  into  solu- 
tion. The  mixture  is  next  strained  through  several  thicknesses  of  fine 
cloth,  and  the  insoluble  material  thoroughly  washed  with  hot,  acidulated 
water.  The  turbid  fluid  thus  obtained  is  evaporated  at  a  very  gentle 
heat  on  the  water-bath  to  a  comparatively  small  bulk,  and  four  or  five 
volumes  of  strong  alcohol  are  slowly  stirred  in.  By  this  means  a  large 
number  of  foreign  bodies,  especially  albuminoids  and  proteids,  are  coagu- 
lated and  rendered  insoluble,  while  the  alkaloidal  salt  remains  in  solu- 
tion in  the  alcohol.  The  mixture  is  now  poured  upon  a  paper  filter,  and 
the  residue  is  thoroughly  washed  with  hot  alcohol.  The  combined  alco- 
holic filtrates  are  evaporated  at  a  very  gentle  heat  on  the  water-bath  to 
the  consistency  of  a  thin  syrup,  and  when  cold  the  extract  is  dissolved 
in  four  or  five  times  its  bulk  of  water  slightly  acidulated  with  sulphuric 
acid,  and  carefully  filtered  from  any  insoluble  material  that  may  have 
separated.  The  acid  filtrate,  which  contains  in  solution  in  a  small  bulk 
all  of  the  alkaloids  originally  present  in  the  material  tested,  is  now 
treated  with  about  half  its  volume  of  ether  and  thoroughly  shaken ; 
upon  standing  a  short  time  the  ether  rises  to  the  top  and  is  removed  by 
a  pipette,  and  the  process  may  be  repeated  a  second  and  even  a  third 
time,  if  deemed  necessary.  By  this  procedure  considerable  coloring  mat- 
ter and  much  other  foreign  material  are  removed,  while  the  alkaloidal 
salts,  as  a  rule,  remain  behind  in  the  aqueous  fluid.  The  ether,  however, 
may  extract,  wholly  or  in  part,  certain  substances  (including  a  few  alka- 
loids), such  as  picric  acid,  salicylic  acid,  digitaline,  caffeine,  colchicine, 
and  delphine,  which  are  sometimes  of  importance  in  toxicological  exam- 
inations ;  the  ether,  therefore,  should  be  allowed  to  evaporate  in  a  large 
watch-glass,  and  the  residue  tested  for  the  above  bodies  if  their  presence 
is  suspected. 

To  the  aqueous  flaid  au  alkali  is  now  added  in  very  slight  excess, 
such  as  ammonium  hydrate,  potassium  hydrate,  or  sodium  carbonate, 
the  first  being  generally  preferable,  although  sometimes  one  of  the 
others  is  more  useful.  By  this  treatment  the  alkaloidal  salt  is  decom- 
posed, and  the  alkaloid  set  at  liberty  and  precipitated.  A  double  volume 
of  chloroform,  or,  in  case  the  presence  of  morphine  is  suspected,  amylic 
alcohol  is  added,  and  the  whole  is  vigorously  shaken  in  a  stout  stoppered 
tube,  flask,  or  separately  bulb.  The  mixture  is  set  aside,  when  the 
chloroform  settles  to  the  bottom  of  the  vessel  and  carries  with  it  in  solu- 
tion the  greater  portion  of  any  alkaloid  that  may  have  been  present. 
By  means  of  a  pipette  the  aqueous  fluid  is  drawn  off,  and  again  shaken 
with  a  double  volume  of  chloroform,  so  as  to  insure  the  complete  extrac- 
tion of  the  alkaloid.  The  united  portions  of  chloroform  are  evapo- 
rated in  a  large  watch-glass  at  a  gentle  temperature,  and  the  character  of 
the  residue  critically  observed.  It  occasionally  happens  that  the  alkaloid 
is  left  in  a  state  of  considerable  purity,  in  which  case  the  residue  may 
be  examined  by  various  tests  at  once.  Usually,  however,  it  contains 
too  much  foreign  material  to  permit  the  direct  application  of  spe- 
cific tests,  and  it  must  be  purified  by  solution  in  dilute  acid,  filtration, 
neutralization,  and  reextraetion  with  chloroform  as  before  described. 
The  residue  from  the  evaporation  of  this  chloroform  is  sometimes  pure 


420  A   SYSTEM   OF  LEGAL   MEDICINE. 

enough  for  the  application  of  the  various  characteristic  tests  for  the  in- 
dividual alkaloids,  but  more  often  still  additional  purification  is  neces- 
sary. One  of  the  best  general  methods  of  accomplishing  this  is  to  wash 
the  residue  on  the  watch-glass  with  a  few  drops  of  ice-cold  water,  repeat- 
ing the  operation,  if  necessary,  two  or  three  times.  By  this  means  con- 
siderable foreign  matter  is  removed,  while  the  alkaloid  is  left  largely 
undissolved.  It  may  now  be  once  more  dissolved  in  dilute  acid,  filtered, 
neutralized,  and  extracted  with  chloroform.  Upon  evaporating  the  lat- 
ter, the  alkaloid  is  generally  obtained  sufficiently  pure  for  testing. 

This  process  of  purification  necessarily  entails  the  loss  of  more  or  less 
of  the  poison ;  but  it  should  be  borne  in  mind  that  a  small  amount  of  a 
pure  alkaloid  is  far  more  readily  and  much  more  certainly  recognized 
than  a  large  quantity  that  is  impure.  The  latter,  indeed,  may  often  fail 
to  respond  to  any  of  the  characteristic  tests  of  the  alkaloid  present. 

Upon  shaking  chloroform  with  the  alkalinized  fluid  containing  the 
suspected  alkaloid,  as  directed  above,  it  quite  frequently  happens  that 
the  agitation  causes  the  chloroform  to  emulsionize.  In  this  event  its 
separation  from  the  aqueous  fluid  is  exceedingly  slow  and  unsatisfac- 
tory. To  remedy  this,  Allen  has  suggested  substituting  a  mixture  of 
equal  volumes  of  chloroform  and  ether.  This  is  an  excellent  solvent  for 
most  of  the  alkaloids,  although  not  quite  equal  to  chloroform  alone; 
but  as  it  does  not  emulsionize  nearly  as  readily  as  the  latter,  it  is  often 
greatly  to  be  preferred. 

Many  modifications  of  the  above  general  method  are  necessary  in 
special  cases,  and  in  connection  with  each  alkaloid  such  departures  as 
may  be  desirable  will  be  noted. 

Professor  Dragendorff  has  suggested  an  exceedingly  elaborate  method 
for  the  extraction  of  alkaloids  from  unknown  mixtures.  Various  solv- 
ents are  used  in  his  process,  and  an  effort  is  made  to  separate,  to  a 
greater  or  less  degree,  any  alkaloids  that  may  be  present  into  a  number 
of  groups,  to  aid  in  their  subsequent  recognition.  While  the  method  is 
of  great  value  in  plant  analysis,  and  is  sometimes  of  marked  utility  in 
testing  parts  of  the  body  (especially  when  there  is  no  clue  to  the  poison 
used,  or  a  number  of  drugs  have  been  administered),  as  a  rule  it  is  un- 
necessarily cumbersome,  and  frequently,  in  my  experience,  gives  less  sat- 
isfactory results  than  the  shorter  and  more  direct  methods. 

It  is  scarcely  necessary  to  add  that  whatever  process  for  extracting 
the  poison  is  seleeted,  the  most  constant  attention  and  painstaking  care 
are  necessary  at  every  step.  None  but  absolutely  pure,  tested  chemicals 
should  be  employed,  every  utensil  should  be  scrupulously  clean,  and  all 
operations  should  be  performed  in  a  room  from  which  poisons  are  ex- 
cluded, and  to  which  the  analyst  alone  has  access. 

The  total  number  of  alkaloids  known  is  large,  but  many  of  them  are 
not  toxic,  and  need  not,  therefore,  be  considered.  Of  the  poisonous  alka- 
loids, moreover,  a  considerable  number  are  so  rare  and  so  seldom  em- 
ployed that  they  do  not  merit  individual  attention  except  in  special  trea- 
tises. For  our  purpose  it  will  be  sufficient  to  consider  only  the  most 
important  of  the  toxic  alkaloids,  as  follows : 

Aconitine,  atropine,  brucine,  cocaine,  colchicine,  coniine,  gelsemine, 
hyoscine,  hyoscyamiue,  jervine,  morphine,  nicotine,  strychnine,  and  vera- 
trine.     Some  of  these  are  rarely  used  in  a  pure  state,  either  as  medicines 


JLKALOIDAL   AND    OTHER   ORGANIC  POISONS.  421 

or  poisons,  but  the  plants  in  which  they  occur  may  be  extensively  em- 
ployed, and  as  their  efficiency  is  due  chiefly  or  entirely  to  the  presence 
of  the  alkaloid,  the  latter  has  an  importance  which  it  otherwise  would 
not  possess. 

ACONITE   AND   ACONITINE. 

Aconitine  (synonyms,  aconitin,  aconitina  and  aconitia)  is  the  active 
principle  of  Aconitum  NapeMus,  commonly  known  as  monk's-hood  or  wolf's- 
bane.  The  alkaloid  is  found  in  all  parts  of  the  plant,  but  it  occurs  in  the 
root  in  the  largest  proportion ;  the  amount,  however,  found  in  the  latter 
is  exceedingly  variable,  ranging  from  less  than  0.1  to  0.6  percent.  In 
addition  to  aconitine,  the  Aconitum  Napellus  frequently  contains  smaller 
quantities  of  other  alkaloids,  which,  however,  are  unimportant.  Other 
varieties  of  the  aconite  plant,  such  as  the  Aconitum  ferox  and  Aconitum 
Fischer i,  owe  their  activity  to  alkaloids  similar  to  aconitine,  and  differ- 
ing practically  so  little  from  it  as  not  to  demand  separate  consideration. 

Properties. — Aconitine  when  pure  is  a  colorless,  crystalline  solid ; 
odorless,  but  possessed  of  an  acrid  taste,  which  is  followed  by  a  charac- 
teristic tingling  and  numbness  of  the  tongue  and  lips.  As  found  in  the 
shops  it  is  exceedingly  variable  in  appearance  and  strength ;  much  of  it 
is  amorphous,  and  some  of  it  has  but  slight  activity,  containing  probably 
but  little  of  the  pure  alkaloid.  Pereira  states  that  he  took  a  grain  of  a 
French  preparation  without  perceiving  the  slightest  effect  either  locally 
in  the  mouth,  or  generally ;  and  Wormley  examined  three  German  speci- 
mens, one  of  which  contained  only  a  trace  of  the  alkaloid,  and  the  other 
two  none.  In  my  own  experience  I  have  never  found  commercial  aconi- 
tine wholly  destitute  of  activity,  but  the  difference  in  the  strength  of  dif- 
erent  samples  is  very  great,  some  specimens  being  fully  six  or  eight  times 
as  powerful  as  others. 

Like  most  of  the  alkaloids,  aconitine  is  sparingly  soluble  in  water, 
but  it  dissolves  readily  in  chloroform ;  in  ether  it  dissolves  very  much 
less  freely.  It  has  decided  basic  powers,  neutralizing  acids  to  form  salts, 
most  of  which  are  readily  soluble  in  water  and  in  alcohol. 

Symptoms. — Poisoning  by  the  alkaloid  aconitine  is  a  comparatively 
rare  occurrence,  but  cases  of  poisoning  by  aconite  or  some  of  its  prepara- 
tions, such  as  the  tincture,  are  not  infrequent.  In  the  latter  case,  how- 
ever, it  is  the  aconitine  that  produces  the  toxic  effects  quite  as  much  as 
if  the  alkaloid  had  been  taken  in  its  pure  state. 

The  symptoms  produced  by  poisonous  doses  of  aconite  are  in  many 
ways  peculiar,  and  are  sometimes  so  characteristic  that  a  diagnosis  may 
be  made  from  them  alone.  Immediately  or  soon  after  swallowing  the 
drug  there  is  a  sense  of  numbness  and  a  peculiar  tingling  of  the  lips, 
tongue,  and  throat ;  this  is  followed  by  a  burning  pain  in  the  stomach, 
accompanied  by  nausea,  and  frequently  by  vomiting.  Purging  is  also 
sometimes  present.  The  tingling  and  numbness,  at  first  confined  to  the 
mouth  and  throat,  extend  to  other  parts  of  the  body,  swallowing  becomes 
difficult  or  impossible,  and  there  is  a  partial  or  entire  loss  of  voice ;  the 
vision  becomes  impaired,  the  body  is  bathed  in  cold  perspiration,  the 
heart's  action  becomes  feeble  and  irregular,  the  face  pale  and  shrunken ; 
there  is  great  prostration  with  entire  loss  of  strength,  and  the  extremi- 
ties are  cold  and  clammy.    Sometimes  there  are  delirium  and  convulsions, 


422  A   SYSTEM  OF  LEGAL  MEDICINE. 

and  death  finally  takes  place  by  syncope.  Variations  from  the  above 
symptoms  are  not  infrequently  seen,  but  in  practically  all  cases  the  tin- 
gling and  numbness  about  the  mouth  and  throat  are  observed,  and  these- 
especially  characterize  this  form  of  poisoning. 

External  application  of  preparations  of  aconite  have  sometimes  occa- 
sioned alarming  symptoms  and  even  death. 

Period  when  Fatal. — Aconite  when  taken  in  sufficiently  large  doses 
usually  produces  death  rapidly.  One  case  is  recorded  in  which  it  occurred 
within  eight  minutes,  and  many  have  been  reported  in  which  a  fatal  ter- 
mination ensued  within  an  hour.  On  the  other  hand,  however,  death 
may  be  delayed  several  hours,  or  even  a  number  of  days.  Professor 
Mallet  has  reported  a  case  in  which  death  occurred  at  the  end  of  four 
days. 

Fatal  Quantity. — As  the  aconitine  of  commerce  frequently  varies 
greatly  in  strength,  it  is  not  surprising  that  great  differences  have  been 
noted  in  the  doses  necessary  to  produce  death.  Pure  aconitine  is  prob- 
ably the  most  actively  poisonous  substance  with  which  we  are  acquainted ; 
one  sixteenth  of  a  grain  has  occasioned  death,  and  probably  half  of  this 
quantity  might  prove  fatal.  Pereira  records  a  case  in  which  one  fiftieth 
of  a  grain  nearly  occasioned  the  death  of  an  elderly  lady ;  and  if  admin- 
istered hypodermically  the  alkaloid  is  even  more  powerfully  poisonous 
than  when  taken  by  the  mouth. 

As  the  preparations  of  the  aconite  plant  vary  exceedingly  in  alka- 
loidal  strength,  it  is  impossible  to  state  with  any  degree  of  accuracy  their 
minimum  fatal  doses ;  twenty-five  drops,  however,  of  the  tincture,  and 
four  grains  of  the  extract,  have  proven  fatal,  although  without  doubt 
smaller  quantities  than  these,  if  prepared  from  very  active  specimens  of 
aconite  root,  might  occasion  fatal  results.  On  the  other  hand,  recoveries 
have  occurred  from  comparatively  large  doses  both  of  the  alkaloid  and 
of  aconite.  Some  of  these  undoubtedly  may  have  been  due  to  the  effi- 
ciency of  the  treatment  pursued,  while  others  may  be  accounted  for  by 
the  inertness  or  slight  activity  of  the  preparation  taken. 

Treatment. — The  stomach  should  be  evacuated  as  soon  as  possible, 
either  by  the  stomach-pump  or  by  emetics,  and  tannic  acid,  or  vegetable 
infusions  containing  it,  and.  solution  of  iodine  in  potassium  iodide  may 
be  administered  with  the  hope  of  reducing  the  solubility  of  the  aconitine, 
and  therefore  retarding  its  absorption.  Heart  stimulants  should  be  freely 
employed,  and  of  these  ammonia,  alcohol,  mix  vomica,  and  digitalis  are 
the  most  useful ;  the  latter  has  been  highly  recommended,  especially  when 
given  hypodermically.  In  all  cases  the  patient  should  be  kept  warm, 
artificial  heat,  if  necessary,  being  applied  to  the  extremities. 

Post=mortem  Appearances. — As  is  the  case  with  most  of  the  poison- 
ous alkaloids,  aconitine  does  not  produce  any  decidedly  characteristic 
post-mortem  appearances.  The  stomach  and  intestines  are  generally 
more  or  less  reddened,  there  is  congestion  of  the  lungs  and  liver,  and 
an  injected  condition  of  the  blood-vessels  of  the  brain  and  its  surround- 
ing membranes.  The  right  side  of  the  heart  usually  contains  more  or 
less  blood,  and  throughout  the  body  the  blood  is  generally  dark  in  color, 
and  abnormally  fluid. 

Tests. — Solutions  of  aconitine  respond  to  the  general  reactions  for 
alkaloids,  being  precipitated  by  tannic  acid,  picric  acid,  etc. ;  the  precipi- 
tates thus  formed,  however,  do  not  in  any  way  distinguish  it  from  other 


ALKALOIDAL  AND    OTHER    ORGANIC  POISONS.  423 

alkaloids,  nor  does  it  produce  any  characteristic  color  reactions.  In  fact, 
there  is  no  reliable  chemical  test  for  aconitine.  The  physiological  effects, 
however,  of  the  alkaloid  are  very  marked  and  quite  characteristic.  If 
an  exceedingly  minute  portion  of  it  in  solution  is  placed  upon  the  lips 
or  tongue  a  peculiar  tingling  and  numbness  of  the  part  is  observed,  which 
may  continue  for  a  number  of  hours.  As  small  an  amount  as  1-1600 
of  a  grain  is  capable  of  producing  a  well  marked  effect.  When  adminis- 
tered to  the  lower  animals  very  small  quantities  produce  fatal  results ; 
the  1-3000  of  a  grain  of  pure  aconitine  injected  hypodermically  will  kill 
a  mouse  within  half  an  hour.  These  physiological  effects  are  the  tests 
chiefly  to  be  depended  upon  in  testing  for  the  presence  of  the  alkaloid. 

Detection  of  the  Poison. — In  the  Contents  of  the  Stomach. — The  mate- 
rial should  first  be  carefully  examined  for  the  presence  of  any  pieces  of 
leaves,  root,  or  bark,  since  the  poisoning  may  have  been  produced  by 
parts  of  the  plant  itself;  in  case  such  portions  are  discovered,  they 
should  be  thoroughly  cleansed  and  examined  under  a  microscope,  and 
also  chewed  between  the  front  teeth  to  observe  whether  a  tingling  sensa- 
tion is  imparted  to  the  tongue  and  lips.  Whether  parts  of  the  plant  are 
found  or  not,  the  contents  of  the  stomach,  finely  comminuted  if  neces- 
sary, are  treated  with  a  small  amount  of  acetic  acid,  very  gently  heated,  and 
the  general  process  described  on  page  418  then  followed.  The  first  chloro- 
form extract  should  be  dissolved  in  a  few  drops  of  water  slightly  acidu- 
lated with  acetic  acid,  and  a  single  drop  placed  on  the  end  of  the  tongue, 
allowed  to  remain  there  for  one  minute,  and  then  discharged.  If  no 
tingling  or  numbness  is  observed  at  the  end  of  fifteen  or  twenty  min- 
utes, it  is  generally  useless  to  proceed  further ;  but  if  these  physiological 
effects  are  manifested,  a  small  amount  of  the  same  solution  may  be  given 
hypodermically  to  a  mouse,  or  some  other  small  animal,  and  the  effects 
observed.  If  aconitine  is  present,  death  will  usually  occur  within  an 
hour.  Should  these  physiological  tests  show  the  probable  presence  of 
aconitine,  what  is  left  of  the  solution  of  the  first  chloroform  extract 
should  be  filtered,  the  filtrate  rendered  alkaline,  and  again  extracted 
witli  chloroform  ;  the  residue  obtained  upon  evaporation  of  the  latter 
should  then  be  dissolved  in  very  dilute  acid,  and  the  generic  tests  for 
alkaloids  applied  to  secure  in  a  general  way  confirm atory  evidence  of 
the  presence  of  the  poison. 

In  the  Tissues. — The  liver  and  kidneys  are  the  organs  in  whose  tissues 
aconitine  is  most  likely  to  be  found.  To  detect  its  presence,  the  organ 
should  be  finely  subdivided,  mixed  with  water  to  a  thin  paste,  and  mod- 
erately acidulated  with  acetic  or  tartaric  acid.  The  process  may  then 
be  conducted  as  directed  above  in  connection  with  the  contents  of  the 
stomach. 

Owing  to  its  exceedingly  toxic  nature,  the  smallness  of  the  dose  re- 
quired to  produce  death,  and  the  somewhat  uncertain  character  of  our 
present  tests  for  its  recognition,  aconitine  possesses  rather  more  interest 
in  legal  medieines  than  most  other  poisons.  It  is  one  of  the  few  sub- 
stances which  in  the  present  state  of  toxicology  might  be  criminally  ad- 
ministered and  leave  no  positive  evidence  of  the  crime ;  if  a  small  but 
fatal  dose  of  the  poison  were  to  be  given,  especially  if  it  were  adminis- 
tered Irypodermically,  the  chances  of  its  detection  in  the  body  after  death 
would  not  be  great. 


424  4-  SYSTEM   OF  LEGAL   MEDICINE. 


BELLADONNA   AND   ATROPINE. 

Atropine  (synonyms,  atropin  and  atropia)  is  the  chief  active  principle 
of  Atropa  Belladonna,  or  deadly  nightshade.  It  exists  in  all  parts  of  the 
plant,  but  more  especially  in  the  root,  where  it  is  found  in  quantities 
ranging  from  0.3  to  0.5  percent. 

Properties. — Atropine  is  a  colorless,  crystalline  solid,  devoid  of  odor, 
and  possessed  of  a  hitter,  acrid  taste.  It  is  sparingly  soluble  in  water, 
but  dissolves  fairly  readily  in  ether  and  very  readily  in  chloroform ;  it 
has  quite  strongly  alkaline  properties,  and  completely  neutralizes  acids 
producing  salts,  most  of  which  are  soluble  in  water. 

Symptoms. — Since  atropine  is  the  active  principle  of  belladonna,  the 
poisonous  effects  of  the  two  are  practically  identical,  the  only  noteworthy 
difference  being,  as  would  be  expected,  that  the  atropine  as  a  rule  acts 
more  rapidly  than  the  crude  drug.  A  toxic  dose  of  either  occasions 
symptoms  which  vary  somewhat,  but  are  in  the  main  as  follows :  There 
is  great  dryness  of  the  mouth  and  throat,  extreme  redness  of  the  tongue, 
difficulty  in  swallowing,  wide  dilatation  of  the  pupils  with  impaired  vision, 
and  well-marked  delirium ;  the  latter  is  somewhat  characteristic,  being 
generally  of  a  pleasing  nature,  although  sometimes  it  assumes  a  maniacal 
form.  Nausea  is  often,  and  vomiting  occasionally,  present.  As  the  case 
progresses  speech  becomes  difficult  or  impossible,  there  is  great  thirst, 
numbness  of  the  extremities,  partial  or  complete  paralysis  of  the  limbs, 
and  frequently  entire  loss  of  sight.  The  pulse  becomes  feeble  and  rapid, 
and  often  intermitting;  a  deep  red  eruption  sometimes  appears  on  the 
skin ;  profound  coma  sets  in,  and  death  occurs,  occasionally  preceded  by 
convulsions. 

Atropine  and  belladonna  exercise  their  poisonous  effects  however  in- 
troduced into  the  system,  and  many  cases  are  reported  of  toxic  symp- 
toms from  their  local  application  to  the  skin  and  to  ulcers,  and  even  when 
used  about  the  eye  or  the  ear.  At  least  one  case  is  reported  of  death 
from  the  external  use  of  the  alkaloid. 

Period  when  Fatal. — The  effects  both  of  atropine  and  belladonna 
usualby  begin  within  an  hour,  sometimes  showing  themselves  a  few 
minutes  after  they  are  taken.  Occasionally,  however,  no  disturbance  is 
shown  for  a  considerable  period,  one  case  being  recorded  in  which  the  first 
symptoms  were  delayed  for  five  hours.  After  the  effects  begin  to  mani- 
fest themselves  the  progress  of  the  case  is  usually  slow,  death  rarely  oc- 
curring before  the  end  of  a  number  of  hours.  In  one  case,  however,  it 
ensued  in  two  hours,  and  in  another  in  three  and  three  quarter  hours ; 
and  a  surprising  case  is  reported  of  death  in  five  minutes  after  the  hypo- 
dermic injection  of  a  small  amount  of  the  alkaloid.  On  the  other  hand, 
the  person  may  linger  fifteen  or  twenty  hours,  and  death  may  occur  even 
as  late  as  the  second  or  third  day. 

Fatal  Quantity. — Probably  the  smallest  fatal  dose  of  atropine  re- 
corded is  one  thirtieth  of  a  grain  given  hypodermically ;  one  twelfth  of 
a  grain  by  the  stomach  has  also  produced  fatal  effects ;  and  a  clyster  of 
belladonna  root,  containing  by  calculation  a  sixth  of  a  grain  of  the  alka- 
loid, has  occasioned  death.  On  the  other  hand,  recovery  has  taken  place 
from  quite  large  doses,  both  of  the  alkaloid  and  of  the  drug.  Drs.  Loomis 
and  Wescott  report  cases  in  which  complete  recovery  occurred  after  tak- 


ALKALOIDAL   AND    OTHER   ORGANIC  POISONS.  425 

ing  a  grain  of  the  alkaloid,  and  in  other  cases  recovery  has  followed  even 
larger  doses,  Dr.  Eliot  recording'  entire  recovery  after  the  ingestion  of 
four  grains  of  the  sulphate.  It  is  an  interesting  fact  that  although  atro- 
pine is  an  exceedingly  active  substance  physiologically,  and  sometimes, 
as  indicated  above,  produces  death  in  small  dose,  yet  as  a  rule  recovery 
takes  place  even  from  large  doses,  and  often,  moreover,  without  antidotal 
treatment ;  of  thirty-two  cases  of  poisoning  by  the  alkaloid,  collected  by 
Dr.  Eliot,  only  two  proved  fatal. 

Treatment. — If  seen  early,  the  stomach  shoidd  be  thoroughly  evacu- 
ated by  the  use  of  emetics  or  the  stomach-pump,  and  at  the  same  time 
chemical  antidotes  may  be  employed.  Of  the  latter  probably  the  best  are 
tannic  acid,  solution  of  iodine,  and  finely  pidverized  charcoal. 

Morphine  should  be  administered,  preferably  hypodermically,  in  doses 
of  from  a  quarter  of  a  grain  to  a  grain,  and  repeated  from  time  to  time 
if  necessary  to  control  the  delirium.  Pilocarpine  by  the  mouth  or  sub- 
cutaneously  has  also  been  highly  recommended.  As  the  poison  is  elimi- 
nated largely  by  the  urine,  stimulating  diuretics,  like  sweet  spirit  of  niter, 
are  sometimes  useful,  and  the  patient  should  be  catheterized,  if  necessary, 
to  avoid  the  danger  of  reabsorption  of  the  poison  from  the  bladder. 

Post=mortem  Appearances. — These  are  not  usually  characteristic, 
and  occasionally  no  post-mortem  effects  are  observable.  The  most  com- 
mon appearances  are  dilated  pupils,  redness  of  the  tongue,  and  injection 
of  the  mucous  membrane  of  the  stomach  and  small  intestines.  The 
blood-vessels  of  the  brain  are  usually  congested,  and  there  is  often  en- 
gorgement of  the  lungs.  The  heart  is  frequently  empty,  and  the  blood 
is  generally  liquid  and  of  a  dark  color. 

Tests. — Atropine  responds  to  all  of  the  general  tests  for  alkaloids, 
giving  precipitates  with  solution  of  iodine,  picric  acid,  tannic  acid,  etc., 
but  there  is  nothing  in  its  behavior  with  these  reagents  which  especially 
characterizes  it,  or  distinguishes  it  from  other  alkaloids.  We  have,  how- 
ever, three  tests  which  are  characteristic,  especially  when  taken  in  con- 
junction with  one  another;  these  are  the  physiological  test,  Vitali's  test, 
and  Wormley's  test. 

(a)  Physiological  Test. — Atropine  when  introduced  into  the  eye  of  man, 
or  into  that  of  one  of  the  lower  animals,  occasions  marked  dilatation  of 
the  pupil ;  this  is  produced  by  very  minnte  quantities,  and  lasts  for  a 
considerable  length  of  time,  often  persisting  several  days.  The  eye  of 
the  cat  is  particularly  well  adapted  for  this  test,  although  that  of  man 
may  be  used  without  danger  if  proper  precautions  be  observed,  such  as 
not  using  too  large  an  amount,  and  taking  pains  to  have  the  material 
employed  and  the  instruments  used  for  introducing  it  entirely  aseptic. 

This  test  is  exceedingly  delicate,  and  cau  detect  even  a  smaller  amount 
than  the  1-100,000  of  a  grain.  Hyoscyamine  and  hyoscine,  which  are, 
as  we  shall  see  further  on,  isomers  of  atropine,  and  which  constitute 
with  it  a  group  of  alkaloids  known  as  the  mydriatics,  produce  the  same 
effect ;  hyosc3ramine,  in  fact,  is  somewhat  more  energetic  in  dilating  the 
pupil  than  atropine,  and  hyoscine  is  more  powerful  than  either. 

A  few  other  substances  also  cause  dilatation  of  the  pupil,  the  most 
conspicuous  of  which  are  cocaine,  and,  to  a  less  degree,  digitalis  and 
coniine ;  all  of  these,  however,  are  far  less  energetic  than  atropine,  and 
their  effects  are  much  more  evanescent. 

Selmi  and  other  investigators  have  found  that  certain  ptomaines  pos- 


426  4-   SYSTEM  OF  LEGAL  MEDICINE. 

sess  mydriatic  power  closely  resembling  that  of  atropine,  but  the  latter 
may  be  distinguished  from  them  by  other  tests,  especially  by  the  one 
next  to  be  considered. 

(b)  Vitali's  Test. — If  atropine  is  treated  with  a  few  drops  of  strong 
nitric  acid,  evaporated  to  dryness  at  a  gentle  heat,  and  the  residue,  which 
is  colorless  or  slightly  yellow,  touched  with  a  drop  of  alcoholic  solution 
of  potassium  hydrate,  a  purple  color  is  developed,  rapidly  changing  to 
violet,  then  to  dark  red,  and  finally  disappearing.  (See  ¥0.  1,  Colored 
Plate.)  This  beautiful  and  highly  characteristic  test  responds  to  an  ex- 
ceedingly minute  quantity  of  the  alkaloid,  considerably  less  than  1-50,000 
of  a  grain  giving  a  decided  reaction. 

The  two  isomers  of  atropine,  hyoscyamine  and  hj'oscine,  produce  the 
same  reaction,  but  no  other  alkaloid  gives  an  effect  which  could  be  mis- 
taken by  a  competent  observer  for  that  of  atropine.  It  has  been  claimed 
that  veratrine  gives  a  somewhat  similar  reaction,  but  I  have  been  unable 
to  verify  the  statement.  Several  specimeus  of  the  alkaloid  of  the  best 
make,  when  examined  by  Vitali's  test,  have  given  only  a  brownish  color. 

Brouardel  and  Ogier  have  been  unable  to  obtain  an  atropine  reaction 
by  this  test  from  any  ptomaine  which  they  have  separated  from  the 
human  body.  It  is  a  test,  therefore,  of  great  value.  In  the  presence  of 
much  foreign  material  it  sometimes  fails  to  respond,  and  it  is  important, 
therefore,  before  applying  it  to  the  suspected  substance,  especially  if  the 
latter  is  an  extraet  from  a  stomach  or  other  organ,  that  it  be  purified  as 
far  as  possible. 

{c)  Wormleifs  Test. — If  a  strong  solution  of  bromine  in  hydrobromic 
acid  is  added  to  a  solution  of  atropine,  a  yellow  precipitate  is  produced, 
which  is  amorphous  at  first  but  on  standing  becomes  crystalline.  This 
test,  discovered  and  introduced  by  Professor  Wormley,  is  quite  delicate, 
the  1-10,000  of  a  grain  yielding  good  results.  The  test  is  also  charac- 
teristic, for  while  most  if  not  all  of  the  other  alkaloids  give  with  the  test 
yellow  precipitates,  they  all  remain  amorphous  with  a  few  exceptions. 
Hyoscyamine  and  hyoscine  give  crystalline  precipitates  which  cannot  be 
distinguished  from  atropine,  and  meconine,  one  of  the  constituents  of 
opium,  also  produces  a  crystalline  precipitate,  which,  however,  is  distin- 
guished under  the  microscope  by  its  different  crystalline  form ;  meco- 
nine, moreover,  is  easily  differentiated  from  atropine  by  not  responding 
to  either  the  physiological  or  Vitali's  test. 

Detection  of  the  Poison. — In  the  Contents  of  the  Stomach. — The  ma- 
terial should  be  carefully  inspected  for  pieces  of  leaves,  root,  or  berries, 
which  are  often  found  in  case  the  poisoning  has  been  produced  b}^  eat- 
ing parts  of  the  plant.  If  such  portions  are  discovered  they  should  be 
thoroughly  washed  and  examined  under  a  lens  to  determine  their  exact 
character.  Whether  portions  of  the  plant  are  found  or  not,  the  con- 
tents of  the  stomach  should  be  finely  comminuted,  if  necessary,  acid- 
ulated with  a  small  amount  of  acetic  acid,  gently  heated  on  the 
water-bath  for  an  hour  or  two,  and  the  general  process  described  011 
page  418  then  followed.  The  first  chloroform  extract  is  rarely  pure  enough 
for  the  various  tests,  and  it  should  be  dissolved  in  a  small  amount  of 
acidulated  water  and  filtered;  the  filtrate  should  be  made  feebly  alkaline 
and  again  extracted  with  chloroform.  The  residue  obtained  upon  evap- 
oration of  the  chloroform  may  now  be  subjected  to  the  three  tests  above 
mentioned,  beginning  with  the  physiological  test,  which  is  best  performed 


ALKALOIDAL  AND    OTHER   ORGANIC  POISONS.  427 

.as  follows :  a  small  portion  of  the  extract  is  dissolved  in  a  little  water 
feebly  acidulated  with  acetic  acid,  the  mixture  carefully  filtered,  gently 
boiled,  and  when  cold  one  or  two  drops  of  the  fluid  taken  up  by  means 
•of  a  small  sterilized  pipette,  and  placed  in  the  eye.  The  pupil  should  be 
carefully  watched  every  few  minutes  and  compared  with  the  untreated 
■eye,  and  if  at  the  end  of  an  hour  no  effect  is  shown,  especially  if  nega- 
tive results  are  obtained  upon  repeating  the  test,  the  absence  of  atropine 
may  be  definitely  stated.  If,  however,  dilatation  is  produced,  the  period 
of  its  duration  should  be  carefully  noted,  and  other  portions  of  the  chlo- 
roform extract  should  be  tested  by  Vitali's  and  Wormley's  tests.  If  the 
two  latter  also  give  positive  results,  the  presence  of  atropine,  or  one  of 
its  isomers,  is  clearly  established. 

In  the  Tissues. — The  organs  to  be  tested,  such  as  the  liver,  kidney, 
or  brain,  should  be  finely  comminuted,  mixed  with  sufficient  water  to 
make  a  thin  paste,  and  acidulated  with  acetic  or  tartaric  acid.  The  mix- 
ture is  gently  heated  on  a  water-bath  for  an  hour  or  two,  and  the  subse- 
quent process  conducted  as  described  above  in  connection  with  the  con- 
tents of  the  stomach. 

HYOSCYAMUS   AND   STRAMONIUM;    HYOSCYAMINE   AND   HYOSCINE. 

The  two  alkaloids  hyoscyamine  and  hyoscine  are  the  active  principles 
-of  Hyoscyamus  Niger,  or  henbane.  Hyoscyamine  is  also  found  in  small 
but  variable  quantities,  associated  with  atropine,  in  belladonna,  and  it  is 
the  chief  active  principle  of  stramonium  (Datura  Stramonium),  in  which 
it  is  accompanied  by  a  little  atropine. 

Hyoscyamine  and  hyoscine  are  isomers  of  atropine,  having  exactly 
the  same  atomic  composition  as  the  latter ;  they  are,  moreover,  very  simi- 
lar in  their  chemical  properties  and  physiological  effects. 

For  convenience'  sake  the  three  are  often  spoken  of  collectively  as 
the  "  mydriatic  alkaloids,"  by  reason  of  their  effect  on  the  pupil,  which 
is  more  marked  than  that  produced  by  any  other  substances. 

On  account  of  their  close  resemblance  all  three  of  the  alkaloids, 
and  the  various  plants  from  which  they  are  produced,  have  essentially 
the  same  toxic  effects ;  hyoscine,  however,  produces  upon  the  system  a 
more  hypnotic  influence,  and  has  less  tendency  to  occasion  delirium  than 
atropine  or  hyoscyamine.  What  has  been  said,  therefore,  concerning  atro- 
pine and  belladonna  may  be  largely  repeated  in  regard  to  hyoscyamus, 
stramonium,  hyoscyamine,  and  hyoscine,  the  symptoms,  treatment,  etc., 
being  practically  identical.  The  alkaloids  hyoscyamine  and  hyoscine  re- 
spond to  the  same  tests  as  atropine.  They  are  to  be  extracted  from  the 
organs  of  the  body  in  the  same  way  as  has  been  described  in  connection 
with  atropine,  and  the  same  method  of  identifying  them  should  be  used. 

Although  the  three  alkaloids  maybe  distinguished  and  separated  from 
one  another  by  a  difference  in  the  solubility  of  certain  of  their  salts  when 
there  is  a  fair  amount  of  material  to  operate  upon,  in  toxicological  exam- 
inations the  quantity  of  alkaloid  extracted  is  almost  invariably  so  small 
that  a  positive  determination  as  to  which  of  the  three  it  is,  generally  is 
impossible.  We  are  usually,  therefore,  obliged  to  admit  that  the  alka- 
loid extracted  may  be  any  one  of  the  three. 

This  is  sometimes  a  matter  of  considerable  medico-legal  importance, 
for  an  indictment  alleging  specifically  the  administration  of  one  only  of 


428  A   SYSTEM   OF  LEGAL   MEDICINE. 

these  bodies  could  not  generally  be  sustained  if  the  chemical  analysis 
alone  were  depended  on.  The  presence  of  one  of  the  mydriatic  alkaloids 
might  be  clearly  established,  but  it  would  generally  be  impossible  to  state 
absolutely  which  of  the  three  it  was. 

COCAINE. 

Cocaine  is  the  active  principle  of  Erythroxylon  Coca,  a  shrub  growing 
in  various  parts  of  South  America.  It  exists  chiefly  ii]  the  leaves  of  the 
plant,  combined  with  cocatannic  acid  and  associated  probably  with  one 
or  two  other  alkaloidal  substances,  which,  however,  are  of  no  great  im- 
portance. The  quantity  of  cocaine  present  in  the  fresh  leaves  ranges 
from  0.3  to  1.0  percent.,  the  average  being  about  0.75  percent. ;  but 
upon  being  kept  some  time  the  alkaloid  gradually  disappears  by  decom- 
position, and  the  drug  becomes  inert. 

Properties. — Cocaine  when  pure  is  a  colorless,  crystalline  solid,  spar- 
ingly soluble  in  water,  but  dissolving  readily  in  ether,  chloroform,  and 
alcohol.  The  free  alkaloid  has  only  a  slightly  bitter  taste,  but  its  salts 
are  decidedly  bitter.  It  is  of  strongly  alkaline  reaction,  uniting  with 
acids,  completely  neutralizing  them,  and  forming  salts.  Of  these  the 
one  produced  by  its  union  with  hydrochloric;  acid,  and  known,  therefore, 
as  the  hydrochloride,  hydrochlorate,  or  muriate  of  cocaine,  is  the  one 
most  commonly  employed  in  medicine. 

Symptoms. — In  most  of  the  reported  cases  of  poisoning  by  cocaine 
the  alkaloid  has  not  been  administered  by  the  mouth,  but  has  either  been 
given  hypodermically  or  applied  locally  to  a  mucous  membrane,  as 
that  of  the  eye,  the  nose,  or  the  urethra.  However  introduced  into  the 
system,  if  in  sufficiently  large  dose  it  occasions  rapid  and  severe  disturb- 
ances. The  symptoms  frequently  vary  greatly  in  different  cases,  being- 
modified  probably  by  the  quantity  absorbed,  the  susceptibility  of  the  in- 
dividual, and  the  concurrent  action  of  known  or  latent  disease.  The  first 
effect  shown  is  generally  great  nervous  excitement,  often  attended  with 
a  sense  of  fullness  and  oppression  in  the  head,  and  sometimes  associated 
with  nausea  and  vomiting.  At  first  there  is  usually  an  increased  fre- 
quency of  the  pulse  and  respiration,  but  this  is  generally  succeeded  by  a 
marked  diminution  of  both,  especially  observable  in  the  breathing,  which 
becomes  slow  and  labored.  The  pupils  are  usually  dilated,  the  extrem- 
ities become  cold,  and  the  difficulty  of  respiration  produces  deficient  oxy- 
genation of  the  blood,  which  is  shown  by  a  cyanotic  condition  of  the  face. 
The  pulse  grows  feeble,  sometimes  being  imperceptible,  the  breathing 
becomes  more  and  more  labored,  violent  convulsions  appear,  succeeded 
by  coma,  and  death  generally  follows  from  apnoea,  although  occasionally 
from  cardiac  failure.  Many  cases  occur  in  which  the  symptoms  differ 
from  these  in  several  respects;  in  some  there  is  delirium,  in  others  un- 
consciousness is  present  almost  from  the  beginning,  while  in  others  the 
only  prominent  symptom  is  an  intense  sense  of  asphyxia. 

Period  when  Fatal. — Cocaine  generally  acts  with  great  rapidity, 
especially  when  given  hypodermically  or  when  applied  to  mucous  sur- 
faces. One  case  is  recorded  in  which  death  occurred  in  twenty  minutes, 
another  in  four  minutes,  and  still  another  in  forty  seconds.  Occasionally 
cases  are  somewhat  more  protracted,  but  generally  if  the  patient  survives 
half  an  hour  recovery  follows. 


ALKALOIDAL  AND    OTHER   ORGANIC  POISONS.  429 

Fatal  Quantity. — It  is  impossible  to  state  definitely,  in  the  present 
condition  of  our  knowledge,  the  smallest  fatal  dose  of  cocaine,  but  it 
probably  is  not  far  from  half  a  grain.  Somewhat  less  than  the  latter 
quantity,  given  hypodermically,  has  produced  death  in  at  least  one  case, 
and  one  twentieth  of  a  grain  given  hypodermically  to  a  girl  of  twelve 
years  has  occasioned  dangerous  symptoms.  Even  as  small  an  amount 
as  the  one  hundredth  of  a  grain  in  solution  applied  to  the  eye  of  a  child 
fourteen  years  old  has  occasioned  decided  symptoms  of  poisoning.  On 
the  other  hand,  recovery  has  followed  the  administration  of  large  doses 
of  the  alkaloid,  such  as  twenty-two  grains  taken  by  the  mouth,  and  ten 
grains  given  hypodermically. 

Treatment. — If  the  poison  has  been  taken  by  mouth,  the  stomach 
should  be  evacuated  promptly  by  the  use  of  an  emetic  or  the  stomach- 
pump,  and  at  the  same  time  tannic  acid,  iodine,  or  charcoal  may  be  ad- 
ministered as  possible  chemical  antidotes.  In  the  great  majority  of  cases 
of  poisoning  by  cocaine,  however,  the  alkaloid  is  given  hypodermically, 
or  has  been  absorbed  from  some  mucous  surface,  and  in  these  instances 
evacuation  of  the  stomach  is  naturally  unnecessary.  The  constitutional 
symptoms  should  be  combated  by  the  use  of  stimulants  such  as  alcohol 
and  ammonia,  given  by  the  mouth  or  by  hypodermic  injection.  Inha- 
lations of  amyl  nitrite  and  hypodermic  injections  of  liitro-glycerine  arc 
often  signally  useful ;  and  inhalations  of  pure  oxygen  are  very  valuable 
in  relieving  threatened  asphyxia.  In  case  breathing  ceases,  artificial  res- 
piration should  be  resorted  to,  and  electricity  may  be  tried,  with  some 
chance  of  favorable  results. 

Post=mortem  Appearances. — No  characteristic  post-mortem  appear- 
ances follow  cocaine  poisoning.  The  blood  is  generally  dark  and  fluid, 
and  there  is  likely  to  be  congestion  of  the  lungs  and  other  internal 
organs,  but  it  is  scarcely  necessary  to  say  that  these  are  not  peculiar  to 
death  from  this  cause. 

Tests. — Cocaine  responds  to  all  the  general  tests  for  alkaloids,  giving 
precipitates  with  tannic  acid,  picric  acid,  solution  of  iodine,  etc.,  but  these 
are  not  distinctive,  nor  unfortunately  do  we  possess  at  the  present  time 
any  one  characteristic  test  for  the  alkaloid.  The  following  reactions,  how- 
ever, taken  conjointly,  will  usually  serve  to  identify  it: 

(a)  Permanganate  Test. — If  to  a  fairly  strong  solution  of  a  salt  of  coca- 
ine a  few  drops  of  a  solution  of  potassium  permanganate  are  added, 
beautiful  violet-colored  crystals  of  cocaine  permanganate  are  formed 
and  precipitated. 

(6)  Ferric  Chloride  Test. — If  cocaine  in  solution  is  boiled  for  a  few 
minutes  with  dilute  sulphuric  acid,  it  is  decomposed  With  the  formation 
of  benzoic  acid.  If  the  liquid  is  now  neutralized  by  the  careful  addition 
of  potassium  hydrate  and  a  few  drops  of  ferric  chloride  solution  then 
added,  a  pale  brownish  }rellow  precipitate  of  ferric  benzoate  is  produced. 

(r)  Odor  Test.— If  cocaine  is  treated  with  fuming  nitric  acid,  evaporated 
to  dryness,  and  the  residue  treated  with  an  alcoholic  solution  of  caustic 
potash,  a  strong  odor  like  that  of  peppermint  is  evolved. 

(d)  Physiological  Tests. — If  a  solution  of  cocaine  is  introduced  into  the 
eye  of  man  or  one  of  the  lower  animals,  it  causes  marked  dilatation  of 
the  pupil,  much  resembling  the  effect  produced  by  atropine  and  the  other 
mydriatic  alkaloids.  The  mydriasis,  however,  following  the  application 
of  cocaine  differs  from  that  occasioned  by  atropine  in  requiring  for  its 


430  A   SYSTEM  OF  LEGAL  MEDLCINE. 

production  a  very  much  larger  dose,  and  in  being  comparatively  evanes- 
cent, disappearing  completely  in  a  few  hours'  time. 

Another  and  more  characteristic  physiological  effect  of  cocaine  is  the 
local  anaesthesia  succeeding  its  application  to  the  tongue,  lips,  or  other 
mucous  surfaces.  The  action  is  transient,  the  effect  disappearing  usually 
in  from  ten  minutes  to  half  an  hour. 

Detection  of  the  Poison. — If  the  poison  is  sought  for  in  one  of  the 
tissues  of  the  body,  such  as  the  liver  or  kidneys,  the  part  should  be  finely 
comminuted,  mixed  with  water  to  a  thin  paste,  and  acidulated  with  acetic 
or  tartaric  acid.  If  vomited  matter  or  the  contents  of  a  stomach  are  to 
be  tested,  the  material  should  be  made  fluid  with  water,  and  acidulated 
as  above.  The  mixture  in  either  case  is  digested  on  the  water-bath  at  a 
gentle  heat  for  an  hour  or  two,  strained,  and  the  general  process  for  the 
extraction  and  purification  of  alkaloids  described  on  page  418  then  pur- 
sued, chloroform  being  by  preference  the  immiscible  solvent  employed.  A 
part  of  the  purified  residue  should  be  dissolved  in  a  very  little  dilute 
acetic  acid,  and  a  drop  applied  to  the  lip  or  tongue,  and  the  local  effect 
observed;  another  drop  should  be  placed  in  the  eye  of  a  cat,  and  the 
pupil  watched  for  several  hours.  If  the  portion  applied  to  the  lips  pro- 
duces decided  numbness,  and  the  solution  introduced  into  the  eye  of  the 
cat  occasions  a  somewhat  fugitive  dilatation  of  the  pupil,  we  have  reason- 
able proof  of  the  presence  of  cocaine.  The  remainder  of  the  purified 
residue  should  then  be  tested  by  the  several  other  reactions  for  the  alka- 
loid, and  if  they  all  give  characteristic  responses,  the  presence  of  cocaine 
is  established. 

COLCHICUM  AND   COLCHICINE. 

Colchicine  (synonyms,  colchicin,  colchichia,  and  colchicina)  is  the  act- 
ive principle  of  Colchicum  autumnale,  or  meadow-saffron.  The  alkaloid 
exists  in  all  parts  of  the  plant  in  quantity  ranging  from  1.0  to  1.5  per- 
cent. 

Properties  of  the  Alkaloid. — Colchicine  when  pure  is  a  white  solid, 
which  is  usually  amorphous,  but  which  may  be  obtained  in  a  crystalline 
form.  It  dissolves  readily  in  water  and  also  in  ether,  alcohol,  and  chloro- 
form. It  is  neutral  or  very  faintly  alkaline  in  its  reaction  to  test-paper, 
and  it  has  but  a  feeble  affinity  for  acids.    Its  taste  is  bitter  and  pungent. 

Symptoms. — Colchicine  is  an  active  poison,  as  are  also  the  various 
parts  of  the  colchicum  plant,  to  which  it  imparts  its  toxicity. 

Cases  of  poisoning  by  the  pure  alkaloid  are  very  rare,  but  the  plant 
and  its  pharmaceutical  preparations  have  not  infrequently  caused  death. 

The  most  characteristic  effects  produced  by  both  the  plant  and  the 
alkaloid  are  those  in  connection  with  the  gastro-intestinal  tract,  the  poi- 
son producing  symptoms  somewhat  similar  to  those  of  the  mineral  irri- 
tants, such  as  arsenic  and  antimony.  There  is  severe  burning  pain 
in  the  stomach  and  bowels,  violent  nausea  and  vomiting,  profuse  purging, 
intense  thirst,  extreme  prostration,  feeble  and  rapid  pulse,  cold  extrem- 
ities, and  great  exhaustion.  The  nervous  system  is  rarely  or  never  in- 
volved ;  convulsions  do  not  occur,  the  intellect  remains  clear,  and  con- 
sciousness may  last  up  to  the  end. 

Period  when  Fatal. — Although  the  toxic  symptoms  presented  by 
large  doses  of  colchicum  are  very  severe,  the  drug  does  not  generally 


ALKAL01DAL  AND   OTHER    ORGANIC  POISONS.  431 

lead  to  a  fatal  termination  rapidly.  In  one  case  death  occurred  in  seven 
hours,  but  usually  a  much  longer  period  intervenes.  Of  five  fatal  cases 
of  poisoning  by  wine  of  colchicum  reported  from  the  convict  hospital  at 
Toulon,  France,  two  died  at  the  end  of  nineteen  hours,  a  third  after 
twenty  hours,  a  fourth  in  twenty-two  hours,  and  the  last  twenty-nine 
hours  after  taking  the  fatal  dose.  Still  longer  periods  are  reported  in 
other  cases,  two  being  recorded  in  which  death  occurred  on  the  four- 
teenth day. 

Fatal  Quantity. — Colchicine  is  a  very  active  poison,  and  one  third 
of  a  grain  may  be  regarded  as  a  probably  minimum  fatal  dose.  Casper 
records  a  case  of  death  from  wine  of  colchicum  which  contained  some- 
what less  than  half  a  grain  of  the  alkaloid,  Wood  states  that  death  has 
been  occasioned  by  two  and  a  half  drams  of  the  wine,  and  Taylor  men- 
tions a  case  in  which  three  and  a  half  drams  proved  fatal. 

On  the  other  hand,  recovery  has  occurred  after  the  ingestion  of  large 
doses,  such  as  an  ounce  of  the  wine  of  colchicum  and  three  fourths  of  a 
grain  of  the  pure  alkaloid. 

Treatment. — In  poisoning  either  by  colchicum  or  its  alkaloid,  the 
stomach  should  be  thoroughly  evacuated  and  washed  out  as  soon  as  pos- 
sible. This  may  be  accomplished  if,  as  usually  is  the  case,  the  patient  is 
already  vomiting,  by  the  copious  administration  of  tepid  water  to  pro- 
mote emesis ;  but  if  vomiting  has  not  occurred  an  emetic  should  be  given, 
or  the  stomach-pump  used ;  tannic  acid  may  be  administered  at  the  same 
time  with  a  hope  of  diminishing  the  solubility  of  the  poison,  and  therefore 
of  retarding  its  absorption.  After  complete  evacuation  of  the  stomach, 
an  opiate  should  be  administered  to  allay  the  pain  and  check  the  vomit- 
ing, and  ammonia,  alcohol,  and  other  stimulants  may  be  freely  used  to 
•counteract  the  depressing  influence  of  the  poison. 

Post=mortem  Appearances. — These  are  by  no  means  characteristic, 
nor  are  the  same  appearances  found  in  all  cases.  The  stomach  and 
bowels  sometimes  show  intense  congestion,  but  on  the  other  hand  these 
•organs  occasionally  present  an  almost  normal  appearance ;  the  lungs, 
the  membranes  of  the  brain,  and  the  kidneys,  however,  are  nearly  always 
■congested,  and  the  blood  is  generally  thick  and  dark  colored. 

Tests. — (a)  Nitric  Acid  Test. — Colchicine  when  treated  with  nitric  acid 
gives  a  bright  violet  color,  which  after  a  time  changes  to  brown  and 
finally  to  yellow.  If  the  alkaloid  is  first  treated  with  sulphuric  acid,  and 
to  the  solution  thus  produced,  after  standing  some  time,  a  drop  of  nitric 
acid  is  added,  the  reaction  above  described  is  said  to  be  produced  more 
sharply  and  more  characteristically.  No  other  alkaloid  treated  with  nitric 
acid  gives  the  same  reaction  as  colchicine. 

(6)  Mandelin's  Test. — Colchicine  gives  with  a  sulphuric  acid  solution 
of  ammonium  vanadate  (one  part  of  the  vanadate  to  two  hundred  of  the 
acid)  an  intense  green  color,  which  rapidly  changes  to  a  violet  brown. 
No  other  alkaloid  that  has  been  submitted  to  this  reagent  gives  the  same 
reaction.  Arbutin,  aloin,  and  chrysophanic  acid,  however,  behave  very 
much  like  colchicine,  but  they  are  clearly  distinguished  from  the  latter 
by  not  producing  with  nitric  acid  a  violet  color. 

(c)  ZeiseVs  Test. — If  the  alkaloid  is  dissolved  in  hydrochloric  acid  and 
ferric  chloride  added,  upon  boiling  the  liquid  becomes  green.  If  the  fluid 
is  now  agitated  with  chloroform  the  latter  takes  up  a  part  or  all  of  the 
coloring  matter,  and  sinks  to  the  bottom. 


432  ^   SYSTEM  OF  LEGAL   MEDICINE. 

(d)  Physiological  Test. — Colchicine  if  given  to  one  of  the  lower  animals 
produces  marked  symptoms,  characterized  by  vomiting,  purging,  great 
prostration,  and,  if  the  dose  is  sufficiently  large,  death. 

The  experiments  of  Vulpian  show  that  about  one  twentieth  of  a  grain 
is  necessary  to  produce  marked  purging  in  a  rather  large  dog,  and  that 
one  third  of  a  grain  is  required  to  kill  a  medium-sized  dog  with  certainty, 
although  half  that  quantity  occasions  intense  symptoms,  and  may  prove 
fatal. 

Detection  of  the  Poison. — The  material  to  be  operated  on  should  be 
finely  subdivided,  mixed  with  water  to  a  thin  consistence,  mildly  acidu- 
lated with  acetic  acid,  and  heated  on  the  water-bath ;  the  mixture  should 
be  strained,  evaporated  to  a  syrupy  consistence,  and  several  volumes  of 
alcohol  added ;  after  filtration  the  filtrate  should  be  gently  heated  to  ex- 
pel the  alcohol,  mildly  alkalinized  with  ammonia,  and  shaken  with  twice 
its  bulk  of  chloroform  or  ether.  Upon  evaporating  the  latter  at  a  gen- 
tle heat,  the  colchicine  is  left  in  an  impure  form  as  an  amorphous,, 
colored  residue.  It  may  be  purified  by  redissolving  in  a  dilute  acid,  fil- 
tering, alkalinizmg,  and  extracting  as  before  with  an  immiscible  solvent. 
The  residue  now  obtained  upon  evaporation  may  be  examined  by  the  sev- 
eral tests  before  described. 

During  decomposition  of  animal  tissues  substances  are  not  infre- 
quently produced  which  behave # strikingly  like  colchicine  with  all  of  the 
general  tests,  excepting  perhaps  Zeisel's  test.  In  a  well-known  case  of 
suspected  poisoning  from  colchicum  occurring  in  Paris  a  few  years  since, 
Brouardel  and  several  other  eminent  scientists,  who  were  called  upon  as 
experts,  found  during  their  investigations  that  ptomaines  might  be  ex- 
tracted from  decomposing  cadavers,  which  produced  reactions  with  nitric 
acid  and  with  Mandelin's  test  strikingly  like  those  occasioned  by  traces 
of  colchicine ;  and  other  investigators  have  obtained  similar  results  on 
many  occasions.  Nothing,  therefore,  short  of  the  extraction  from  the 
suspected  body  of  a  ponderable  quantity  of  material  giving  all  of  the 
chemical  reactions  and  physiological  effects  of  the  pure  alkaloid,  should 
be  accepted  as  proof  of  the  presence  of  the  poison. 

Resistance  to  Putrefaction. — The  experiments  of  Ogier,  director  of 
the  Laboratory  of  Toxicology  at  Paris,  show  that  colchicine  resists  putre- 
factive processes  to  a  considerable  degree.  Three  dogs  were  poisoned 
by  the  alkaloid  and  buried  for  five  and  a  half  months ;  at  the  end  of  that 
time  the  remains  were  examined,  and  indisputable  evidence  of  the  pres- 
ence of  the  poison  was  obtained  in  each  case. 


CONIUM   AND   CONIINE. 

Coniine  (synonyms,  coniin,  conine,  conia,  conicine,  and  conicina)  is- 
the  alkaloid  which  imparts  activity  to  Conium  maculatum,  the  umbellifer- 
ous herb  commonly  known  as  hemlock.  It  is  found  in  all  parts  of  the 
plant  combined  with  an  organic  acid,  but  it  is  most  abundant  in  the 
fruit,  where  it  exists  in  a  proportion  of  between  0.5  and  2.0  percent. 

The  pure  alkaloid  is  an  exceedingly  energetic  poison,  almost  approach- 
ing hydrocyanic  acid  in  its  activity.  But  few  cases  of  death,  however, 
have  occurred  from  the  alkaloid,  but  poisoning  by  the  plant  and  its  vari- 
ous pharmaceutical  preparations  have  not  been  infrequent.     The  herb 


ALKALOIDAL   AND    OTHER   ORGANIC  POISONS.  433 

has  occasionally  been  mistaken  for  parsley  or  other  edible  vegetables, 
and  the  great  majority  of  deaths  from  coniine  have  occurred  through 
this  misapprehension. 

Properties  of  the  Alkaloid. — Pure  coniine  is  a  colorless,  oily  fluid, 
lighter  than  watei',  and  possessed  of  an  unpleasant  odor  resembling  that 
of  the  urine  of  mice.  It  boils  at  163.5°  C,  and  is  slowly  volatile  at  ordi- 
nary temperatures.  Unlike  most  of  the  alkaloids,  it  is  fairly  soluble  in 
water,  requiring  about  one  hundred  parts  to  dissolve  it ;  and  it  is  very 
easily  soluble  in  ether  and  chloroform.  It  has  marked  alkalinity,  read- 
ily uniting  with  acids  forming  salts.  In  contact  with  air  it  changes 
chemically,  becoming  dark-colored,  and  eventually  being  converted  into 
a  brown  resin. 

Symptoms. — As  coniine  is  the  active  principle  of  conium,  the  effects 
produced  by  the  two  are  identical,  except  that  the  alkaloid  acts  some- 
what more  rapidly  and  energetically  than  the  crude  drug.  They  both 
exercise  a  profound  influence  on  the  motor  nerves,  completely  paralyz- 
ing them.  This  effect  is  first  manifested  in  the  extremities,  but  eventu- 
ally the  organs  of  respiration  are  affected,  and  death  ensues  from  apncea, 
the  heart  continuing  to  beat  after  the  breathing  has  ceased.  The  symp- 
toms usually  observed  are  great  muscular  weakness,  beginning  in  the 
arms  and  legs,  inability  to  walk,  profound  lassitude,  dilatation  of  the 
pupils,  huskiness  or  loss  of  voice,  embarrassment  of  breathing,  and 
finally  death  from  paralysis  of  the  muscles  of  respiration.  The  intel- 
lect generally  remains  clear  until,  through  deficient  respiratory  action, 
the  blood  becomes  overcharged  with  cai-bon  dioxide,  when  we  may  have 
unconsciousness  accompanied  by  convulsions  and  delirium. 

Period  when  Fatal. — Both  coniine  and  conium  act  with  rapidity,  the 
symptoms  setting  in  soon  after  the  poison  is  swallowed,  and  generally 
ending  fatally  in  from  one  to  three  hours. 

Fatal  Quantity. — One  fifth  of  a  grain  of  the  alkaloid  has  produced 
serious  effects,  and  a  drop  has  occasioned  alarming  symptoms.  This 
may  be  regarded  as  a  probably  minimum  fatal  dose. 

Treatment. — The  stomach  should  be  thoroughly  evacuated  as  soon 
as  possible,  and  iodine,  tannic  acid,  or  charcoal  administered  with  the 
hope  of  retarding  the  absorption  of  the  poison.  Stimulants  should  be 
employed,  such  as  alcohol  and  ammonia,  and,  on  theoretical  grounds, 
strychnine  has  been  suggested  as  a  valuable  antidotal  agent.  Electricity 
may  be  serviceable,  and  copious  inhalations  of  pure  oxygen  are  unques- 
tionably useful. 

Post=mortem  Appearances. — Coniine  does  not  produce  any  charac- 
teristic post-mortem  appearances.  Those  seen  are  such  as  are  commonly 
found  after  death  by  apnoea.  The  lungs  are  congested,  the  brain  more 
or  less  so,  and  the  blood  is  dark  and  fluid. 

Tests. — Coniine  is  characterized  by  the  following  reactions : 

(a)  Odor— The  mousey  odor  of  coniine  is  peculiar  and  exceedingly 
marked;  one  part  of  the  alkaloid  in  50,000  of  water,  according  to 
Wormley,  is  recognizable  by  the  sense  of  smell. 

(b)  Hydrochloric  Acid  Test. — If  a  watch-glass  containing  a  small  quan- 
tity of  the  alkaloid  is  covered  with  another  glass  on  the  under  surface 
of  which  is  a  little  hydrochloric  acid,  copious  white  fumes  are  produced 
by  the  union  of  the  vapor  of  the  two  substances,  and  the  coniine  soon 
becomes  a  mass  of  white  crystalline  needles. 


434  A   SYSTEM  OF  LEGAL  MEDICINE. 

(c)  Butyric  Acid  Test. — If  coniine  is  treated  with  a  mixture  of  potas- 
sium bichromate  and  dilute  sulphuric  acid,  and  gently  heated,  butyric 
acid  is  formed,  and  may  be  recognized  by  its  characteristic  odor. 

(d)  Alloxan  Test. — If  coniine  is  added  to  a  solution  of  alloxan  an  in- 
tense purple-red  color  is  produced  and  white  needle-shaped  crystals  sep- 
arate, which  dissolve  in  solution  of  potassium  hydrate  with  the  produc- 
tion of  a  purple  color  and  the  development  of  a  mousey  odor. 

Detection  of  the  Poison. — The  suspected  material,  whether  the  con- 
tents of  the  stomach  or  one  of  the  organs,  such  as  the  liver  or  kidneys, 
should  be  finely  subdivided,  made  into  a  thin  paste  with  water,  mildly 
acidulated  with  acetic  acid,  and  gently  heated  on  the  water-bath ;  the 
mixture  is  then  strained,  the  liquid  evaporated  to  a  small  bulk,  treated 
with  four  or  five  times  its  volume  of  strong  alcohol,  and  filtered  from 
the  separated  insoluble  material.  The  filtrate  is  carefully  heated  to  ex- 
pel the  alcohol,  the  residual  liquid  mixed  with  a  little  water,  again  fil- 
tered, the  filtrate  rendered  alkaline  by  potassium  hydrate,  and  vigorously 
shaken  with  twice  its  volume  of  ether.  The  latter,  after  separation  from 
the  aqueous  fluid,  is  removed,  placed  in  a  large  watch-glass,  and  put  in 
a  cool  place.  Upon  evaporation  of  the  ether  any  coniine  that  may  have 
been  present  will  be  left  behind  as  oily  drops,  which  are  usually  more  or 
less  colored  by  the  presence  of  adhering  impurities.  To  purify  before 
testing,  the  residue  should  be  dissolved  in  dilute  acetic  acid,  filtered, 
alkalinized,  shaken  with  ether  as  before,  and  the  ether  again  allowed  to 
evaporate  spontaneously  from  a  large  watch-glass.  If  an  oily  liquid  is 
now  obtained  which  exhales  a  strong  mousey  odor,  it  may  be  submitted 
to  the  other  tests  for  the  alkaloid.  If  all  of  them  give  unequivocal,  char- 
acteristic reactions  for  coniine,  the  presence  of  the  poison  is  established, 
but  nothing  short  of  the  most  absolutely  perfect  response  to  all  the  tests 
should  be  accepted  as  proof  of  the  alkaloid.  Numerous  animal  tissues 
and  fluids,  especially  if  somewhat  decomposed,  yield  not  infrequently, 
upon  examination  as  above,  compounds  of  an  oily  character,  possessed 
of  a  mousey  odor,  fuming  with  hydrochloric  acid,  and  otherwise  comport- 
ing themselves  somewhat  like  coniine.  A  number  of  cases  are  recorded 
in  which  the  poisonous  alkaloid  was  at  first  supposed  to  have  been  dis- 
covered, but  a  mistake  was  afterward  proved  to  have  been  made.  The 
analyst  should  under  no  circumstances  regard  the  presence  of  coniine  as 
established  unless  all  of  his  tests  agree  in  every  respect  with  those  to  be 
obtained  from  the  pure  alkaloid. 

There  seems  to  be  some  evidence  that  coniine,  or  at  least  a  substance 
that  possesses  most  if  not  all  of  its  properties,  is  at  times  actually  pro- 
duced in  animal  tissue  by  decomposition.  In  view  of  this  fact,  death 
from  coniine  poisoning  should  never  be  affirmed  from  the  result  of 
chemical  analysis  alone,  unless  the  latter  has  been  made  immediately 
after  death,  and  before  decomposition,  therefore,  has  set  in. 


GELSEMIUM,  GELSEMINE,  AND   GELSEMIC   ACID. 

Gelsemium,  the  rhizome  and  roots  of  Gelsemixm  sempervirens,  or  yellow 
jasmine,  owes  its  activity  to  the  presence  of  a  powerful  alkaloid,  gelse- 
mine  (synonyms,  gelsemin  and  gelsemia).  This  was  first  obtained  in  the 
pure  state  and  critically  examined  by  Professor  Wormley  in  1870,  who 


ALKALOIDAL  AND   OTHER   ORGANIC  POISONS.  435 

also  discovered  in  the  drug  a  peculiar  acid,  to  which  he  gave  the  name 
of  gelsemic  acid  or  gelseminic  acid.  For  most  of  ovu*  knowledge  con- 
cerning both  of  these  substances  we  are  indebted  to  the  careful  investi- 
gations of  this  eminent  scientist. 

Professor  Wormley  found,  as  a  mean  of  several  tests,  that  the  root 
contains  about  0.25  percent,  of  gelsemine  and  0.5  percent,  of  gelsemic 
acid. 

Properties. — (a)  Gelsemine. — In  the  pure  state  gelsemine  is  a  color- 
less, odorless  solid,  having  an  intensely  bitter  taste,  and  crystallizing  with 
difficulty.  It  is  a  strong  base,  uniting  with  acids  readdy,  forming  salts. 
It  is  freely  soluble  in  chloroform  and  ether,  but  requires  644  parts  of 
water  for  its  solution.  The  alkaloid  is  exceedingly  poisonous,  one  eighth 
of  a  grain  killing  a  cat  in  one  and  a  half  hours,  and  one  sixth  of  a  grain 
may  be  regarded  as  a  fatal  dose  for  man. 

(6)  Gelsemic  Acid. — This  is  a  colorless,  odorless  solid,  nearly  tasteless 
and  highly  crystalline ;  it  has  but  feeble  acid  powers ;  it  requires  nearly 
3000  parts  of  water  to  dissolve  it,  but  it  is  readily  soluble  in  ether,  chlo- 
roform, and  alcohol. 

Gelsemic  acid  does  not  seem  to  have  any  well-defined  physiological 
effects  upon  the  higher  animals,  although  it  is  very  poisonous  to  frogs. 

Symptoms. — Cases  of  poisoning  by  the  pure  alkaloid  are  not  known, 
but  the  various  pharmaceutical  preparations  of  the  root  have  often  pro- 
duced fatal  effects;  and  several  deaths  are  recorded  from  the  eclectic 
preparation  "  gelsemin,"  which  is  probably  the  true  alkaloid  mixed  with 
considerable  foreign  matter. 

The  symptoms  observed  in  poisoning  by  gelsemium  usually  begin 
with  a  sense  of  bewilderment  and  unsteadiness,  the  vision  becomes 
double,  and  frequently  all  external  objects  assume  a  yellow  hue ;  there  is 
difficulty  in  opening  the  eyes,  the  upper  lids  dropping  almost,  or  quite, 
beyond  control;  the  face  becomes  congested,  the  lips  blue,  the  pupils 
dilated  and  frequently  insensible  to  light ;  speech  is  labored,  the  lower 
jaw  falls,  and  the  mouth  sometimes  remains  wide  open ;  the  pulse  is 
small  and  feeble,  and  respiration  is  difficult.  The  mind  is  not  usually 
affected  until  near  the  end,  when  convulsions  may  occur  and  coma  set  in. 
Death  is  produced  by  apnoea. 

Period  when  Fatal. — Death  from  gelsemium  poisoning  usually  oc- 
curs early,  one  case  being  recorded  of  a  fatal  issue  within  an  hour,  and 
several  others  within  two  or  three  hours ;  but  on  the  other  hand,  death 
has  been  postponed  until  the  seventh  or  eighth  hour.  Usually  if  the 
patient  survives  four  or  five  hours  recovery  is  highly  probable. 

Fatal  Quantity. — We  do  not  know  surely  the  minimum  fatal  dose 
of  gelsemium,  but  the  smallest  recorded  amount  that  has  produced  death 
in  an  adult  is  a  dram  of  the  fluid  extract.  This  quantity  represents, 
according  to  Professor  Wormley,  about  one  sixth  of  a  grain  of  pure  gel- 
semine. Children  are  naturally  much  more  susceptible,  and  one  case  is 
reported  of  death  from  a  quantity  of  the  tincture  equivalent  to  twelve 
minims  of  the  fluid  extract. 

Treatment. — The  stomach  should  be  evacuated  as  promptly  as  pos- 
sible, and  general  stimulants  freely  administered.  Electricity  has  been 
highly  recommended,  and  inhalations  of  pure  oxygen  would  undoubtedly 
be  useful  in  the  latter  stages  when  symptoms  of  asphyxia  begin  to  show 
themselves. 


43G  ^   SYSTEM   OF  LEGAL   MEDICINE. 

Post=mortem  Appearances. — In  the  few  cases  in  which  post-mortem 
examinations  have  been  made  after  poisoning"  by  gelsemium,  absolutely 
no  characteristic  appearances  were  observed.  As  would  be  naturally 
supposed,  since  death  occurs  from  apncea,  the  blood  was  found  dark  and 
fluid. 

Tests. — i.  Gelsemic  Acid. — (a)  Fluorescence. — If  gelsemic  acid  is 
treated  with  a  solution  of  a  caustic  alkali,  like  ammonium  or  potassium 
hydrate,  it  assumes  a  yellow  color,  and  quickly  dissolves,  producing  a 
highly  fluorescent  liquid.  The  fluorescence  is  very  marked  even  with 
small  quantities  of  the  acid,  one  grain  in  100,000  giving  a  distinct  reac- 
tion. Several  other  vegetable  substances  are  also  highly  fluorescent,  so 
that  this  test  is  reliable  only  when  taken  in  conjunction  with  others. 

(b)  Nitric  Acid  Test. — If  gelsemic  acid  is  treated  with  nitric  acid,  it 
dissolves  to  a  yellow  or  reddish  solution ;  on  treating  this  with  an  excess 
of  ammonia  the  color  turns  to  a  deep  red. 

(c)  Sulphuric  Acid  and  Ammonia  Text. — Sulphuric  acid  slowly  dissolves 
gelsemic  acid  to  a  clear  solution ;  if  a  drop  of  ammonia  water  is  allowed 
to  flow  into  this,  the  gelsemic  acid  immediately  separates  in  the  form  of 
crystalline  needles. 

These  tests,  taken  together,  distinguish  gelsemic  acid  from  other  sub- 
stances with  which  it  might  be  confounded. 

2.  Gelsemin. — The  alkaloid  gives  precipitates  with  most  of  the  gen- 
eral alkaloidal  reagents,  but  is  characterized  especially  by  the  following 
tests : 

(a)  Oxidation  Test. — Gelsemine  when  pure  dissolves  in  sulphuric  acid 
with  little  or  no  change  of  color ;  but  if  the  solution  is  treated  with  an 
oxidizing  agent,  such  as  potassium  bichromate,  manganese  dioxide,  or 
cerosoceric  oxide,  a  beautiful  reddish  purple  color  manifests  itself. 

(b)  Nitric  Acid  Test. — Pure  gelsemine  dissolves  in  nitric  acid  to  a 
colorless  solution,  which  on  spontaneous  evaporation  leaves  a  permanent 
bluish  green  stain.  If  this  greenish  residue  is  treated  with  a  small  quan- 
tity of  sulphuric  acid  and  an  oxidizing  agent,  the  reddish  purple  color 
described  in  the  first  test  is  developed,  so  that  the  same  quantity  of  the 
alkaloid  may  be  used  for  both  of  these  reactions. 

Both  tests  (a)  and  (b)  are  highty  delicate,  and  are  quite  characteristic, 
especially  when  they  are  used  conjunctively  in  the  manner  spoken  of 
above. 

Detection  of  the  Poison. — In  the  Contents  of  the  Stomach. — The  finely 
comminuted  substance  should  be  acidulated  with  acetic  acid,  diluted  with 
water  if  necessary,  digested  on  the  water-bath  for  an  hour  or  two,  and 
then  strained.  The  strained  liquid  should  be  evaporated  to  a  small  bulk, 
treated  with  several  volumes  of  strong  alcohol,  filtered,  and  the  filtrate 
heated  gently  until  the  alcohol  has  been  expelled.  The  fluid  is  now  ex- 
amined separately  for  gelsemic  acid  and  gelsemine. 

{a)  Gelsemic  Acid. — The  acid  liquid  is  shaken  with  twice  its  volume 
of  ether,  which  takes  up  any  gelsemic  acid  that  may  be  present.  The 
ether  is  carefully  separated  from  the  aqueous  fluid,  allowed  to  evaporate 
spontaneously,  and  the  residue  examined  for  the  acid  by  the  tests  given 
above. 

[b)  Gelsemine. — The  acid  liquid,  after  treatment  by  ether  for  removal 
of  gelsemic  acid,  should  be  rendered  alkaline  and  shaken  with  chloroform. 
Upon  evaporation  of  the  latter,  any  gelsemine  that  may  be  present  will 


ALKAL01DAL   AND    OTHEll    UllGAXIC  FOISOXS.  437 

be  found  in  the  residue,  aud  its  presence  may  be  detected  by  the  tests 
already  described. 

Should  the  first  chloroform  residue  be  too  impure  for  direct  testing, 
it  may  be  purified  by  solution  in  dilute  acid,  filtering,  alkalinizing,  and 
reextracting  with  chloroform.  The  residue  from  the  evaporation  of  the 
latter  will  usually  be  sufficiently  pure  for  the  various  tests. 

In  the  Tissues. — The  parts  should  be  finely  comminuted,  mixed  with 
dilute  acidulated  alcohol,  heated  gently  on  the  water-bath,  strained,  the 
fluid  evaporated  to  a  small  bulk,  and  the  subsequent  examination  con- 
ducted exactly  as  in  connection  with  the  contents  of  the  stomach. 

Both  gelsemic  acid  and  gelsemine  resist  decomposition  at  least  fairly 
well.  Professor  Wormley  reports  a  case  in  which  he  was  able  four  and 
a  half  months  after  death  to  extract  both  the  acid  and  the  alkaloid  from 
the  body  of  a  woman  who  died  from  the  effects  of  three  teaspoonf  uls  of  the 
fluid  extract  of  gelsemium. 

TOBACCO   AND   NICOTINE. 

Nicotine  (synonyms,  nicotin,  nicotia,  and  nicotina)  is  the  active  prin- 
ciple of  Nicotiana  Tdbacum,  or  common  tobacco.  It  exists  in  all  parts  of 
the  plant  combined  with  an  organic  acid,  the  amount  varying  greatly  in 
different  specimens,  and  ranging  from  two  to  eight  percent.,  the  average 
being  about  five  percent. 

Nicotine  when  pure  is  one  of  the  most  violent  poisons  with  which  we 
are  acquainted,  fully  equaling,  if  not  surpassing,  hydrocyanic  acid  in  its 
toxic  powers ;  oidy  a  few  cases  of  death,  however,  are  recorded  from  the 
alkaloid  itself,  but  tobacco  in  its  various  forms  has  often  proved  fatal. 

Properties  of  the  Alkaloid. — Nicotine  when  pure  is  a  colorless  liquid, 
slightly  heavier  than  water,  and  possessed  of  a  very  penetrating  odor, 
like  that  of  tobacco,  and  of  a  burning,  pungent  taste.  It  boils  at  250°  C, 
and  slowly  volatilizes  at  ordinary  temperatures.  It  is  readdy  soluble  in 
water,  and  dissolves  with  ease  in  alcohol,  ether,  and  chloroform.  It  is 
highly  alkaline,  neutralizing  acids  completely  and  producing  neutral 
salts.  When  exposed  to  the  air  and  light  it  slowly  becomes  colored, 
and  finally  is  converted  into  a  brown  resinous  substance. 

Symptoms. — Tobacco  owes  its  effects  entirely  to  nicotine,  and  the 
symptoms  produced,  therefore,  by  the  plant  are  identical  with  those  occa- 
sioned by  the  alkaloid,  differing  only  in  rapidity  of  action.  Soon  after 
taking  a  toxic  dose  of  either  the  plant  or  the  alkaloid,  there  is  experi- 
enced a  violent  sense  of  giddiness,  accompanied  by  great  prostration, 
trembling  of  the  limbs,  severe  nausea  and  vomiting,  and  frequently  copi- 
ous purging;  the  heart's  action  is  disturbed,  the  pulse  becoming  rapid 
and  feeble,  and  the  respiration  is  difficult;  the  pupils  are  usually  widely 
dilated,  although  sometimes  contracted;  the  face  becomes  blanched,  the 
lips  blue,  the  extremities  cold,  and  the  respiratory  act  becomes  more  and 
more  embarrassed;  the  intellect  is  clouded,  convulsions  often  occur,  fol- 
lowed by  coma,  and  death  takes  place  by  apncea,  the  heart  continuing  to 
beat  after  breathing  has  ceased. 

The  external  application  of  tobacco  to  ulcers,  and  even  to  the  sound 
skin,  has  not  infrequently  been  followed  by  violent  symptoms,  and  some- 
times by  death.  Infusion  of  tobacco,  used  as  an  enema  for  medical  pur- 
poses, has  occasionally  produced  severe  symptoms  of  poisoning,  and  in 


438  A   SYSTEM  OF  LEGAL  MEDICINE. 

a  number  of  cases  has  proved  fatal.  The  smoking  of  tobacco  occasions 
decided  symptoms  of  poisoning  with  persons  not  accustomed  to  it,  and 
in  not  a  few  instances  it  has  produced  death.  It  is  surprising,  in  view 
of  the  great  prevalence  of  tobacco-smoking,  that  a  greater  number  of 
fatal  cases  have  not  been  recorded.  The  reason  for  this  probably  lies  in 
the  fact  that  during  the  combustion  of  the  tobacco  a  large  part  of  the 
nicotine  is  destroyed,  only  about  one  seventh  of  that  originally  present 
passing  unchanged  into  the  smoke.  Its  place  is  taken  in  the  products 
of  combustion  by  less  poisonous  pyridine  bases. 

Period  when  Fatal. — Pure  nicotine  acts  with  great  rapidity,  one  case 
being  recorded  in  which  death  occurred  three  minutes  after  its  admin- 
istration ;  and  in  the  well-known  case  in  which  the  Count  de  Bocarme 
poisoned  his  brother-in-law,  Gustave  Fougnies,  by  this  agent,  the  victim 
died  in  five  minutes.  A  tobacco  enema  has  prove  fatal  in  one  case  in 
fifteen  minutes,  in  another  in  eighteen  minutes,  and  in  a  third  in  thirty- 
five  minutes.  On  the  other  hand,  a  fatal  termination  has  been  delayed 
for  several  hours,  and  in  one  case  at  least,  until  the  second  day. 

Fatal  Quantity. — The  pure  alkaloid  is  an  exceedingly  violent  poi- 
son ;  its  smallest  fatal  dose,  however,  is  not  definitely  known,  although 
it  is  probably  only  a  fraction  of  a  grain.  The  plant  is  also  actively  poi- 
sonous to  those  not  accustomed  to  its  use,  an  injection  of  only  thirty 
grains  having  proved  rapidly  fatal  in  one  case,  while  somewhat  larger 
doses  have  killed  in  a  few  other  instances. 

Treatment. — The  stomach  should  be  at  once  evacuated,  and  iodine 
and  pulverized  charcoal  may  be  administered  with  the  hope  of  retarding 
the  absorption  of  the  alkaloid ;  general  stimulants  should  be  given,  elec- 
tricity applied  to  promote  the  respiratory  efforts,  and  inhalations  of  pure 
oxygen  administered  to  increase  the  oxygenation  of  the  blood. 

Post=mortem  Appearances.-^The  body  after  death  from  tobacco 
does  not  present  any  characteristic  signs.  The  stomach  is  sometimes 
found  exceedingly  reddened,  the  membranes  of  the  brain  congested,  the 
lungs  engorged,  the  liver  and  kidneys  congested,  and  the  blood  dark 
and  fluid.  None  of  these  appearances,  however,  excepting  the  condition 
of  the  blood,  are  constant. 

Tests. — Nicotine  responds  to  most  of  the  reagents  for  the  alkaloids,, 
such  as  giving  precipitates  with  iodine,  picric  acid,  etc.  It  is  distin- 
guished, however,  from  all  of  the  other  ordinary  alkaloids,  except  coni- 
ine,  by  being  an  oily  liquid,  and  not  a  crystalline  solid,  as  vegetable 
bases  generally  are.  It  is  further  characterized  by  its  peculiar  odor  and 
by  the  following  tests : 

(a)  Hydrochloric  Acid  Test. — If  a  watch-glass  containing  a  little  nico- 
tine has  inverted  over  it  another  glass  moistened  with  a  drop  of  hydro- 
chloric acid,  white  fumes  are  rapidly  formed,  and  an  amorphous  solid  is 
deposited  on  the  watch-glass.  This  reaction  distinguishes  it  from  coni- 
ine,  which  under  similar  treatment  produces  a  crystalline  deposit. 

(6)  Mercuric  Chloride  Test. — If  a  solution  of  corrosive  sublimate  is 
added  to  a  solution  of  nicotine,  a  white  precipitate  is  produced,  which  at 
first  is  amorphous,  but  which  soon  becomes  crystalline.  Most  of  the  al- 
kaloids, coniine  included,  produce  with  mercuric  chloride  a  white  precipi- 
tate, but  they  are  easily  distinguished  from  that  occasioned  hy  nicotine 
by  remaining  amorphous.  Strychnine  alone  of  all  the  other  alkaloids 
gives  a  crystalline  precipitate,  but  this  may  be  easily  distinguished  from 


ALEALOIDAL  AXD    OTHER   OEGANIC  POISONS.  43$ 

the  crystals  produced  with  nicotine  by  the  fact  that  the  strychnine  crys- 
tals are  insoluble  in  acetic  acid,  while  those  obtained  with  nicotine  read- 
ily dissolve  in  that  agent.  Moreover,  the  crystalline  forms  of  the  two 
are  different. 

(c)  Iodine  Test  (Eoussin's  Reaction). — If  to  a  solution  of  nicotine  in 
ether  an  ethereal  solution  of  iodine  is  added,  long  ruby-red  crystals  are 
deposited,  appearing  within  a  few  minutes  if  the  nicotine  solution  con- 
tains one  percent,  of  the  alkaloid,  but  requiring  several  hours  to  form 
if  the  solution  is  quite  dilute. 

(d)  Physiological  Test. — If  even  a  very  small  quantity  of  nicotine  is 
placed  in  the  bill  of  a  small  bird,  the  animal  falls  dead  in  a  few  seconds. 
Larger  animals  are  affected  similarly  by  proportionately  greater  doses ; 
a  drop  put  on  the  tongue  of  a  cat  proves  fatal  in  one  or  two  minutes. 
Smallness  of  fatal  dose  and  great  rapidity  of  action  characterize  nicotine,, 
although  coniine  is  almost  equally  toxic. 

Detection  of  the  Poison. — The  method  described  under  coniine  should 
be  followed  in  extracting  nicotine.  The  residue  obtained,  if  it  has  the 
physical  properties  of  the  alkaloid,  should  be  submitted  to  the  tests  for 
nicotine  just  described,  beginning  with  the  physiological  test.  The  same 
precautions  should  be  observed  in  applying  the  tests,  and  in  drawing  con- 
clusions from  them,  as  have  been  laid  down  in  connection  with  coniine, 
since  substances  are  occasionally  extracted  from  putrefying  bodies  that 
bear  many  strong  resemblances  to  nicotine,  and  which  can  be  distin- 
guished from  the  latter  only  by  the  most  painstaking  comparative  tests. 
Moreover,  in  examining  a  body  for  nicotine  it  should  alwa3rs  be  remem- 
bered that  a  large  majority  of  men  and  a  considerable  number  of  women 
use  tobacco  habitually,  and  the  detection  in  a  corpse  of  a  small  quantity 
of  the  alkaloid  would  not  necessarily  be  significant  of  death  from  this 
poison. 

Resistance  to  Putrefaction. — The  alkaloid  resists  decomposition  to 
a  marked  degree,  and  it  may  be  detected,  therefore,  in  a  body  even  after 
the  lapse  of  a  considerable  period  of  time.  One  experimenter  was  able 
to  find  the  poison  in  two  dogs  that  had  been  buried  in  the  earth  for 
seven  years,  and  it  has  repeatedly  been  found  in  animals  buried  for 
shorter  periods. 

OPIUM   AND   MORPHINE. 

Opium,  the  inspissated  juice  of  the  poppy  (Papaver  somniferum),  is  an 
exceedingly  complex  substance  containing  a  large  number  of  constitu- 
ents, such  as  alkaloids,  gum,  resin,  oil,  coloring  matter,  etc.  Of  these 
by  all  odds  the  most  important  are  the  alkaloids,  to  which  opium  owes 
entirely  its  remedial  value  and  powerful  toxic  effects.  The  number  of 
alkaloids  in  opium  is  large,  about  twenty  having  been  already  isolated, 
and  it  is  quite  likely  that  others,  which  have  not  yet  been  determined, 
may  be  present  in  small  quantities.  Of  the  alkaloids,  decidedly  the  most 
important  is  morphine,  which  is  present  in  somewhat  varying  propor- 
tions in  different  specimens,  ranging  from  six  to  fifteen  percent.  The 
United  States  Pharmacopoeia  demands  the  presence  of  not  less  than  nine 
percent,  in  opium  in  its  normal  moist  state,  and  from  thirteen  to  fifteen 
percent,  in  dried  pulverized  opium. 

The  most  important  other  alkaloids  in  opium  are  narcotine,  codeine, 


440  ^   SYSTEM  OF  LEGAL   MEDICINE. 

narceine,  thebaiiie,  and  papaverine,  and  they  constitute  conjointly  gen- 
erally from  four  to  ten  percent,  by  weight  of  the  opium.  Codeine  and 
narceine  are  narcotics  like  morphine,  but  thebaiiie  is  a  powerful  tetaniz- 
ing  agent. 

The  alkaloids  in  opium  are  present  united  chiefly  with  meconic  acid 
as  meconates.  This  acid  is  found  in  no  other  substance  than  opium, 
and  is  therefore  entirely  characteristic  of  it — a  fact  of  considerable  im- 
portance not  infrequently  in  toxicologic^!  investigations. 

Although  the  physiological  effects  of  opium  are  not  precisely  like 
those  of  morphine,  yet  the  two  are  so  nearly  identical  that  they  may  be 
considered  together.  Morphine  is  commonly  regarded  as  having  from 
four  to  six  times  the  activity  of  opium. 

Pharmaceutical  Preparations. — Opium  is  the  active  constituent  of  a 
considerable  number  of  pharmaceutical  preparations,  of  which  the  most 
important  are  the  following,  their  strength  in  opium  also  being  given : 

Tincture  of  opium,  or  laudanum 10.0  percent. 

Vinegar  of  opium,  or  black  drop 10.0 

Camphorated  tincture  of  opium,  or  paregoric 0.4 

Dover's  powder 10.0 

What  is  known  as  Magendie's  solution  contains  sixteen  grains  of  sul- 
phate of  morphine  to  the  fluid  ounce. 

Properties  of  Morphine. — Morphine  is  a  white,  odorless,  crystalline 
alkaloid  of  marked  basic  powers,  neutralizing  acids  completely  forming 
stable  salts.  It  is  very  sparingly  soluble  in  cold  water,  requiring  upward 
of  four  thousand  parts  to  effect  its  solution  at  ordinary  temperature ;  it 
is  also  but  slightly  soluble  in  ether  and  chloroform,  but  dissolves  with  a 
fair  degree  of  ease  in  ordinary  alcohol  and  in  amylic  alcohol,  especially 
if  they  are  heated. 

Symptoms. — As  already  stated,  the  effects  produced  by  opium  and 
morphine  are  essentially  the  same  ;  the  latter,  however,  owing  to  its  con- 
centrated form  and  greater  solubility  in  the  fluids  of  the  stomach,  usually 
acts  more  rapidly  than  the  former.  The  effects  of  both  are  those  of  en- 
ergetic narcotic  poisons. 

The  person  is  generally  first  taken  with  a  sense  of  dizziness  and  eon- 
fusion,  rapidly  followed  by  great  drowsiness  and  an  irresistible  inclination 
to  sleep.  There  is  often  intense  itching  of  the  nose,  and  this  symptom 
is  frequently  of  great  value  in  the  diagnosis  of  opium  poisoning.  The 
breathing  is  slow  and  labored,  becoming  less  and  less  frequent  as  the 
case  progresses,  the  respirations  sometimes  not  exceeding  two  or  three  a 
minute ;  the  pulse  is  at  first  full  and  slow,  but  toward  the  end  it  becomes 
rapid,  feeble,  and  irregular.  The  stupor  increases,  complete  insensibility 
setting  in.  The  pupils  are  generally  strongly  contracted,  although  some- 
times in  the  later  stages  they  become  widely  dilated.  The  skin  is  cold 
and  damp,  the  lips  bluish,  and  the  whole  muscular  system  is  relaxed. 
As  the  case  progresses  the  breathing  becomes  more  difficult,  and  finally 
ceasing,  death  ensues,  although  sometimes  the  end  comes  unexpectedly 
through  sudden  heart  failure.  Convulsions  are  occasionally  seen  when 
opium  is  given,  especially  in  children,  this  effect  being  probably  due 
chiefly  to  the  tetauizing  effect  of  its  thebaiiie. 

The  external  application  of  opium  or  morphine  to  ulcers,  abraded 
surfaces  of  the  skin,  and  even  to  the  sound  skin,  has  not  infrequently 


ALKALOIDAL   AXD    OTHER   ORGANIC  POISOXS.  441 

been  followed  by  dangerous  symptoms  of  poisoning,  and  even  by  death. 
Administered  by  the  rectum  or  hypodermically,  fatal  residts  have  also 
not  infrequently  been  produced. 

Diagnosis  of  Opium  Poisoning. — There  are  numerous  diseases  or 
conditions  which  are  liable  to  be  confounded  with  opium  poisoning,  the 
most  important  being  apoplexy,  uraemie  coma,  acute  alcoholism,  and  poi- 
soning by  chloral  or  other  narcotics.  With  a  full  knowledge  of  the  his- 
tory of  the  case  and  of  the  post-mortem  appearances,  we  sometimes  may 
make  an  accurate  diagnosis,  but  from  the  symptoms  alone  it  is  probably 
impossible  in  any  case  to  be  absolutely  certain.  When,  therefore,  the 
history  is  somewhat  obscure  and  the  post-mortem  appearances  are  more 
or  less  negative,  we  are  obliged  to  depend  almost  exclusively  on  the  re- 
sults of  chemical  analysis  to  make  an  accurate  diagnosis ;  and  since,  as 
we  shall  see  later,  the  detection  of  opium  or  morphine  in  a  body  is  at- 
tended with  many  difficulties,  no  conclusion  can  justifiably  be  reached 
unless  the  evidence  from  the  chemical  investigation  is  absolutely  clear 
and  unequivocal. 

Period  when  Fatal. — Both  opium  and  morphine  generally  begin  to 
show  their  effects  soon  after  their  administration  ;  sometimes  the  symp- 
toms appear  within  a  few  minutes,  and  they  are  usually  not  delayed  be- 
yond an  hour.  Occasionally,  however,  they  are  much  retarded  in  mani- 
festing themselves,  in  one  case  no  well-marked  symptoms  being  observed 
until  the  eighteenth  hour.  After  the  poisonous  effects  have  commenced 
to  show  themselves  the  case  usually  progresses  somewhat  slowly,  the 
time  of  death  being  generally  from  six  to  twelve  hours  after  the  admin- 
istration of  the  poison.  Death,  however,  has  occurred  within  forty-five 
minutes,  and,  on  the  other  hand,  it  has  been  delayed  until  the  end  of 
fifty-six  hours. 

Fatal  Quantity. — The  average  minimum  fatal  dose  of  opium  for  the 
healthy  adult  may  be  placed  at  about  four  or  five  grains,  and  that  of 
morphine  at  about  one  grain.  If,  however,  the  person  is  feeble,  death 
may  be  produced  by  a  smaller  dose,  and  children  as  a  rule  have  a  marked 
intoleration  both  of  opium  and  morphine,  a  single  drop  of  laudanum 
having  produced  fatal  effects  with  very  young  children  in  several  cases. 
Morphine  if  given  hypodermically  is  much  more  toxic  than  when  taken 
by  the  mouth,  and  a  number  of  cases  of  death  are  recorded  after  the 
hypodermic  administration  of  from  one  sixth  to  one  half  of  a  grain. 
Recovery,  however,  has  not  infrequently  followed  very  large  doses,  such 
as  one  to  two  ounces  of  opium  and  two  drams  of  morphine. 

As  is  well  known,  the  intensity  of  the  effects  of  opium  and  morphine 
is  greatly  modified  by  a  number  of  conditions,  such  as  idiosyncrasy,  dis- 
ease, pain,  and  habituation  to  their  use. 

Treatment. — The  stomach  should  be  thoroughly  evacuated  as  soon 
as  possible.  For  this  purpose  the  stomach-pump  or  tube  is,  as  a  rule,  to 
be  preferred  to  emetics,  as  the  latter  are  often  unreliable  and  sometimes 
entirely  useless  in  this,  as  in  most  other  forms  of  narcotic  poisoning. 
Preceding  the  use  of  the  stomach-pump  or  tube,  tannic  acid,  solution  of 
iodine,  or  pulverized  charcoal  may  be  administered  with  the  hope  of 
retarding  the  absorption  of  the  drug,  but  these  should  never  be  depended 
upon  to  the  exclusion  of  the  evacuation  of  the  stomach. 

After  getting  rid  of  the  contents  of  the  stomach,  atropine  should  be 
administered  in  small  doses,  repeated  occasionally,  until  marked  dilata- 


442  A   SYSTEM  OF  LEGAL   MEDICINE. 

tion  of  the  pupil  is  secured,  but  its  administration  should  not  be  pressed 
beyond  this  point.  A  strong  decoction  of  coffee  by  the  mouth  or  by 
injection  into  the  rectum  is  undoubtedly  of  sei'vice  as  a  heart  stimulant, 
and  caffeine  may  be  used  hypodermically  for  the  same  purpose.  The 
patient  should  not  be  permitted  to  sleep,  but  should  be  kept  awake  at  all 
hazards  by  flagellations,  constant  walking,  and  continuous  conversation. 
Cold  water  may  be  dashed  over  the  head  and  chest  for  the  same  purpose, 
and  electricity  is  often  found  useful  as  a  stimulant  to  the  respiratory  and 
circulatory  centers.  If  the  breathing  cease,  artificial  respiration  must 
be  resorted  to,  and  inhalations  of  pure  oxygen  are  sometimes  of  sendee. 

Post=mortem  Appearances. — Those  which  are  most  commonly  seen 
are  congestion  of  the  cerebral  vessels,  effusions  in  and  about  the  brain, 
congestion  of  the  lungs,  and  unusual  fluidity  and  darkness  of  the  blood. 
These  appearances,  however,  are  by  no  means  constant,  nor  when  present 
•do  they  necessarily  indicate  death  from  opium. 

Tests. — The  two  most  important  and  characteristic  substances  in 
opium  are  its  chief  alkaloid,  morphine,  and  its  peculiar  acid,  meconic. 
Both  substances  are  distinguished  by  well-marked  reactions. 

1.  Morphine. — Many  tests  have  been  proposed,  and  nearly  all  of  them 
are  sometimes  useful ;  but  the  four  that  are  chiefly  important  are  the 
nitric  acid,  ferric  chloride,  sulpho-molybdic  acid,  and  iodic  acid  tests. 

(a)  Nitric  Acid. — If  morphine  is  treated  with  nitric  acid  it  assumes  a 
reddish  yellow,  or  sometimes  a  brownish  yellow  color,  which  upon  stand- 
ing fades  to  a  light  yellow.  (See  PL  VIII.,  No.  2)  The  reaction  is 
moderately  delicate  and  fairly  characteristic.  Brucine  gives  with  nitric 
acid  a  red  color,  but  upon  the  addition  of  stannous  chloride  it  is  changed 
to  purple,  while  that  from  morphine  is  unaffected,  or  nearly  so.  Quite  a 
number  of  other  organic  substances,  chiefly  those  of  a  gummy  and  resin- 
ous character,  also  produce  a  reddish  color  with  nitric  acid  ;  but  these  sub- 
stances are  not  crystalline,  and  therefore  differ  materially  from  morphine. 

In  applying  the  nitric  acid  test  to  a  suspected  substance  extracted 
from  a  stomach  or  other  part  of  a  body,  it  is  highly  important,  in  order 
that  any  just  conclusion  may  be,  drawn,  that  the  material  be  crystalline 
and  free  from  extraneous  matter.  I  have  repeatedly  seen  extracts 
from  various  organs  of  the  body  give  with  nitric  acid  a  reaction  which 
could  not  be  distinguished  from  that  produced  by  morphine,  although 
not  a  trace  of  the  latter  Avas  present ;  but  in  none  of  these  cases  was  the 
residue  crystalline. 

(h)  Ferric  Chloride. — Morphine  when  treated  with  a  neutral  solution 
of  ferric  chloride  or  ferric  sulphate  produces  a  deep  blue,  slowly  chang- 
ing to  a  dark  greenish  blue  color,  which  is  destroyed  by  free  acids,  by 
alkalies,  and  by  heating.  [See  PI.  VIII,  No.  3.)  The  1-10,000  of  a 
grain  gives  a  fairly  marked  reaction.  Carbolic  acid,  salicylic  acid,  gallic 
acid,  and  some  forms  of  tannic  acid,  also  strike  with  ferric  chloride  a 
bluish  color ;  but  all  of  these  are  soluble  in  water  or  ether,  by  which  they 
should  be  removed  in  the  course  of  analysis  from  the  suspected  material, 
before  the  ferric  chloride  is  applied.  By  taking  this  precaution  the  test 
becomes  a  valuable  one.  The  blue  color  produced  by  ferric  chloride  and 
morphine  is  destroyed  by  nitric  acid,  and  a  reddish  yellow  mixture  is 
produced,  due  to  the  action  of  the  acid  on  the  morphine ;  by  operating 
in  this  way  two  tests  for  the  alkaloid  may  be  obtained  from  the  same 
material. 


ALKALOIDAL  AND    OTHER   ORGANIC  rOISONS.  443 

No  ptomaine  has  been  found  giving  a  morphine  reaction  with  ferric 
•chloride,  according  to  the  observations  of  Brouardel  and  Ogier. 

(c)  Sulpho-molybdic  Acid. — Snlpho-molybdic  acid  produces  a  beautiful 
and  fairly  characteristic  play  of  colors  with  morphine — a  fact  to  which 
attention  was  first  directed  by  Froehde,  and  the  test  conseqnently  bears 
his  name.  The  reagent  may  be  conveniently  prepared  by  dissolving  a 
milligram  of  mol}'bdic  acid  in  a  cubic  centimeter  of  concentrated  sul- 
phuric acid  by  the  aid  of  gentle  heat.  When  morphine  is  treated  with 
this  solution,  a  play  of  colors  is  produced,  beginning  with  purple,  chang- 
ing to  violet,  passing  through  several  other  shades,  and  finally  ending  in 
a  dark  blue.  (See  PL  VIII.,  No.  4.)  The  reaction  is  very  delicate,  and 
if  properly  employed  is  characteristic ;  a  few  glucosides  and  papaverine 
give  a  similar  reaction,  but  as  these  should  be  separated  from  morphine 
by  the  process  of  extraction  and  purification,  they  need  not  be  further 
considered.  The  test  is  likely  to  be  interfered  with,  or  even  wholly  pre- 
vented, by  the  presence  of  foreign  matter  such  as  is  prone  to  accompany 
morphine  when  extracted  from  complex  organic  mixtiu*es.  Before  apply- 
ing the  test,  therefore,  the  substance  under  examination  should  be  care- 
fnlly  purified  as  directed  further  on. 

(d)  Iodic  Acid. — A  solution  of  iodic  acid  if  treated  with  morphine  is 
deoxidized,  its  iodine  is  set  at  liberty,  and  imparts  to  the  liquid  a  brown- 
ish color.  If  starch  is  present  it  is  colored  blue  by  the  formation  of 
iodide  of  starch ;  or  if  the  liquid  is  shaken  with  chloroform,  the  latter  by 
dissolving  the  iodine  assumes  a  purplish  color.  This  reaction,  however, 
is  produced  by  many  other  substances,  and  it  is  of  value  chiefly  as  a 
negative  test,  for  which  purpose  it  is  often  very  useful. 

2.  Meconic  Acid. — Meconic  acid  is,  when  pure,  a  white  crystalline  solid, 
somewhat  sparingly  soluble  in  cold  water,  but  readily  dissolving  in  alcohol. 
It  is  characterized  for  toxicological  purposes  chiefly  by  two  reactions. 

(a)  Ferric  chloride  strikes  with  meconic  acid  and  its  salts  a  deep  red 
color,  which  is  not  discharged  by  corrosive  sublimate,  nor  by  even  a  con- 
siderable excess  of  a  free  mineral  acid. 

Sulphocyanates,  such  as  are  found  in  saliva,  and  which  may  there- 
fore be  present  in  the  stomach,  also  strike  with  ferric  chloride  a  deep 
Ted  color,  but  the  color  thus  produced  is  readily  discharged  by  corrosive 
sublimate,  which  clearly  distinguishes  it  from  the  reaction  of  meconic 
acid.  So,  too,  strong  acetic  acid  and  most  of  its  salts  give  with  ferric 
•chloride  a  red  color;  this,  however,  is  destroyed  by  the  free  mineral  acids 
much  more  easily  than  that  produced  by  meconic  acid. 

(b)  When  treated  with  a  solution  of  lead  acetate  a  yellowish  white 
precipitate  of  lead  meconate  is  thrown  down;  this  is  insoluble  even  in  a 
large  excess  of  acetic  acid,  and  upon  being  treated  with  ferric  chloride 
it  strikes  a  deep  red  color.  These  reactions  combined  are  highly  char- 
acteristic of  meconic  acid. 

Numerous  other  acids,  such  as  sulphuric,  phosphoric,  sulphocyanic, 
tannic,  citric,  etc.,  either  in  the  free  state  or  combined  as  salts,  when 
treated  with  lead  acetate  give  white  or  yellowish  white  precipitates ;  but 
the  latter  all  differ  from  the  precipitate  produced  with  meconic  acid, 
either  in  being  soluble  in  excess  of  acetic  acid,  or  in  failing  to  give  a  red 
color  with  ferric  chloride. 

Detection  of  the  Poison. — In  the  Contents  of  the  Stomach. — If  opium 
or  one  of  its  pharmaceutical  preparations  is  believed  to  have  been  taken, 


444  A   SYSTEM  OF  LEGAL  MEDICINE. 

we  examine  for  both  meconic  acid  and  morphine  ;  but  if  suspicion  points 
to  the  nse  of  the  pure  alkaloid,  we  naturally  test  for  morphine  alone. 
As  meconic  acid  is  found  in  opium  only,  the  detection  in  the  stomach  of 
this  substance  is  as  positive  evidence  of  the  administration  of  opinm  as 
the  discovery  of  morphine ;  and  since  its  reactions  are  sometimes  some- 
what more  delicate  than  those  for  the  alkaloid,  we  should  not  omit  search- 
ing- for  it. 

If,  in  an  unknown  case,  both  meconic  acid  and  morphine  are  discov- 
ered, we  know  that  opium  or  one  of  its  preparations  must  have  been  ad- 
ministered; but  if  morphine  alone  is  found,  the  alkaloid  must  have  been 
used. 

The  contents  of  the  stomach  should  first  be  critically  examined  for 
the  presence  of  bits  of  undissolved  opium,  and  the  odor  should  be  care- 
fully observed,  as  the  presence  of  opium  and  its  different  preparations 
often  betrays  itself  by  its  peculiar  smell.  The  material  should  then  be 
finely  comminuted,  moderately  acidulated  with  acetic  acid,  and  digested 
on  the  water-bath  for  half  an  hour  or  an  hour.  The  mixture  is  filtered, 
the  filtrate  evaporated  to  a  small  bulk,  three  or  four  volumes  of  strong- 
alcohol  slowly  stirred  in,  and  the  separated  insoluble  material  removed 
by  carefnl  filtration.  The  filtrate  should  be  evaporated  to  expel  the  alco- 
hol, and  the  syrupy  residue  dissolved  in  water  acidulated  with  acetic  acid. 
After  filtration  a  slight  excess  of  lead  acetate  is  added,  by  which  a  pre- 
cipitate is  produced  containing  any  meconic  acid  that  may  be  present  in 
the  form  of  insoluble  lead  meconate.  The  mixture  is  thrown  on  a  filter 
and  the  precipitate  thoroughly  washed  with  water.  We  now  have  two 
portions  to  examine — the  material  on  the  filter  for  meconic  acid,  and  the 
filtrate  for  morphine. 

1.  Contents  of  the  Filter  for  Meconic  Acid. — While  still  moist  the  pre- 
cipitate is  removed,  diffused  through  water,  and  a  stream  of  hydrogen 
sulphide  passed  through  the  mixture  to  saturation  ;  the  lead  salts  will  I  >e 
converted  by  this  process  into  black  insoluble  sulphide,  while  any  me- 
conic acid  present  will  go  into  solution.  The  mixture  is  filtered  and  the 
filtrate  evaporated  to  a  small  bulk ;  a  part  of  the  liquid  is  treated  with 
ferric  chloride  and  the  remainder  with  lead  acetate,  and  if  from  both  we 
get  the  characteristic  reactions  alreaxty  described,  the  presence  of  meconic 
acid  is  demonstrated. 

2.  The  Filtrate  for  Morphine. — Hydrogen  sulphide  gas  is  passed  through 
the  fluid  to  saturation  to  remove  the  excess  of  lead  acetate  by  convert- 
ing the  lead  into  the  insoluble  sulphide.  The  mixture  is  set  aside  in  a 
warm  place  for  a  number  of  hours  until  the  sulphide  has  subsided,  and 
the  fluid  is  then  separated  from  it  by  filtration.  The  filtrate  is  evapo- 
rated at  a  gentle  heat  until  all  odor  of  hydrogen  sulphide  has  disappeared  ; 
it  is  then  placed  in  a  stout  test-tube,  a  slight  excess  of  ammonia  added, 
and  a  double  volume  of  hot  amylic  alcohol  immediately  poured  in  and 
violently  shaken.  Upon  standing,  the  amyl  alcohol,  which  now  contains 
the  greater  portion  of  any  morphine  that  may  have  been  present,  rises 
to  the  top,  and  may  be  removed  by  means  of  a  pipette.  The  aqueous 
fluid  should  be  again  shaken  with  amylic  alcohol,  which  after  separation 
may  be  added  to  the  first  portion ;  the  combined  amylic  alcohols  are  now 
evaporated  at  a  gentle  heat  on  the  water-bath  in  a  large  watch-glass,  and 
the  residue  is  to  be  carefully  examined  under  a  low  power  of  the  micro- 
scope.   If  much  morphine  is  present,  crystals  will  often  be  seen  in  greater 


ALEALOIDAL  AND   OTHER   ORGANIC  POISONS. 


445 


or  less  abundance ;  but  whether  crystals  are  found  or  not,  the  residue 
should  be  very  carefully  purified  and  thoroughly  freed  from  extraneous 
matter.  The  presence  of  impurities  is  always  liable  to  lead  to  confus- 
ing- results  when  operating  for  any  alkaloid,  and  this  is  particularly  true 
when  testing  for  morphine.  To  effect  this  purification  the  residue  may 
be  dissolved  in  a  little  dilute  acetic  acid,  the  mixture  filtered,  the  filtrate 
alkalinized,  and  shaken  at  once  with  a  double  volume  of  hot  amylic  alco- 
hol as  before  described.  Upon  evaporating  the  alcohol  in  a  watch-glass, 
if  morphine  is  present  in  more  than  small  traces  it  will  now  usually  ap- 
pear, partially  at  least  in  crystalline  form.  Occasionally  the  product  i& 
sufficiently  pure  to  subject  it  directly  to  the  various  tests  for  morphine, 
but  in  the  great  majority  of  cases  it  is  necessary  to  remove  still  further 
any  extraneous  matter  that  may  be  present  by  washing  the  material 
once  or  twice  with  a  few  drops  of  ice-cold  water  and  afterward  with  a 
little  absolute  ether.  The  residue  from  these  operations  shoidd  then  be 
submitted  to  the  four  tests 
for  morphine  previously  de- 
scribed. If  the  material  ex- 
amined is  crystalline,  and 
each  one  of  the  four  tests 
mentioned  gives  unequivocal 
results,  the  presence  of  mor- 
phine is  demonstrated. 

It  is  of  the  utmost  impor- 
tance in  examining  for  mor- 
phine that  the  residue  to  be 
tested  should  be  thoroughly 
purified  and  freed  to  the  great- 
est extent  possible  from  all 
foreign  material.  None  of 
the  tests  for  the  alkaloid  are 
absolutely  conclusive  when 
acting  upon  unknown  com- 
plex mixtures.  Professor 
Vaughan  has  clearly  shown 
that  under  certain  conditions 
normal  constituents  of  the 
gastro-intestinal  tract  may  give  reactions  strikingly  similar  to  those  pro- 
duced by  morphine  when  no£  thoroughly  purified,  and  I  have  myself  on 
two  or  three  occasions  extracted  from  the  stomachs  of  persons  who  died 
from  other  poisons,  compounds  which  behaved  remarkably  like  morphine, 
and  which  coidd  be  distinguished  from  the  latter  only  after  the  most  rigid 
purification.  I  should  lie  unwilling  to  accept  the  presence  of  morphine 
as  having  been  demonstrated  unless  the  alkaloid  had  been  isolated  in  a 
pure  or  practically  pure  crystalline  form,  and  had  given  with  all  four 
tests  before  described  unequivocal  reactions. 

If,  in  a  suspected  case,  morphine  alone  is  believed  to  have  been  given, 
the  above  process  may  be  materially  shortened  by  omitting  that  part 
which  relates  to  the  determination  of  meconic  acid;  the  precipitation  by 
lead  acetate,  and  the  subsequent  filtration  and  treatment  of  the  filtrate 
with  hydrogen  sulphide,  may  be  dispensed  with,  and  the  liquid  may  be 
operated  on  at  once  for  the  extraction  of  morphine  as  above. 


Fig.  80.— Crystals  (if  Morphine  from  Stomach,  crys- 
tallized from  amyl  alcohol.  Magnified  18  diameters. 
(Drawn  with  the  camera  lucida  by  Dr.  E.  R.  Le  Count.) 


44G  ^   SYSTEM  OF  LEGAL   MEDICINE. 

In  the  Tissues. — As  a  rale  meconic  acid  and  morphine  are  not  detected 
in  the  tissues  of  the  body  even  after  considerable  doses  have  been  taken, 
but  in  case  the  examination  is  to  be  made  we  may  proceed  as  follows : 
A  part  or  the  whole  of  the  organ,  such  as  the  liver,  kidney,  or  brain,  is  to 
be  very  finely  subdivided,  mixed  with  water  to  a  thin  paste,  and  heated 
gently  for  two  or  three  hours  after  having  been  rather  strongly  acidu- 
lated with  tartaric  or  some  other  equally  active  acid.  The  mixture  is 
then  strained  and  gently  evaporated  to  a  moderate  bulk,  when  three  or 
four  times  its  volume  of  strong  alcohol  should  be  slowly  stirred  in,  and 
the  liquid  filtered  from  the  insoluble  precipitate  produced ;  the  filtrate  is 
concentrated  on  the  water-bath  until  all  alcohol  has  been  expelled  and  a 
syrupy  residue  is  obtained ;  this  is  extracted  with  water,  filtered,  and  the 
filtrate  treated  with  ammonia  and  hot  amylic  alcohol  as  before  described. 
The  alcohol  is  evaporated  on  a  watch-glass,  and  the  residue  may  be  puri- 
fied and  tested  as  given  above  in  connection  with  the  examination  of  the 
contents  of  the  stomach. 

Failure  to  Detect. — Opium  and  morphine  both  resist  decomposition 
in  a  marked  degree,  so  that  there  is  a  possibility  of  detecting  their  pres- 
ence even  a  considerable  time  after  death.  Allen  obtained  satisfactory 
proof  of  the  presence  of  meconic  acid  in  the  stomachs  of  two  children 
exhumed  five  months  after  death,  and  Taylor  has  detected  both  meconic 
acid  and  morphine  in  mixtures  which  had  undergone  decomposition 
for  a  period  of  fourteen  months.  On  the  other  hand,  however,  there  is 
not  infrequent  failure  to  detect  any  trace  of  the  poison  even  when  the 
examination  is  promptly  made.  Of  all  the  ordinarily  used  poisons,  none 
is  more  likely  to  escape  discovery  than  opium  and  morphine.  Why  this 
is  we  do  not  fully  know,  but  several  causes  probably  conspire  to  produce 
this  result:  (1)  Death  does  not  usually  occur  until  the  end  of  a  number 
of  hours,  auct  a  chance  is  afforded  for  the  complete  absorption  of  the  poi- 
son from  the  stomach,  and  its  entire  or  partial  elimination  from  the  rest 
of  the  body ;  (2)  our  tests  for  meconic  acid  and  morphine  when  in  com- 
plex or  organic  mixtures  are  not  extremely  delicate ;  and  (3)  it  appears 
quite  likely  that  under  some  conditions  opium  and  morphine  undergo 
chemical  change  in  the  body  even  before  death  takes  place. 

Surgeon-Major  Boss  reports  that  there  were  forty-five  fatal  cases  of 
opium  poisoning  in  the  Bengal  Presidency  in  1869,  and  that  an  analysis 
was  made  in  each  case,  yet  in  only  two  was  opium  detected  in  the  stomachs. 
This  is  an  extreme  case,  and  may  be  accounted  for,  partially  at  least,  by 
the  fact  that  the  means  for  detecting  opium  twenty-five  years  ago  were 
not  nearly  as  delicate  as  those  used  to-day.  Still,  a  considerable  number 
of  cases  in  late  years  have  been  recorded  of  known  death  from  opium  in 
which  the  poison  was  not  afterward  discovered  in  the  stomach.  I  have 
myself  had  at  least  one  such  experience,  having  failed  to  find  the  slight- 
est trace  of  morphine  in  the  stomach  of  a  woman  who  was  known  to 
have  taken  not  less  than  ten  or  fifteen  grains  of  the  drug  for  suicidal 
purpose.  She  lived  for  about  eighteen  hours  after  swallowing  the  poi- 
son ;  the  stomach  was  removed  soon  after  death  and  was  promptly  ex- 
amined, but  not  the  faintest  reaction  for  .morphine  was  obtained  after 
repeated  and  most  careful  tests. 

Note. — As  opium  and  morphine  are  extensively  used  as  remedial 
agents,  and  are  not  infrequently  taken  for  the  relief  of  pain  without  the 
advice  of  a  physician,  and,  moreover,  as  these  substances  are  present  in 


ALEALOIDAL  AND    OTHER   ORGANIC  POISONS.  447 

a  considerable  number  of  patent  medicines  which  are  in  common  use,  the 
detection  of  morphine  or  meconic  acid  in  a  body  after  death  would  by  no 
means  necessarily  indicate  that  poisoning'  had  occurred. 


NUX   VOMICA  AND   STRYCHNINE. 

Nux  vomica,  the  seed  of  Strychnos  Xiix-vomica,  owes  its  poisonous 
properties  chiefly  to  the  presence  of  strychnine  ^nonyms,  strychnin 
and  strychnia).  It  contains,  however,  another  alkaloid,  brucine,  which 
is  analogous  in  its  physiological  properties  to  strychnine,  but  is  so  much 
feebler  that  it  adds  comparatively  little  to  the  toxic  powers  of  the  drug. 
•Strychnine  exists  in  nux  vomica,  combined  with  lactic  and  igasuric  acids, 
in  the  proportion  of  from  0.5  percent,  to  upward  of  1.5  percent.  Strych- 
nine is  also  found  in  the  seeds  of  Strychnos  Ignatii,  and  in  three  or  four 
other  species  of  strychnos. 

Chemical  Properties  of  Strychnine. — Strychnine  appears  in  com- 
merce either  as  a  white  powder  made  up  of  minute  crystals,  or  in  the 
form  of  larger  crystals,  which  are  sometimes  octahedral  and  sometimes 
prismatic. 

It  is  very  sparingly  soluble  in  water,  requiring  8333  parts  of  that  fluid 
to  dissolve  it  when  cold,  but  it  is  somewhat  more  soluble  in  hot  water. 
It  dissolves  in  a  little  more  than  200  parts  of  alcohol  at  ordinary  tem- 
perature, and  in  about  400  parts  of  whiskey  and  other  similar  spirituous 
liquors ;  it  requires  1400  parts  of  pure  ether  to  effect  its  solution,  but  it 
dissolves  readily  in  8  or  10  parts  of  chloroform ;  it  also  dissolves  readily 
in  a  mixture  of  equal  volumes  of  ether  and  chloroform. 

The  alkaloid  is  of  alkaline  reaction,  and  when  brought  in  contact  with 
acids  neutralizes  them,  producing  salts  most  of  which  are  quite  readdy 
soluble  in  water  and  alcohol.  The  salt  most  commonly  used  in  medicine 
is  the  sulphate,  which  occurs  in  commerce  in  the  form  of  colorless  or 
white  prismatic  crystals,  soluble  in  50  parts  of  water  and  about  100  parts 
■of  alcohol. 

An  interesting  and  important  point  in  connection  with  the  properties 
of  strychnine  is  its  resistance  to  the  destructive  effects  of  sulphuric  acid 
even  when  heated  on  the  water-bath.  Most  organic  compounds  when 
treated  with  sidphuric  acid,  especially  when  they  are  heated  with  it,  are 
•chemically  changed  and  lose  their  identity ;  the  difference  in  the  behavior 
of  strychnine  in  this  respect  affords  a  valuable  means  of  separating  it 
from  other  substances,  and  of  completely  purifying  it  during  the  process 
of  extraction  from  the  stomach  or  other  organs  of  the  body. 

Strychnine  is  intensely  bitter,  this  property  being  so  strongly  marked 
that  one  part  of  it  gives  a  decided  taste  to  70,000  parts  of  water ;  its  bit- 
terness, moreover,  is  very  persistent,  clinging  tenaciously  to  the  tongue 
and  fauces,  and  being  removed  with  difficulty.  It  is  an  important  fact, 
however,  that  some  persons  are  unable  to  recognize  the  bitterness  of 
strychnine,  and  I  have  personally  met  four  illustrations  of  this.  They 
were  all  men  in  good  health,  and  they  knew  that  beer,  quassia,  and  many 
other  substances  are  bitter,  but  they  coidd  not  recognize  the  bitterness 
of  strychnine;  they  described  it  as  having  a  rough  or  slightly  musty 
tnste.  All  of  the  men  in  question  used  tobacco,  and  one  of  them  drank 
liquor  somewhat  to  excess ;  one  also  had  some  nasal  catarrh,  but  not  to 


448  ^   SYSTEM  OF  LEGAL  MEDICINE. 

such  a  degree  as  to  interfere  materially  with  the  appreciation  of  ordinary 
odors  and  tastes. 

The  fact  that  strychnine  is  not  necessarily  bitter  to  all  people  is  occa- 
sionally of  medico-legal  importance  in  such  cases  as  the  following :  A 
person  after  partaking  of  food  is  suddenly  seized  with  violent  convul- 
sions and  soon  dies.  In  spite  of  the  fact  that  strychnine  is  found  in  the 
body  by  analysis,  yet  as  the  person  made  no  complaint  that  the  food 
eaten  was  bitter,  although  abundant  opportunity  was  afforded  for  doing 
so,  doubt  is  entertained  as  to  the  cause  of  death,  and,  in  case  of  legal 
inquiry,  this  circumstance  is  made  a  strong  point  by  the  defense.  It  is 
quite  possible,  however,  in  such  cases  that  the  deceased,  like  the  persons 
mentioned  above,  was  either  wholly  or  largely  incapable  of  recognizing 
the  bitterness  of  strychnine. 

The  taste  of  strychnine,  moreover,  may  be  considerably  masked,  and 
its  bitterness  largely  concealed,  by  the  presence  of  certain  other  sub- 
stances, such  as  tannic  acid,  licorice,  and  chocolate.  In  a  case  of  poison- 
ing which  came  under  my  observation  not  long  since,  it  was  claimed  by 
the  defense  at  the  time  of  trial  that  strychnine  coidd  not  have  been  ad- 
ministered, as  the  deceased  had  complained  of  bitterness  but  slightly 
after  eating  some  confectioneiy  which  the  prosecution  alleged  contained 
the  poison.  Since  the  candy,  however,  was  composed  largely  of  chocolate, 
the  absence  of  intense  bitterness  was  easily  explained. 

Symptoms. — Both  mix  vomica  and  strychnine  produce  essentially 
the  same  effects,  the  only  difference  observable  being  that  the  latter, 
as  would  naturally  be  expected,  acts  somewhat  more  rapidly  than  the 
former. 

The  symptoms  occasionally  begin  to  show  themselves  immediately 
after  the  swallowing  of  the  poison,  but  more  often  they  are  delayed  for 
ten  or  fifteen  minutes ;  they  do  not  usually  appear  earlier  than  five  min- 
utes, nor  are  they  often  delayed  later  than  an  hour,  although  they  have 
been  known  to  be  postponed  until  the  end  of  the  third  hour.  This  great 
difference  in  time  of  the  first  symptoms  is  due  chiefly  to  the  form  in 
Avhich  it  is  administered  and  to  the  condition  of  the  stomach.  If  taken 
in  solution  it  acts  more  rapidly  than  in  the  form  of  a  powder,  and  in 
pills  it  is  still  slower  in  its  action ;  if  taken  on  an  empty  stomach  it  is 
absorbed  more  quickly  and  produces  its  effects  earlier  than  when  the 
stomach  is  full  of  food. 

The  first  symptom  manifested  is  usually  a  sense  of  discomfort,  ac- 
companied by  a  feeling  of  tightness  about  the  chest  and  throat,  and  a 
twitching  of  the  muscles  of  the  hands  and  feet.  These,  however,  usually 
last  but  a  short  time,  and  are  followed  suddenly  by  a  violent  tetanic 
convulsion ;  sometimes  the  entire  muscular  system  seems  to  be  affected 
almost  simultaneously,  but  generally  the  rigidity  appears  first  in  the 
extremities,  rapidly  extending  to  the  trunk,  and  finally  to  the  face  and 
jaws.  The  legs  are  extended,  the  feet  arched,  and  the  head  is  thrown 
violently  backward,  so  that  the  body  often  rests  only  upon  the  heels  and 
occiput,  producing  a  condition  known  as  opisthotonos ;  the  arms  are 
sometimes  widely  extended  and  sometimes  drawn  tightly  across  the 
chest ;  the  muscles  of  respiration  become  so  rigid  that  breathing  is  diffi- 
cult and  often  seems  to  cease,  and  the  pulse  is  weak  and  irregular,  occa- 
sionally becoming  imperceptible.  The  countenance  is  livid,  the  eyes 
staring,  the  pupils  widely  dilated ;  foam  often  appears  at  the  mouth,  and 


ALEALOIDAL   AND   OTHER   ORGANIC  POISONS.  449 

the  countenance  generally  assumes  a  ghastly,  grinning  expression.  The 
convulsion  lasts  from  half  a  minute  to  several  minutes,  when  the  mus- 
cular rigidity  nearly  or  entirely  disappears.  There  is  generally  now  a 
condition  of  great  relaxation :  cold  perspiration  breaks  out  over  the 
whole  body,  the  pupils  contract,  a  sense  of  weariness  is  expressed,  and 
the  patient  not  infrequently  sinks  into  a  profound  sleep.  This  period  of 
intermission  continues  from  a  few  minutes  to  half  an  hour,  when  another 
paroxysm  shows  itself.  It  sometimes  conies  on  unexpectedly,  but  often 
is  preceded  by  a  few  moments  of  intense  anxiety  on  the  part  of  the 
patient,  who  piteously  pleads  for  relief.  All  the  senses  are  unnaturally 
excited,  and  the  convulsion  is  often  brought  on  by  a  loud  noise,  the 
slamming  of  a  door,  a  sudden  current  of  air,  or  even  a  gentle  touch. 
The  second  paroxysm  is  usually  a  counterpart  of  the  first,  but  is  more 
severe ;  the  breathing  is  more  difficult,  the  strength  more  exhausted,  and 
the  suffering  more  acute.  After  two  or  more  paroxysms,  unless  relief 
is  afforded,  the  patient  dies,  either  in  the  height  of  a  convulsion  from 
asphyxia,  or  at  the  close  of  one  from  exhaustion.  The  mind  is  usually 
not  affected,  the  intellect  generally  remaining  clear  until  the  end,  and 
there  is  a  thorough  appreciation  of  the  gravity  of  the  situation  and  the 
imminence  of  death.     Vomiting  is  occasionally  but  not  often  seen. 

However  given,  strychnine  produces  essentially  the  same  effects,  and 
numerous  cases  are  recorded  of  violent  symptoms  from  its  hypodermic 
use ;  it  is  usually  more  active  when  thus  administered  than  when  taken 
by  the  mouth,  one  sixteenth  of  a  grain  having  occasioned  alarming 
symptoms. 

When  associated  with  other  drugs,  as  would  naturally  be  expected, 
the  effects  of  strychnine  may  be  materially  masked ;  opium,  morphine, 
chloral,  and  other  narcotics  greatly  retard,  its  action  and  modify  its 
symptoms. 

Diagnosis  of  Strychnine  Poisoning. — The  manifestations  produced 
by  a  poisonous  dose  of  strychnine  are  so  characteristic  that  usually  there 
is  but  little  difficulty  in  making  an  accurate  diagnosis  from  the  symptoms 
alone.  On  various  medico-legal  occasions,  however,  it  has  been  claimed 
that  several  diseases  might  be  mistaken  for  strychnine  poisoning,  among 
others  being  epilepsy,  ursemic  and  puerpural  convulsions,  chorea,  the 
various  forms  of  tetanus,  and  even  syphilis.  But  all  of  these,  with  the 
exception  possibly  of  tetanus,  differ  so  essentially  in  their  manifestations 
from  strychnine  poisoning,  that  they  could  not  possibly  be  confounded 
by  a  competent  observer.  The  different  forms  of  tetanus  do  in  some 
respects  resemble  strychnine  poisoning,  yet  there  are  such  well-marked 
differences  between  them  that  after  careful  examination  they  should 
never  be  mistaken  for  each  other.  In  both,  it  is  true,  there  are  violent 
tonic  spasms  which  are  strikingly  similar,  but  in  almost  all  other  respects 
they  are  unlike. 

In  tetanus  we  almost  always  have  a  history  of  an  injury,  and  the  dis- 
ease usually  comes  on  gradually  and  progresses  slowly  to  a  fatal  termina- 
tion, a  number  of  days  generally  elapsing  between  the  onset  of  the  dis- 
ease and  death,  while  in  strychnine  poisoning  there  is  no  antecedent 
injury,  and  the  manifestations  appear  suddenly,  almost  without  warning. 
and  progress  rapidly  to  a  fatal  termination ;  in  tetanus  the  muscles  first 
affected  are  generally  those  of  the  back  of  the  neck,  and  those  of  the 
jaw  are  early  invaded,  producing  persistent  lockjaw,  while  in  strychnine 


.±50  J-   SYSTEM  OF  LEGAL   MEDLCINE. 

poisoning  either  the  muscles  of  the  extremities  are  first  affected,  and 
those  of  the  neck  and  jaw  last  attacked,  or  the  entire  muscular  system  is 
thrown  into  a  spasm  almost,  or  quite,  simultaneously ;  in  tetauus  there 
is  usually  considerable  persistence  of  the  muscular  rigidity  even  between 
the  severe  spasms,  and  opisthotonos,  or  some  other  perverted  position  of 
the  body,  is  generally  permanent,  while  in  strychnine  poisoning  there  is 
almost  always  complete  relaxation  between  the  spasms,  and  the  opisthot- 
onos, which  may  have  been  very  marked  during  the  attack,  entirely  passes 
away ;  in  tetanus  the  temperature  is  generally  somewhat  elevated  beyond 
the  normal,  while  in  strychnine  poisoning  it  is  not  usually  affected. 

There  are,  it  is  true,  occasionally  marked  exceptions  to  the  above 
differences,  one  case  being  recorded  in  which  tetanus  proved  fatal  in 
twelve  hours  after  the  first  twitchings,  another  within  an  hour  and  a 
half  after  the  first  convulsion,  and  a  third  in  fifteen  minutes  after  the 
injury  producing  the  disease ;  on  the  other  hand,  a  case  of  strychnine 
poisoning  is  recorded  in  which  death  occurred  after  a  lapse  of  eighteen 
hours,  and  several  cases  are  known  in  which  repeated  small  doses  of  the 
poison  have  been  administered  in  such  a  wajr  as  to  extend  the  symptoms 
over  a  period  of  several  days.  So  also  in  tetauus,  cases  are  occasionally 
seen  in  which  little  or  no  increase  of  temperature  is  found,  while  in  poi- 
soning by  strychnine  the  temperature  is  sometimes  elevated.  In  spiter 
however,  of  these  irregularities  both  in  strychnine  poisoning  and  in 
tetanus,  a  competent  observer  will  rarely  have  difficulty  in  distinguish- 
ing the  two,  the  difference  in  the  order  in  which  the  muscles  are  attacked 
and  the  marked  dissimilarity  in  the  condition  of  the  patient  between 
the  spasms  generally  sufficing  to  establish  the  exact  character  of  the 
derangement. 

Period  when  Fatal. — One  or  two  cases  are  recorded  in  which  death 
is  said  to  have  occurred  almost  immediately  after  the  ingestion  of  the 
poison,  and  two  or  three  are  on  record  in  which  the  fatal  termination 
came  in  ten  minutes.  In  most  cases  strychnine  acts  rapidly,  and  death 
almost  always  occurs  within  two  hours ;  if  the  person  lives  beyond  this 
time  his  chance  of  recovery  is  good.  Some  cases,  however,  are  much 
prolonged;  at  least  four  are  recorded  iu  which  death  was  delayed  for 
six  hours,  and  Tardieu  and  Roussin  have  reported  a  protracted  case  in 
which  death  did  not  occur  until  the  eighteenth  hour.  In  a  case  of  strych- 
nine poisoning  which  I  was  called  on  to  investigate  two  years  since,, 
death  occurred  in  eleven  hours  after  the  administration  of  the  poison ; 
morphine  and  chloroform,  however,  had  been  abundantly  administered,, 
and  this  probably  accounted  for  the  long  delay. 

Fatal  Quantity. — A  quarter  of  a  grain  is  recorded  as  having  occa- 
sioned death,  and  good  authorities  believe  that  even  one  sixth  of  a  grain 
should  be  regarded  as  a  possibly  fatal  dose.  Dr.  Warner,  who  took  by 
mistake  not  over  half  a  grain  of  the  sulphate  of  strychnine,  died  from 
its  effects  in  eighteen  minutes. 

But  numerous  cases  are  reported  of  recovery  from  large  doses,  such 
as  fifteen,  twenty,  and  even  forty  grains ;  in  almost  all  of  these,  however, 
there  was  early  vomiting,  or  the  stomach  was  promptly  evacuated  by 
emetics  or  by  the  stomach-pump,  and  energetic  general  treatment  was 
employed. 

Treatment. — The  stomach  should  be  at  once  evacuated  by  the  use 
of  emetics  or  the  stomach-pump ;  owing,  however,  to  the  violent  spasms 


ALKALOIDAL  AND    OTHER    ORGANIC  POISONS.  451 

which  early  set  in,  it  is  often  difficult  or  impossible  to  use  the  stomach- 
pump  until  by  the  plentiful  administration  of  chloroform  the  tetanic 
condition  is  relieved,  when  the  tube  may  be  inserted  with  ease.  Tannic 
acid,  solution  of  iodine,  or  finely  pulverized  charcoal  may  be  adminis- 
tered as  supplements  to  the  use  of  emetics  or  the  pump ;  they  render 
the  strychnine  less  soluble  and  retard  its  action.  Chloroform  should  be 
freely  given  by  inhalation  during  the  paroxysms,  and  chloral  may  be  ad- 
ministered with  great  advantage  in  the  intervals,  either  by  the  mouth  or 
hypodermically.  During  the  convulsions,  when  there  seems  impending 
death  by  asphyxia,  pure  <  >xygen  may  be  played  over  the  mouth  and  nose, 
and  it  sometimes  affords  marked  relief. 

The  patient  should  be  kept  as  quiet  as  possible ;  all  strangers  should 
be  excluded  from  the  room,  direct  draughts  of  air  should  be  shut  off,  and 
loud  noises,  such  as  those  produced  by  the  slamming  of  doors,  stamping 
of  feet,  etc.,  should  be  prevented.  For  the  same  reason,  as  little  medicine 
as  possible  should  be  given  internally,  as  the  mere  raising  of  the  head, 
or  the  touching  of  the  lips  with  a  spoon  may  cause  a  convulsion.  Ex- 
periments on  animals  have  repeatedly  shown  that  absolute  quiet  is  a  very 
important  factor  in  securing  recovery  from  poisonous  doses  of  strych- 
nine ;  and  clinical  experience  abundantly  demonstrates  that  the  same  is 
true  with  man. 

Post=mortem  Appearances. — The  stomach  is  usually  normal,  but  is 
sometimes  found  in  a  state  of  intense  congestion  ;  the  liver,  kidneys,  and 
lungs  are  frequently  engorged  with  blood ;  the  heart  is  occasionally  full 
and  distended,  but  rather  more  often  is  empty  and  flaccid.  The  brain 
and  spinal  cord  and  their  surrounding  membranes  are  occasionally 
normal  in  appearance,  but  usually  are  congested,  and  sometimes  present 
effusions  of  serum  or  blood.  The  muscles  immediately  after  death  are 
usually  relaxed,  but  rapidly  take  on  extreme  rigidity,  which  is  generally 
very  marked ;  neither  arms  nor  legs  can  be  bent  except  with  great  diffi- 
culty, and  the  body  often  lies  in  a  condition  of  opisthotonos.  The  rigid- 
ity occasionally  disappears  within  a  few  hours,  but  sometimes  lasts  for 
weeks,  and  even  months.  In  a  case  of  death  from  strychnine  which  I 
examined  some  time  ago,  I  found  the  body  five  months  after  death  in- 
tensely rigid,  though  decomposition  had  progressed  to  a  marked  degree. 

None  of  the  above  post-mortem  appearances  are  entirely  character- 
istic of  death  by  strychnine,  although  the  congestion  of  the  brain  and 
spinal  cord,  the  effusions  of  blood  and  serum  about  them,  and  the  well- 
marked  rigor  mortis  are  rarely  produced  collectively  b}r  any  other  cause. 

Tests. — Strychnine  responds  to  all  the  general  reactions  for  alkaloids, 
giving  precipitates  with  tannic  acid,  picric  acid,  iodine,  etc.,  but  these 
are  not  particularly  distinctive.  Fortunately,  however,  we  possess  sev- 
eral tests  that  are  highly  characteristic,  of  which  four  are  particularly 
valuable,  namely :  the  taste,  the  color  test,  the  chromate  test,  and  the 
physiological  test. 

(a)  The  Taste. — As  has  already  been  stated,  strychnine  is  intensely 
bitter,  and  it  has  this  property  in  a  higher  degree  than  any  other  known 
substance.  In  examining  a  suspected  residue,  therefore,  we  expect  to 
find  more  or  less  bitterness  if  the  alkaloid  is  present.  Many  other 
substances,  however,  as  is  well  known,  are  also  bitter,  such  as  quinine, 
salicine,  and  morphine,  but  none  of  these  approaches  strychnine  in  the 
intensity  of  its  bitterness. 


452  ^   SYSTEM   OF  LEGAL   MEDICINE. 

(b)  The  Color  Test. — If  strychnine  is  treated  with  strong  sulphuric 
acid  it  dissolves,  if  pure,  without  the  production  of  color;  but  if  an  oxi- 
dizing agent  is  now  added  a  highly  characteristic  display  of  colors  mani- 
fests itself  in  the  following  order :  first,  a  deep  blue,  almost  immediately 
passing  to  purple,  then  lilac,  rapidly  changing  to  red,  which  slowly  fades 
away,  leaving  a  mixture  which  is  nearly  colorless.    (See  PL  VIII.,  No.  5.) 

A  considerable  number  of  oxidizing  agents  have  been  proposed  for 
producing  this  reaction,  the  most  important  of  which  are  potassium 
bichromate,  manganese  dioxide,  lead  peroxide,  potassium  permanganate, 
and  cerosoceric  oxide.  Any  one  of  these  when  properly  employed  gives 
good  results,  but  personally  I  prefer  either  the  bichromate  or  the  ceroso- 
ceric oxide.  In  my  hands  the  first  of  these  yields  almost  uniformly  good 
results,  but  the  cerosoceric  oxide  has  the  advantage  of  occasioning  a  some- 
what slower  change  of  colors,  and  producing  a  cherry  red  at  the  end, 
which  is  very  persistent  and  quite  characteristic.  Whichever  oxidizing 
agent  is  used,  the  best  way  to  proceed  in  making  the  test  is  to  treat  the 
suspected  substance  with  a  single  drop  of  strong  sulphuric  acid,  when  no 
color  should  be  produced,  or  at  most  only  a  slight  darkening  from  the 
presence  of  a  trace  of  impurity ;  a  small  particle  of  the  oxidizing  material 
is  then  cautiously  drawn  into  the  mixture,  and  very  gently  and  slowly 
moved  about ;  if  strychnine  is  present  the  colors  above  spoken  of  will 
manifest  themselves  in  the  order  named — blue,  purple,  violet,  and  red ; 
the  blue,  however,  is  sometimes  so  evanescent  as  to  be  almost  impercep- 
tible. Dr.  Letheby  has  suggested  passing  an  electrical  current  through 
the  mixture  for  the  purpose  of  developing  the  color,  the  nascent  oxygen 
evolved  by  the  electrolysis  of  the  acid  acting  as  the  oxidizing  agent.  My 
own  experience  with  this  test,  however,  has  not  been  very  satisfactory, 
and  I  should  place  it  below  all  the  others  both  in  delicacy  and  con- 
venience. 

The  color  test  for  strychnine  when  properly  applied  is  exceedingly 
delicate,  being  capable  of  detecting  a  very  minute  quantity  of  the  alka- 
loid ;  it  has  been  stated,  and  quite  correctly,  that  the  smallest  particle 
of  strychnine  that  can  be  seen  by  the  unaided  eye  will  give  this  reaction 
unmistakably.  Not  only  is  the  test  exceedingly  delicate,  but  when  accu- 
rately made  it  is  entirely  reliable.  It  is  true  that  some  other  substances, 
among  them  being  aniline,  curarine,  quebrachine,  cod-liver  od,  papaverine, 
and  veratrine,  when  treated  with  sulphuric  acid  and  an  oxidizing  agent, 
produce  a  play  of  colors  more  or  less  resembling  those  occasioned  by 
strychnine ;  but,  with  the  exception  of  quebrachine,  all  of  them  are  either 
colored  by  sidphurie  acid  alone,  or  the  colors  developed  by  adding  the 
oxidizing  agent  do  not  have  the  same  sequence  as  those  produced  by 
strychnine.  Thus,  curarine,  cod-liver  oil,  papaverine,  and  veratrine  are 
colored  by  sulphuric  acid  alone,  and  therefore  may  be  distinguished  from 
strychnine  by  this  fact,  while  aniline,  although  not  colored  by  the  acid 
separately,  when  treated  with  both  the  acid  and  oxidizing  agent  gives 
colors  almost  opposite  in  order  to  those  produced  by  strychnine,  begin- 
ning with  yellow,  passing  to  blue,  and  finally  becoming  black. 

Quebrachine  (one  of  the  alkaloids  of  quebracho  bark)  alone,  of  all  the 
substances  with  which  we  are  acquainted,  might  easily  be  mistaken  for 
strychnine  upon  applying  the  color  test.  It  dissolves  in  sulphuric  acid 
with  little  or  no  change,  and  upon  adding  an  oxidizing  agent  practically 
the  same  colors  are  developed  as  with  strychnine,  and  in  the  same  order. 


ALKALOIDAL   AND    OTHER    ORGANIC   POISONS. 


455 


By  a  careful  comparison  of  the  two  substances  when  tested  side  by  side, 
a  slight  difference  can  be  seen  in  the  intensity  and  duration  of  the  colors ; 
but  if  the  strychnine  is  somewhat  impure,  as  is  likely  to  be  the  case  upon 
extracting-  it  from  a  part  of  the  body,  the  two  reactions  are  practically 
indistinguishable.  Quebrachine,  however,  is  destroyed  by  heating  it  on 
the  water-bath  with  strong  sulphuric  acid,  while  stiychnine  is  not,  and 
by  this  process  we  may  separate  the  two  absolutely.  Aspidospermine 
(another  alkaloid  of  quebracho  bark)  as  it  appears  in  the  market  some- 
times contains  so  much  quebrachine  as  to  give  it  a  well-marked  strych- 
nine-like reaction. 

In  a  few  rare  cases  ptomaines  have  been  found  which  gave  a  color 
reaction  somewhat  similar  to  that  of  strychnine;  but  as  they  differed 
from  strychnine  in  other  properties,  and  as,  without  doubt,  they  would 
be  destroyed  by  heating  with  sulphuric  acid,  there  would  be  no  possi- 
bility of  confounding  the  two  if  proper  skill  were  employed  in  making 
the  tests. 

The  color  reaction  for  stiychnine  is  more  or  less  interfered  with  by 
the  presence  of  a  number  of  other  substances,  such  as  morphine,  brucine, 
and  nitrates;  of  these  the  most  important  is  morphine,  which  has  the 
power  in  a  marked  degree  of  preventing  the  color  reaction  if  present  in 
moderate  amount.  I  have  known  of  at  least  one  case  in  which  the  pres- 
ence of  strychnine  in  the  organs  of  a  body  was  entirely  overlooked  on 
account  of  its  association  with  a  considerable  quantity  of  morphine,  and 
the  use  of  inadequate  means  of  separating  the  two  in  the  analytical  pro- 
cess employed.  When  the  two  alkaloids  are  present  in  a  mixture  they 
may  be  separated  by  a  number  of  means,  but  heating  with  strong  sul- 
phuric acid  is  generally  the  best ;  it  removes  the  morphine  and  enables 
the  strychnine  to  be  recog- 
nized readily.  Practically, 
the  most  common  substance 
interfering  with  the  color  test 
in  toxicological  examinations 
are  certain  indefinite  organic 
•compounds  derived  from  the 
organs  examined,  which  are 
almost  sure  to  be  extracted  to 
a  greater  or  less  degree  with 
the  strychnine.  The  presence 
of  even  a  moderate  amount 
of  this  material  sometimes 
wholly  prevents  the  recogni- 
tion of  the  alkaloid  bjr  this 
test.  By  careful  purification, 
however,  it  may  be  removed, 
when  the  color  reaction  comes 
out  distinctly. 

(c)  Ghromate  Test. — If  an 
aqueous  solution  of  a  salt  of 
strychnine  is  treated  with  a 
solution  of  potassium  bichromate,  a  yellow  precipitate  of  strychnine  chro- 
mate  is  produced,  unless  the  solutions  are  too  dilute.  The  precipitate,  if 
examined  under  a  microscope,  is  found  to  consist  of  a  mixture  of  octahe- 


Fig.  81.— Crystals  of  strychnine  chrornate.  Magni- 
fied 90  diameters.  (Drawn  with  the  camera  luc&da  by 
Dr.  E.  R.  Le  Count.) 


■456 


A   SYSTEM   OF  LEGAL  MEDICINE. 


dral  and  dendroidal  crystals,  which  are  very  characteristic.  If  the  crystals- 
are  allowed  to  settle,  the  supernatant  fluid  drained  off,  and  the  precipitate 
well  dried,  upon  touching  them  with  a  drop  of  strong  sulphuric  acid  a 
fine  play  of  colors  is  at  once  produced,  exactly  the  same  as  those  de- 
scribed under  the  color  test.  This  double  reaction  for  strychnine  is  prob- 
ably the  best  we  possess  for  the  alkaloid,  as  it  combines  the  characteristic 
play  of  colors  of  the  oxidation  test  with  the  peculiar  crystals  of  the 
chromate  of  strychnine.  No  other  known  substance  produces  the  same 
effects. 

(<1)  Physiological  Test. — If  strychnine  is  administered  to  a  frog  the 
animal  is  soon  thrown  into  convulsions,  and  if  the  dose  is  sufficiently 
large,  death  ensues.  Advantage  may  be  taken  of  this  fact  in  testing  an 
unknown  substance  for  the  presence  of  the  alkaloid.  The  material  should 
be  dissolved  in  a  little  dilute  acid  and  given  to  a  small  frog,  either  by 
hypodermic  injection  or  by  blowing  it  into  the  animal's  stomach  through 

a  small  tube.  The  frog  should 
then  be  covered  with  a  bell- 
jar  and  carefully  watched ;  if 
strychnine  is  present,  in  the 
course  of  a  few  minutes  the 
animal  becomes  vigorously 
tetanized ;  its  head  and  trunk 
become  rigid,  and  its  hind  legs 
are  violently  extended.  The 
paroxysms  at  first  have  remis- 
sions, during  which  the  ani- 
mal assumes  its  normal  pos- 
ture, but  by  blowing  across 
it,  by  striking  the  table,  or  by 
otherwise  slightly  disturbing 
the  animal,  it  is  again  thrown 
into  a  violent  convulsion,  and 
if  these  are  kept  up  sufficiently 
long  death  follows.  This  test, 
if  applied  to  a  very  small 
animal,  is  fairly  delicate,  the 
1-10,000  of  a  grain  usually 
being  recognizable  by  it.  It 
is  also  quite  characteristic,  for  while  some  other  substances  occasion  con- 
vulsions in  frogs,  they  differ  materially  from  those  produced  by  strych- 
nine in  lacking  the  intense  tetanic  character  of  the  latter.  The  test, 
therefore,  is  a  good  one,  and  should  be  applied  when  it  is  practicable, 
but  I  do  not  agree  with  some  authors  who  insist  that  without  it  the  pres- 
ence of  strychnine  has  not  been  definitely  established ;  it  is  absolutely 
certain  that  in  competent  hands  the  chemical  tests  for  strychnine  are 
more  delicate  than  and  fully  as  reliable  as  the  physiological  test. 

Detection  of  the  Poison. — In  the  Contents  of  the  Stomach. — The  ma- 
terial should  be  finely  comminuted  if  necessary,  mixed  with  enough  water 
to  make  it  thoroughly  fluid,  strongly  acidulated  with  acetic  acid,  and 
digested  on  the  water-bath  for  about  an  hour,  replacing  from  time  to 
time  the  liquid  that  may  evaporate  with  a  little  water.  The  hot  mix- 
ture should  be  strained,  the  liquid  evaporated  on  the  water-bath  to  about 


Fig.  82. — Crystals  of  strychnine  from  stomach, 
crystallized  from  chloroform.  Magnified  12  diame- 
ters. (Drawn  with  the  camera  lucida  by  Dr.  E.  R.  Le 
Count.) 


ALKALOIDAL  AND    OTHER   ORGANIC  POISONS. 


457 


a  quarter  of  its  original  bulk,  and  while  still  hot  five  or  six  times  its 
volume  of  strong  alcohol  slowly  stirred  in.  This  causes  the  separation  of 
a  considerable  amount  of  insoluble  material,  which  should  be  removed 
by  filtration.  The  filtrate  is  evaporated  to  a  syrupy  consistence  on  the 
water-bath,  and  when  cold  is  taken  up  with  a  small  amount  of  water 
slightly  acidulated  with  acetic  acid ;  the  mixture  is  filtered  into  a  strong 
flask,  test-tube,  or  separately  bulb,  a  very  slight  excess  of  potassium 
hydrate  added,  an  equal  bulk  of  chloroform  at  once  poured  in,  and  the 
mixture  vigorously  shaken.  When  the  chloroform  has  settled  out  the 
aqueous  fluid  is  removed  and  again  shaken  with  another  volume  of 
chloroform ;  the  two  chloroform  solutions  thus  obtained  are  united  and 
allowed  to  evaporate  at  a  gentle  heat  in  a  porcelain  dish.  The  residue, 
which  contains  practically  all  of  the  strychnine  present  in  the  stomach, 
is  usually  too  much  contaminated  with  extraneous  substances  for  direct 
testing  for  the  alkaloid,  and  should  be  further  purified ;  this  may  be  at 
least  partially  accomplished 
by  stirring  it  up  with  dilute 
acetic  acid,  filtering,  render- 
ing alkaline,  and  shaking  with 
chloroform  as  before.  Upon 
evaporating  the  chloroform 
the  strychnine  will  occasion- 
ally be  deposited  in  a  crystal- 
line and  nearby  pure  condi- 
tion, but  more  often  there  is 
still  enough  impurity  present 
to  interfere  somewhat  with 
the  unequivocal  recognition 
of  the  poison,  and  as  a  rule  it 
is  much  safer,  before  apply- 
ing tests,  to  purify  the  resi- 
due still  further.  For  this 
purpose  it  is  treated  with 
two  or  three  drops  of  strong 
sulphuric  acid,  and  heated  on 
the  water-bath  for  an  hour 
or  two.  During  this  process 
the  strychnine  is  but  slightly 
changed,  while  most  or  all  of  the  accompanying  impurities  are  carbonized 
or  are  otherwise  chemically  altered  and  lose  their  identity.  The  mixture 
is  diluted  with  water,  filtered,  alkalinized,  shaken  out  with  chloroform, 
and  the  latter  allowed  to  evaporate  in  a  watch-glass.  The  residue  is  now 
almost  always  sufficiently  pure  to  be  tested  for  the  presence  of  the  alka- 
loid. It  should  first  be  examined  under  a  low  power  of  the  microscope 
for  the  presence  of  crystals,  which  will  usually  be  found  in  case  the 
amount  of  strychnine  is  more  than  a  trace.  The  residue  may  then  be 
dissolved  in  a  little  dilute  acetic  acid :  one  drop  of  this  is  put  upon  the 
tongue,  and  the  taste  carefully  observed ;  another  is  evaporated  on  a 
small  porcelain  plate,  and  the  residue  treated  with  sulphuric  acid  and 
an  oxidizing  agent  for  the  color  reaction ;  to  a  third  drop  a  solution  of 
potassium  bichromate  is  added,  and  any  precipitate  obtained  is  carefully 
examined  under  the  microscope,  and  subsequently  dried  and  treated  with 


Fig.  83.  — Strychnine  from  stomach,  crystallized 
from  chloroform,  showing  different  crystalline  forms 
from  those  in  Fig.  82,  p.  -156,  Magnified  40  diameters. 
(Drawn  with  the  camera  lucida  by  Dr^E.  R.  Le  Count.) 


458  d   SYSTEM  OF  LEGAL  MEDICINE. 

sulphuric  acid  as  before  described ;  and  finally  a  few  drops  are  adminis- 
tered to  a  small  frog',  and  the  effects  critically  observed.  If  the  results 
of  all  these  tests  agree  with  those  obtained  from  strychnine,  the  presence 
of  the  poison  is  established. 

It  is  very  desirable  in  testing  an  unknown  residue  for  strychnine,  or 
for  any  other  poison,  to  have  a  small  amount  of  the  substance  for  which 
we  are  examining  at  hand,  and  to  apply  the  same  tests  side  by  side  to 
the  suspected  and  to  the  known  material.  If  we  obtain  identical  reactions 
with  all  our  tests,  the  evidence  of  the  presence  of  the  poison  is  conclusive, 
but  not  otherwise. 

Upon  shaking  the  alkaline  fluid  with  chloroform  as  directed  above, 
it  not  infrequently  happens  that  an  emulsion  is  formed,  from  which  the 
chloroform  separates  very  slowly  and  imperfectly ;  to  obviate  tins  a  mix- 
ture of  equal  parts  of  chloroform  and  ether  may  advantageously  be  used, 
as  has  already  been  spoken  of  on  page  420. 

The  use  of  strong  sulphuric  acid  for  purifying  strychnine,  as  described 
above,  is  strongly  recommended  ;  it  removes  very  efficiently  a  large  num- 
ber of  other  substances,  some  of  which  may  seriously  interfere  with  the 
tests  for  the  alkaloid,  and  it  very  materially  adds,  therefore,  to  the  cer- 
tainty of  detecting  the  poison.  The  sulphuric  acid  used,  however,  must 
be  entirely  free  from  nitrous  compounds,  since  the  latter  when  heated  with 
strychnine  destroy  it. 

In  the  Tissues. — If  the  person  lives  sufficiently  long  after  a  fairly  large 
dose  of  strychnine,  the  alkaloid  may  generally  be  found  in  nearly  all 
parts  of  the  body ;  the  organs,  however,  in  which  it  is  usually  most  eas- 
ily detected  are  the  liver  and  the  kidneys,  and  it  may  often  be  discovered 
in  the  spleen,  heart,  brain,  and  blood.  To  separate  it  from  these,  the  tis- 
sue is  to  be  very  finely  subdivided  and  digested  for  an  hour  at  a  gentle 
heat  with  dilute  alcohol  strongly  acidulated  with  acetic  or  tartaric  acid. 
The  mixture  is  then  filtered,  the  residue  repeatedly  washed  with  acidu- 
lated alcohol,  and  the  mixed  filtrates  evaporated  almost  to  dryness.  The 
residue  is  taken  up  with  a  little  water,  filtered,  alkalinized,  and  shaken 
with  chloroform.  The  chloroform  is  evaporated,  and  the  residue  puri- 
fied and  tested  as  directed  above  in  connection  with  the  contents  of  the 
stomach. 

Quantitative  Determination. — It  sometimes  is  of  great  importance 
to  determine  the  amount  of  strychnine  present  in  the  contents  of  the 
stomach  or  in  the  tissues,  for  as  mix  vomica  and  strychnine  are  exten- 
sively used  in  medicines,  the  finding  of  a  mere  trace  or  even  a  remedial 
dose  of  the  alkaloid  in  the  body  would  not  necessarily  point  to  poison  as 
the  cause  of  death.  Whenever,  therefore,  strychnine,  or  any  preparation 
containing  it,  is  known  to  have  been  taken  for  medicinal  purposes  before 
death,  a  most  rigorous  quantitative  determination  of  the  poison  should 
be  made.  For  this  purpose  the  method  described  above  may  be  followed 
as  far  as  allowing  the  chloroform,  after  the  carbonizing  process,  to  evap- 
orate in  a  watch-glass.  The  residue  thus  obtained,  although  it  may  be 
sufficiently  pure"  for  qualitative  tests,  is  not  fit  for  weighing,  as  it  still  is 
liable  to  contain  more  or  less  impurity.  It  should  be  washed,  therefore, 
with  a  few  drops  of  ice-cold  water,  dried,  again  carbonized  with  strong 
sulphuric  acid,  and  again  extracted  with  chloroform  as  before.  The  hit 
ter  should  be  allowed  to  evaporate  in  a  tared  watch-glass,  and  the  residue 
obtained  should  once  more  be  washed  with  one  or  two  drops  of  ice-cold 


ALKALOID AL   AND   OTHER   ORGANIC  POISONS.  459 

water,  carefully  dried  on  the  water-bath,  and  when  cold,  weighed.  This 
process  is  somewhat  long,  and  in  carrying  it  out  some  strychnine  is 
always  lost,  but  it  yields,  when  properly  executed,  a  very  pure  product, 
which  may  be  weighed  with  great  assurance  as  being  the  alkaloid  nearly, 
if  not  quite,  free  from  impurities. 

In  several  cases  of  strychnine  poisoning  the  accused  at  the  time  of 
trial  has  presented  the  defense  that  the  strychnine  found  in  the  body 
came  from  homeopathic  preparations  of  mix  vomica  which  the  deceased 
had  been  using.  Such  a  plea,  however,  is  rarely  or  never  valid  in  case  a 
ponderable  amount  of  pure  strychnine  was  found  in  the  remains,  for  the 
quantity  of  the  alkaloid  in  the  ordinarily  used  homeopathic  preparations 
is  very  minute ;  I  have  found  that  a  grain  of  the  third  decimal  trituration 
of  mix  vomica,  as  obtained  from  a  reliable  homeopathic  pharmacy,  when 
mixed  with  the  contents  of  a  stomach  afforded  absolutely  no  definite, 
qualitative  test  for  the  presence  of  strychnine,  and  consequently  was  very 
far  from  giving  a  quantitative  result. 

Detection  after  Long  Periods. — Strychnine  resists  decomposition  to 
a  very  marked  degree,  and  it  may  be  detected,  therefore,  in  a  body  even 
a  considerable  period  after  death.  Professor  Wood  reports  finding  the 
poison  a  year  after  death,  and  I  also  on  one  occasion  extracted  it  in  pon- 
derable quantity  from  a  body  that  had  been  buried  nearly  twelve  months. 
Allen  states  that  he  detected  strychnine  in  a  stomach  which  had  been 
kept  untreated  in  a  jar  for  six  years ;  Richter  was  able  to  extract  it  from 
putrid  tissues  exposed  for  eleven  years ;  and  Woodman  and  Tidy  report 
finding  it  in  a  dog's  stomach  after  it  had  been  sealed  up  in  a  bottle  for 
thirteen  years.  Experiments  on  animals  seem  to  indicate,  however,  that 
the  alkaloid  slowly  disappears  when  the  body  is  buried  underground, 
so  that  the  amount  that  can  be  extracted  progressively  diminishes,  and 
finally  the  poison  can  be  no  longer  recognized. 

Failure  to  Detect. — It  has  occasionally  happened  that  no  strychnine 
has  been  found  in  the  body  after  death  even  when  it  was  known  to  have 
been  taken.  Probably  the  larger  number  of  these  failures  to  detect  have 
been  due  to  imperfect  methods  of  extraction,  or  to  incompetent  manipu- 
lation ;  still,  a  few  cases  are  on  record  in  which  expert  investigators  have 
been  unable  to  find  the  poison  though  it  was  known  to  have  been  used. 
Such  a  case  is  reported  by  Dr.  Reese,  and  Professor  Sonnenschein  reports 
another  case  in  which  he  could  not  discover  the  poison  in  either  the  tis- 
sues or  the  blood,  although  he  detected  it  in  the  stomach.  A  few  months 
since  I  was  called  on  to  examine  the  stomachs  of  two  children  who  died 
suddenly  with  all  the  symptoms  of  strychnine  poisoning ;  no  other  cause 
of  death  was  found  or  could  be  suspected,  yet  most  careful  examinations 
failed  to  show  the  presence  of  the  slightest  trace  of  the  poison  in  either 
organ.  Upon  adding  a  tenth  of  a  grain  of  the  alkaloid  to  a  reserved 
portion  of  the  stomachs  it  was  easily  detected,  showing  that  the  method 
used  was  reliable,  and  that  no  interfering  substance  was  present.  In 
both  of  these  cases  the  amount  of  strychnine  taken  was  probably  the 
minimum  fatal  dose,  and  as  the  stomachs  were  not  presented  for  analysis 
until  more  than  a  month  after  death,  it  is  barely  possible  that  the  poison 
may  have  undergone  decomposition. 

Elimination. — Strychnine  is  eliminated  from  the  body  chiefly  by  the 
kidneys,  and  its  presence  iu  the  urine  may  usually  readily  be  demon- 
si  rated  even  when  fairly  small  doses  have  been  taken.     The  examination 


460  A   SYSTEM  OF  LEGAL   MEDICINE. 

of  the  urine  for  strychnine  is  sometimes  of  great  importance  in  cases  of 
suspected  poisoning,  as  a  means  of  verifying  the  presence  of  the  poison 
in  the  system.  The  elimination  by  the  kidneys  is  rapid,  no  strychnine 
being  found  in  the  urine  generally  after  the  second  day.  The  poison, 
therefore,  seems  to  be  eliminated  from  the  body  within  forty-eight  hours. 


BRUCINE. 

Brucine  (synonyms,  brucin  and  brucia)  is  found  in  various  stryclmos 
plants  associated  with  strychnine.  Both  alkaloids  have  similar  physical 
and  chemical  properties,  and  produce  almost  identical  physiological  effects. 
Brucine,  however,  is  much  feebler  in  its  toxic  powers  than  strychnine, 
being  estimated  as  having  only  from  one  seventh  to  one  thirty-eighth 
of  the  latter's  activity.  The  cause  of  this  wide  difference  of  opinion  as 
to  its  powers  is  probably  due  to  the  fact  that  some  of  the  experimenters 
have  operated  with  specimens  of  the  alkaloid  that  were  more  or  less 
impure ;  still,  it  is  safe  to  say  that  brucine  does  not  have  more  than  one 
fifteenth  the  activity  of  strychnine.  In  its  physiological  action  it  is  iden- 
tical with  the  latter  in  the  character  of  its  effects,  differing  only  in  in- 
tensity. All  that  has  been  said,  therefore,  concerning  the  symptoms  of 
strychnine  poisoning  may  be  repeated  in  regard  to  brucine,  provided  a 
sufficient  dose  of  the  latter  is  taken.  The  same  treatment  should  be  pur- 
sued, and  the  same  post-mortem  appearances  are  observed.  The  poison 
may  be  extracted  from  the  contents  of  the  stomach  and  from  the  tissues 
in  a  manner  similar  to  that  described  under  strychnine ;  but  the  tests  by 
which  we  identify  it  are  different.  Like  strychnine,  brucine  is  intensely 
bitter,  and  when  administered  to  a  frog  it  also  occasions  tetanic  convul- 
sions, but  the  quantity  necessary  to  produce  this  effect  is  much  larger 
than  with  strychnine.  Unlike  strychnine,  however,  when  treated  with 
sulphuric  acid  and  an  oxidizing  agent  brucine  does  not  produce  the  char- 
acteristic play  of  colors  occasioned  by  the  former,  and  in  this  way  the 
two  alkaloids  may  be  easily  distinguished. 

The  best  and  most  characteristic  test  for  brucine  is  the  combined  use 
of  nitric  acid  and  stannous  chloride.  If  the  alkaloid  is  treated  with  nitric 
acid  a  blood-red  color  is  produced,  which  is  very  intense,  even  though 
the  amount  of  brucine  present  be  small ;  upon  gently  warming  the  color 
fades  to  orange  and  yellow,  and  after  cooling,  if  a  solution  of  stannous 
chloride  is  added  a  fine  purple  color  is  developed.  This  reaction  distin- 
guishes it  not  only  from  strychnine,  but  from  all  other  alkaloids.  Nitric 
acid,  it  is  true,  strikes  a  red  color  with  morphine  and  with  several  other 
substances,  but  with  none  of  these  is  there  a  change  to  purple  upon  the 
subsequent  addition  of  the  tin  salt. 

VERATRUM,    VERATRINE,   AND   JERVINE. 

The  various  veratrums  are  characterized  by  the  presence  of  a  number 
of  alkaloids,  most  important  of  which  are  veratrine  and  jervine.  The 
chief  veratrums  in  medicine  and  toxicology  are  Verdtrum  album,  or  white 
hellebore,  and  Veratrum  viride,  or  American  hellebore,  in  both  of  which 
veratrine  and  jervine  are  found  associated  with  three  or  four  other  alka- 
loids. 


ALKALOIDAL  AND   OTHER    ORGANIC  POISONS.  461 

Both  the  white  and  the  green  veratrums  and  their  two  chief  alkaloids 
have  similar  toxic  powers,  and  all  may  be  considered  together. 

Properties  of  the  Alkaloids. — Both  veratrine  and  jervine  when  pure 
are  colorless,  odorless  solids,  which  may  be  obtained  in  a  crystalline  form 
with  ease  in  the  case  of  jervine,  and  with  difficulty  in  the  case  of  vera- 
trine. They  have  an  exceedingly  acrid,  bitter  taste,  and  veratrine  is  ex- 
cessively irritating  when  applied  locally  to  the  skin ;  if  inhaled  into  the 
nostrils,  even  in  very  minute  quantities,  it  produces  violent  sneezing. 
Both  are  very  sparingly  soluble  in  water,  but  both  dissolve  with  readi- 
ness in  chloroform ;  veratrine  dissolves  in  ether  without  difficulty,  while 
jervine  is  but  slightly  soluble  in  it.  Both  alkaloids  possess  well-marked 
basic  properties,  uniting  with  acids  and  producing  salts. 

Symptoms. — After  the  ingestion  of  a  poisonous  dose  of  either  vera- 
trum  album  or  veratrum  viride,  or  their  alkaloids,  the  effects  generally 
shown  are  severe  burning  and  pain  in  the  stomach  and  bowels,  in- 
tense nausea,  violent  vomiting,  painful  purging,  great  prostration,  cold 
extremities,  small  and  feeble  pulse,  vertigo,  bhndness,  and  sometimes 
convulsions  and  coma. 

These  symptoms  are  by  no  means  invariable  ;  in  some  cases  the  effects 
upon  the  brain  predominate,  while  in  others  the  cerebrum  appears  to  be 
but  little  involved.  Intense  nausea,  vomiting,  and  purging  are  generally 
present,  yet  occasionally  they  are  nearly  or  quite  absent. 

Period  when  Fatal. — Just  as  with  colchicum,  the  active  principle  of 
which  was  formerly  confounded  with  veratrine,  the  two  veratrums  gen- 
erally lead  to  a  fatal  result  only  after  a  lapse  of  considerable  time.  A 
case  is  reported  in  which  death  occurred  from  veratrum  album  in  three 
hours,  and  another  in  six  hours  from  veratrum  viride,  but  as  a  rale  a 
fatal  termination  is  not  reached  short  of  a  considerably  longer  period 
than  these,  and  one  case  is  on  record  in  which  death  did  not  occur  until 
four  weeks  after  taking  the  fatal  dose. 

Fatal  Dose. — Twenty  grains  of  veratrum  allium  in  the  form  of  a  pow- 
der, and  half  a  dram  of  the  tincture  of  veratrum  viride,  have  proved 
fatal;  but  on  the  other  hand,  very  large  doses  have  been  recovered  from. 
Dr.  H.  C.  Wood  states  that  he  has  several  times  known  a  teaspoonful  of 
the  fluid  extract  of  veratrum  viride  to  be  taken  without  producing  death, 
and  recovery  has  occurred  after  the  ingestion  of  a  tumblerful  of  the  tinct- 
ure of  the  same  drug.  Dr.  Blake,  of  St.  George's  Hospital,  reports  the 
recover}^  of  a  patient  after  swallowing  a  liniment  supposed  to  contain 
three  grains  of  veratrine. 

Treatment. — Vomiting,  if  present,  should  be  encouraged  by  the  copi- 
ous administration  of  tepid  water ;  if  emesis  does  not  oecur  spontane- 
•  >usly,  an  emetic  should  be  given  or  the  stomach-pump  used.  The  patient 
should  be  kept  flat  upon  his  back,  the  head  lower  than  the  feet,  and  after 
the  stomach  has  been  thoroughly  evacuated  an  opiate  should  be  given  to 
control  the  pain  and  quiet  the  vomiting.  The  prostration  should  be  com- 
bated by  stimulants  such  as  external  heat,  alcohol,  and  ammonia,  and  in- 
halations of  amyl  nitrite  have  been  recommended. 

Post=mortem  Appearances. — The  gastro-intestinal  tract  is  usually 
found  in  a  state  of  congestion,  although  this  is  sometimes  entirely  want- 
ing, and  the  lungs,  liver,  and  other  viscera  are  usually  engorged  with 
blood ;  the  post-mortem  appearances,  however,  as  in  most  other  cases  of 
poisoning  with  alkaloids,  are  neither  constant  nor  characteristic. 


462  ^   SYSTEM  OF  LEGAL  MEDICINE. 

Tests. — Both  veratrine  and  jervine  respond  to  the  general  tests  for 
alkaloids,  giving  precipitates  with  tannic  acid,  iodine,  etc.  The  special 
reactions  which  characterize  them  are  as  follows : 

i.  Veratrine. — (a)  Sulphuric  Acid  Test. — If  veratrine  is  treated  with 
strong  sulphuric  acid  it  dissolves  to  a  yellow  solution,  which  upon  stand- 
ing changes  to  a  brilliant  red,  the  latter  color  persisting  unchanged  for 
many  hours.  (See  PI.  VIII.,  No.  G.)  If  after  applying  the  sulphuric 
acid  the  mixture  is  heated,  the  deep  red  color  is  developed  at  once,  and 
upon  further  application  of  heat  it  remains  unchanged  for  a  long  time. 

This  is  an  exceedingly  delicate  test  for  veratrine,  and  when  properly 
observed  a  very  characteristic  one.  Several  other  substances,  it  is  true, 
when  treated  with  strong  sulphuric  acid  produce  colored  mixtures,  some 
of  which,  like  that  obtained  with  veratrine,  are  dark  red ;  but  the}'  may 
be  distinguished  from  the  latter  alkaloid  either  by  the  fact  that  their  red 
color  is  developed  immediately  upon  the  application  of  the  acid,  or  else 
that  upon  heating  the  color  is  changed  quite  differently  from  that  pro- 
duced by  veratrine.  Salicine,  for  instance,  is  colored  deep  red  by  contact 
with  strong  sulphuric  acid,  but  the  color  is  developed  at  once,  and  upon 
moderate  heating  it  turns  brown  and  finally  almost  black. 

(b)  Hydrochloric  Acid  Test. — Strong  hydrochloric  acid  dissolves  vera- 
trine without  change  of  color,  but  if  the  solution  is  boiled  for  some  time 
it  assumes  an  intense  red  color.  This  reaction,  like  the  preceding  one, 
is  very  delicate,  and  is  even  more  characteristic,  for  no  other  alkaloid, 
according  to  Dragendorff,  gives  a  similar  reaction.  It  should  be  stated, 
however,  that  ptomaines  have  been  extracted  from  dead  bodies  which 
gave  reactions  strikingly  similar  to  those  produced  by  veratrine  both 
with  this  test  and  with  the  preceding  one. 

(c)  Physiological  Test. — If  a  small  quantity  of  veratrine  is  administered 
to  a  frog  hypodermically,  it  produces  characteristic  effects.  Very  soon 
after  the  administration  the  animal  vomits,  and  the  pulsations  of  the 
heart  rapidly  diminish  to  ten  or  fifteen  a  minute ;  at  the  same  time  pecu- 
liar spasmodic  contractions  of  the  muscles  set  in,  which  sometimes  resem- 
ble the  tetanic  convulsions  produced  by  strychnia ;  and  finally,  if  the  dose 
of  the  alkaloid  is  sufficiently  large,  the  animal  dies. 

2.  Jervine. — The  most  characteristic  test  for  jervine  is  based  upon 
the  fact  that  its  salts  with  sulphuric,  hydrochloric,  and  nitric  acids  are 
sparingly  soluble  in  pure  water,  and  are  still  more  insoluble  in  the  pres- 
ence of  an  excess  of  the  acid.  If,  therefore,  to  a  fairly  strong  solution 
of  the  alkaloid  in  acetic  acid  a  slight  excess  of  one  of  the  mineral  acids 
lief  ore  named  is  added,  the  jervine  is  precipitated  in  the  form  of  a  diffi- 
cultly soluble  and  highly  crystalline  salt. 

Detection  of  the  Poison. — In  the  Contents  of  the  Stomach. — The  exam- 
ination should  be  conducted  as  described  on  page  418  for  the  general  ex- 
traction of  alkaloids.  The  first  chloroform  residue,  if  mixed  with  much 
foreign  matter,  should  be  purified  by  re-solution  in  dilute  acetic  acid,  fil- 
tration, alkalinization,  and  reextraction  with  chloroform ;  the  residue  from 
this  is  generally  fit  for  the  application  of  the  various  tests  for  veratrine 
or  jervine. 

The  physiological  test  for  veratrine  should  not  be  omitted,  since,  as 
we  have  seen  before,  ptomaines  have  been  found  which  gave  chemical 
reactions  much  like  those  produced  by  veratrine,  but  they  have  not  given 
the  characteristic  physiological  effects  of  the  alkaloid. 


ALKALOIDAL  AND    OTHER   ORGANIC  POISONS.  463 

In  the  Tissues. — The  parts  should  be  finely  subdivided,  mixed  with 
dilute  alcohol  strongly  acidulated  with  acetic  acid,  gently  heated  on  the 
water-bath  for  some  time,  the  mixture  strained,  and  the  subsequent  ex- 
amination conducted  exactly  as  with  the  contents  of  the  stomach. 


2.  Organic  Poisons  not  Alkaloids, 
digitalis. 

All  parts  of  the  plant  commonly  called  foxglove,  and  known  botanic- 
ally  as  Digitalis  purpurea,  are  possessed  of  marked  physiological  activity. 
The  leaves  are  the  portion  commonly  used  in  medicine,  and  they  are  the 
part  that  is  official  in  the  United  States  Pharmacoi^ceia  under  the  name 
of  digitalis. 

The  drug  contains  a  number  of  active  principles,  of  which  the  most 
important  are  digitalin,  digitonin,  digitoxin,  and  digitaldn. 

These  substances  differ  decidedly  in  many  respects  from  the  active 
principles  we  have  been  considering,  such  as  strychnine,  morphine,  etc. ; 
unlike  the  latter,  they  do  not  contain  nitrogen,  and  are  not  possessed  of 
basic  properties,  and  are  therefore  not  alkaloids.  Upon  being  treated 
with  dilute  sulphuric  or  hydrochloric  acid  they  are  decomposed,  one  of 
the  products  of  decomposition  (except  in  the  case  of  digitoxin)  being 
glucose ;  hence  they  belong  to  the  class  of  substances  known  as  gluco- 
sides.  Digitoxin  is  converted  by  boiling  with  dilute  acids  into  an 
amorphous  body,  toxiresin,  and  is  not,  therefore,  a  glucoside. 

Of  the  four  active  principles  above  mentioned,  digitalin  and  digi- 
toxin are  the  most  important,  and  it  is  to  them  that  digitalis  chiefly 
owes  its  remedial  virtues  and  poisonous  properties.  Both  bodies  when 
pure  appear  in  the  form  of  colorless  crystals  of  neutral  reaction  and 
possessed  of  an  intensely  bitter  taste.  They  are  very  sparingly  soluble 
in  water,  in  benzine,  and  in  ether,  but  dissolve  without  difficulty  in 
chloroform  and  alcohol.  The  substance  known  in  commerce  and  phar- 
macy as  "  digitalin "  varies  greatly  in  composition  according  to  the 
method  of  its  manufacture,  but  it  is  usually  composed  of  variable  mix- 
tures of  digitoxin  and  true  digitalin. 

Symptoms. — Digitalis  when  taken  in  toxic  doses  develops  two  chief 
series  of  symptoms :  those  referable  to  the  heart,  whose  action  is  remark- 
ably retarded  and  enfeebled,  and  those  connected  with  the  gastrointes- 
tinal tract,  upon  which  the  drug  acts  much  like  one  of  the  irritant 
poisons,  producing  violent  vomiting  and  persistent  purging.  Sometimes 
the  cardiac  symptoms  are  most  prominent  and  at  other  times  those  of 
the  gastro-intestinal  tract  are  the  most  conspicuous,  but  the  usual  mani- 
festations are  as  follows :  Soon  after  taking  the  toxic  dose  there  is  severe 
pain  in  the  stomach  and  bowels,  accompanied  by  violent  vomiting  and 
persistent  purging ;  the  heart's  action  becomes  depressed  and  irregular, 
the  pulsations  sometimes  being  reduced  to  one  half  or  one  quarter  of  the 
normal ;  there  is  great  thirst,  the  surface  is  pale  and  moist,  and  the  ex- 
tremities become  cold ;  the  pupils  are  usually  dilated  and  vision  is  im- 
perfect, and,  according  to  Tardieu,  the  sclerotic  frequently  assumes  a 
characteristic  blue  tint ;  delirium  often  sets  in,  accompanied  by  convul- 
sions, and  death  occurs  through  syncope. 


464  ^   SYSTEM  OF  LEGAL  MEDICTNE. 

Digitalis  is  a  cumulative  poison.  Frequently  no  effects  are  shown 
until  a  number  of  doses  have  been  taken,  when  suddenly  the  toxic  effects 
of  the  drug  may  be  violently  manifested.  Many  cases  are  recorded  in 
which  no  untoward  symptoms  were  produced  until  the  drug  had  been 
taken  for  a  number  of  days,  when  the  full  poisonous  force  of  the  digitalis 
suddenly  appeared. 

Period  when  Fatal. — Digitalis  generally  produces  death  slowly,  a 
fatal  termination  rarely  occurring  earlier  than  the  end  of  twenty  or 
twenty-four  hours,  and  it  may  be  postponed  for  a  number  of  days.  One 
case  is  recorded  of  death  on  the  sixth  day,  another  on  the  twelfth  day, 
and  another  at  the  end  of  three  weeks. 

Fatal  Quantity. — It  is  quite  difficult,  if  not  impossible,  to  state  the 
minimum  fatal  dose  of  digitalis.  The  drug,  as  is  well  known,  varies  in 
its  activity  according  to  its  age  and  the  care  taken  in  the  selection  and 
curing  of  the  leaves.  All  the  pharmaceutical  preparations  consequently 
are  of  variable  strength,  and  the  digitalins  of  commerce  are  also  quite 
uncertain  in  their  activity.  Moreover,  the  cumulative  effect  of  the  drug 
makes  it  still  more  difficult  to  estimate  the  exact  intensity  of  action  of  a 
single  dose.  Two  or  three  grains  of  the  powdered  leaves  have  occasion- 
ally produced  severe  symptoms,  and  eight  or  ten  grains  may  be  regarded 
as  a  dangerous  and  possibly  even  fatal  dose.  Very  large  quantities, 
however,  of  the  drug  and  its  preparations,  such  as  a  dram  of  the  leaves 
aud  a  half -ounce  or  an  ounce  of  the  tincture,  have  been  administered 
without  producing  untoward  symptoms,  but  it  is  probable  that  in  these 
cases  the  article  employed  was  largely  inert. 

Treatment. — The  stomach  should  be  evacuated  as  soon  as  possible. 
If  vomiting  is  already  present,  as  is  usually  the  case,  it  should  be  en- 
couraged by  copious  draughts  of  tepid  water  so  as  thoroughly  to  wash 
out  the  stomach;  but  if  vomiting  has  not  occurred  spontaneously,  it 
should  be  produced  by  an  emetic,  or  the  stomach  should  be  freed  from 
its  contents  by  the  stomach-pump  or  stomach-tube.  Tannic  acid,  or 
vegetable  infusions  containing  it,  may  be  copiously  administered,  since 
the  active  principles  of  digitalis  are  rendered  sparingly  soluble  by  this 
agent.  The  pain  may  be  c<  >ml  >ated  by  small  doses  of  opium,  and  the  de- 
pressing effects  of  the  drug  should  be  counteracted  by  the  use  of  stimu- 
lants, such  as  alcohol,  ammonia,  electricity,  and  external  heat.  Above  all 
things,  the  patient  should  be  kept  cpiiet,  and  always  in  a  recumbent  posi- 
tion, in  order  that  the  least  possible  work  may  be  thrown  upon  the  heart. 
Death  has  not  infrequently  occurred  from  syncope  upon  the  patient  get- 
ting out  of  bed,  or  even  sitting  up. 

Post=mortem  Appearances. — As  with  most  other  vegetable  poisons, 
no  characteristic  post-mortem  appearances  are  produced  by  digitalis. 
Sometimes  there  is  injection  of  the  mucous  membrane  of  the  stomach 
and  the  membranes  of  the  brain,  but  often  these  are  lacking,  and  abso- 
lutely nothing  abnormal  presents  itself.  Digitalis  or  its  active  princi- 
ples, therefore,  may  produce  death  and  leave  no  post-mortem  appearances 
even  remotely  to  suggest  its  administration. 

Tests. — Unfortunately,  we  do  not  possess  at  present  any  conclusive 
chemical  tests  either  for  digitalis  or  its  active  principles.  The  nearest 
approach  to  characteristic  reactions  are  the  two  following : 

(a)  Grandeau's  Test. — Digitalin  dissolves  in  concentrated  sulphuric 
acid  with  the  production  of  a  green  color,  which  on  the  addition  of  bro- 


ALEALOIDAL  AND    OTHER   ORGANIC  POISONS.  465 

mine  changes  to  a  violet  red,  and  again  becomes  green  on  dilution  with 
water. 

(b)  Lafon's  Test. — If  digitalin  is  gently  heated  with  a  few  drops  of  a 
mixture  of  equal  parts  of  alcohol  and  sulphuric  acid  a  light  yellowish- 
brown  color  is  developed,  which  on  the  addition  of  a  drop  of  dilute  solu- 
tion of  ferric  chloride  changes  to  a  beautiful  blue,  or  greenish-blue  color, 
which  persists  for  several  hours. 

Neither  of  these  chemical  tests,  however,  is  entirely  conclusive,  and 
we  are  obliged  to  depend  chiefly  upon  the  physiological  effects  of  the 
drug  for  its  recognition  in  toxicological  examinations.  The  gastroin- 
testinal symptoms  and  the  remarkable  slowing  of  the  heart's  action  are 
well  shown  when  the  substance  is  administered  to  one  of  the  lower  ani- 
mals, and  this  is  our  principal  means  of  determining  the  presence  of  the 
poison. 

Detection  of  the  Poison. — Vomited  matter,  the  contents  of  the  stom- 
.ach,  or  other  suspected  material,  should  be  mixed  with  alcohol,  slightly  acid- 
ulated with  acetic  acid,  and  digested  on  the  water-bath  at  a  slight  eleva- 
tion of  temperature  for  some  time.  The  mixture  is  then  strained  and  the 
filtrate  freed  from  alcohol  by  slow  evaporation  at  a  moderate  tempera- 
ture. The  resulting  aqueous  fluid  is  shaken  with  petroleum  ether,  which 
dissolves  out  many  foreign  bodies  but  does  not  remove  the  active  prin- 
ciples of  the  digitalis.  After  separating  the  ether,  the  liquid  is  shaken 
with  chloroform,  which  upon  spontaneous  evaporation  leaves  behind 
the  toxic  principles  of  the  drug,  associated  usually  with  a  considerable 
amount  of  foreign  material.  A  little  of  the  residue  should  be  given  by 
hypodermic  injection  to  a  cat  or  small  dog,  and  the  effects  carefully 
watched.  If  digitalis,  or  one  of  its  preparations,  was  present  in  the 
material  examined,  the  animal  should  show  the  toxic  effects  of  the  drug 
by  vomiting  and  purging,  dilatation  of  the  pupils,  slow  and  irregular 
heart-action,  and,  if  the  dose  is  sufficiently  large,  by  death  at  the  end  of 
.a  number  of  hours.  Another  portion  of  the  residue  may  be  administered 
to  a  frog,  and  its  exposed  heart  carefully  watched.  At  the  same  time 
another  frog  should  be  treated  with  a  small  quantity  of  known  digitalin, 
and  a  third  untreated  animal  should  be  used  as  a  standard  of  compari- 
son. If  the  effect  of  the  suspected  extract  on  the  heart  is  the  same  as 
that  of  the  digitalin,  we  know  at  least  that  some  heart-poison  is  present, 
If  these  several  physiological  tests  give  positive  results,  a  portion  of  the 
chloroform  extract  may  be  submitted  to  the  two  chemical  tests  before 
described ;  and  while  their  results  by  themselves  alone  cannot  be  regarded 
as  very  conclusive,  yet  in  conjunction  with  the  tests  with  animals  they 
are  often  of  much  value  in  deciding  as  to  the  presence  or  absence  of 
digitalis. 

Resistance  to  Putrefaction. — Digitalis  and  its  active  principles  re- 
sist decomposition  in  the  body  after  death  for  at  least  a  moderate  period. 
In  the  well-known  De  la  Pommerais  case  at  Paris,  the  deceased  was  ex- 
humed thirteen  days  after  death,  and  extracts  of  the  organs  produced 
physiological  effects  indicating  the  presence  of  digitalin ;  and  recently 
Lafon  has  demonstrated  that  digitalin  is  not  decomposed  by  the  various 
fluids  of  the  gastro-intestinal  tract,  and  that  it  resists  for  a  considerable 
length  of  time  the  destructive  influence  of  the  microbes  of  putrefaction. 


466  A  SYSTEM  OF  LEGAL  MEDICINE. 


CHLOROFORM. 

Chloroform  is  a  colorless,  neutral  liquid,  of  specific  gravity  1.5 ;  it  is 
possessed  of  an  agreeable  odor  and  of  a  burning  and  slightly  sweetish 
taste.  It  is  sparingly  soluble  in  water,  but  mixes  in  all  proportions  with 
alcohol  and  ether.  It  is  readily  volatile  at  ordinary  temperatures,  and 
boils  at  61°  C.     Its  composition  is  represented  by  the  formula  CHC13. 

Chloroform  in  sufficient  dose  is  possessed  of  poisonous  properties 
whether  taken  as  a  liquid  by  the  mouth  or  inhaled  as  a  vapor  into  the 
lungs.  As  the  effects  are  somewhat  different  in  the  two  cases,  each 
should  be  considered  separately. 

(a)  As  a  Liquid  by  the  Mouth. 

Symptoms. — Chloroform  taken  by  the  mouth  presents  two  distinct 
classes  of  symptoms :  those  produced  by  its  local  irritant  action,  and 
those  developed  by  its  effects  upon  the  nervous  centers. 

Immediately  after  swallowing  a  poisonous  dose  of  liquid  chloroform 
there  is  experienced  an  intense  burning  sensation  in  the  mouth,  throat, 
and  stomach ;  this  is  usually,  although  not  always,  accompanied  by 
vomiting,  and  the  vomited  matter  is  not  infrequently  mixed  with  blood. 
As  the  chloroform,  however,  is  absorbed  and  its  sedative  effects  upon 
the  nervous  centers  are  developed,  vomiting  ceases.  Profound  narcotic 
effects  now  manifest  themselves.  The  patient  becomes  drowsy  and  falls 
into  a  deep  stupor ;  the  face  is  pale,  moist,  and  frequently  cyanotic ;  the 
pulse  becomes  feeble  and  irregular,  the  breathing  is  stertorous,  and  con- 
vulsions often  occur.  Death  takes  place  either  from  paralysis  of  the 
heart  or  asphyxia. 

Period  when  Fatal. — Chloroform  when  taken  by  the  mouth  acts 
usually  somewhat  slowly,  death  not  generally  occurring  for  ten  or 
twelve  hours.  One  case,  however,  is  recorded  in  which  there  was  a  fatal 
termination  in  three  hours ;  but,  on  the  other  hand,  another  is  reported 
in  which  life  was  prolonged  until  the  eighth  day. 

Fatal  Quantity. — A  little  less  than  half  an  ounce  of  chloroform  has 
proved  fatal  to  an  adult,  and  this  quantity  may  be  regarded  as  probably 
the  minimum  fatal  dose.  Children,  however,  as  would  naturally  be  ex- 
pected, are  much  more  sensitive  to  its  effects,  and  the  death  of  a  child 
is  reported  from  a  dram  of  the  fluid.  Large  doses  have  been  recovered 
from,  four  ounces  having  been  taken  in  one  case  and  the  person  sur- 
vived. 

Treatment. — The  stomach  should  be  promptly  evacuated,  and  this 
is  best  done  by  means  of  the  stomach-pump  or  stomach-tube,  as  the 
sedative  influence  of  the  drug  upon  the  nervous  system  makes  emetics 
uncertain  in  their  action. 

The  depressing  effect  of  the  poison  should  be  combated  by  hypoder- 
mic injections  of  strychnine  and  ammonia.  The  patient  should  be  kept 
warm,  and  should  be  aroused  from  slumber  as  much  as  possible  by 
persistent  conversation.  Artificial  respiration  may  be  resorted  to  if 
necessary,  and  electricity  is  often  useful  in  stimulating  the  respiratory 
center.  If  there  is  much  cyanosis,  inhalations  of  pure  oxygen  are  fre- 
quently beneficial. 


ALKALOIDAL   AND   OTHER   ORGANIC   POISONS.  467 

Post-mortem  Appearances.— The  mouth,  throat,  and  stomach  are 
usually  intensely  reddened  by  the  local  irritating  action  of  the  poison, 
although  these  appearances  are  sometimes  wanting.  The  blood  is  gen- 
erally dark  and  fluid,  the  vessels  of  the  brain  are  frequently  gorged  with 
blood,  and  there  is  usually  congestion  of  the  lungs  and  often  of  the  liver 
and  kidneys. 

(b)  As  a  Vapor  by  the  Lungs. 

Symptoms. — Vapor  of  chloroform  when  inhaled  produces  at  first 
a  moderate  general  excitement  of  the  system,  but  this  is  rapidly  followed 
by  drowsiness,  deep  sleep,  and  complete  insensibility.  If  chloroform  is 
given  in  moderation  and  mixed  with  sufficient  air,  anaesthesia  may  be 
maintained  with  but  slight  danger  for  a  considerable  period  of  time,  as 
is  often  done  during  surgical  operations ;  but  if  too  great  a  quantity  is 
used,  or  the  amount  of  air  with  which  the  vapor  is  mixed  is  too  small, 
it  acts  as  a  narcotic  poison,  producing  cyanosis,  stertorous  breathing, 
irregular  heart-action,  convulsions,  and  death,  the  latter  occurring  some- 
times through  heart  failure  and  sometimes  through  paralysis  of  the  re- 
spiratory center. 

Even  with  the  most  skillful  administration  the  vapor  of  chloroform 
sometimes  produces  death,  notwithstanding  the  amount  given  is  small 
and  largely  diluted  with  air.  The  records  of  surgery  contain  many  such 
cases. 

Treatment. — The  patient  should  be  put  in  a  well-ventilated  place 
with  an  abundance  of  fresh  air  blowing  over  the  face,  but  the  body 
should  be  kept  warm,  artificial  heat  being  used  if  necessary.  If  breath- 
ing has  ceased,  artificial  respiration  should  be  resorted  to,  and  pure 
oxygen,  if  possible,  should  be  allowed  to  play  freely  over  the  face  at  the 
same  time.  Electricity  may  be  employed  to  stimulate  the  respiratory 
and  circulatory  centers,  and  inhalations  of  amyl  nitrite  may  sometimes 
be  given  with  advantage. 

Fatal  Quantity  and  Fatal  Period. — Both  the  fatal  quantity  and 
fatal  period  of  chloroform  when  taken  by  inhalation  are  uncertain. 
Persons  have  died  almost  as  soon  as  the  administration  of  the  vapor  was 
commenced,  and,  on  the  other  hand,  death  has  not  occurred  until  a  large 
quantity  of  the  drug  had  been  inhaled  for  a  considerable  period  of  time. 
Some  persons  appear  to  lie  highly  sensitive  to  the  action  of  this  agent, 
while  others  bear  it  in  large  amount  without  unfavorable  symptoms. 
It  may  be  stated,  perhaps,  that  the  fatal  dose  ranges  from  a  few  whiffs 
of  the  vapor  to  many  ounces,  and  the  fatal  period  from  a  few  minutes 
to  several  hours. 

Post=mortem  Appearances. — The  appearances  after  death  are  similar 
to  those  observed  after  the  ingestion  of  liquid  chloroform,  excepting  the 
redness  produced  by  the  local  irritation  of  the  latter  in  the  mouth,  throat, 
and  stomach. 

Tests. — The  test  for  chloroform  upon  which  we  mainly  rely  in  toxi- 
cological  examinations  depends  upon  the  fact  that  the  vapor  of  chloro- 
form if  passed  through  a  tube  heated  to  redness  is  decomposed,  being 
broken  up  into  carbon,  hydrochloric  acid,  and  free  chlorine.  The  hydro- 
chloric acid  and  chlorine  thus  produced  may  be  readily  recognized  by 
the  reddening  effect  of  the  one  and  the  bleaching  action  of  the  other  on 
blue  litmus,  by  their  liberating  iodine  from  potassium  iodide,  and  by 


468  J   SYSTEM  OF  LEGAL  MEDICINE. 

their  producing,  when  brought  in  contact  with  silver  nitrate  solution,  a 
white  precipitate  of  silver  chloride,  which  is  insoluble  in  nitric  acid  but 
readily  soluble  in  ammonia. 

Detection  of  the  Poison. — If  the  chloroform  was  taken  by  the  mouth 
the  contents  of  the  stomach  usually  give  the  most  positive  evidence  of 
the  poison,  although  the  blood  and  lungs  may  also  be  examined ;  but 
when  death  has  occurred  from  inhalation  of  the  vapor,  the  lungs  gener- 
ally afford  the  most  certain  results,  although  the  blood  should  also  be 
tested. 

The  material  under  examination  should  be  finely  comminuted  and 
placed  in  a  flask  provided  with  a  doubly  perforated  stopper,  through 
which  pass  two  glass  tubes — one  reaching  nearly  to  the  bottom  of  the 
flask,  while  the  other  goes  but  a  short  distance  into  its  upper  part.  The 
latter  tube  is  connected  with  a  piece  of  tubing  of  hard  glass,  a  section 
of  which  is  heated  to  redness  in  a  burner,  and  a  few  inches  beyond  are 
placed  a  piece  of  moistened  blue  litmus-paper  and  a  strip  of  filter-paper 
saturated  with  starch  paste  and  potassium  iodide.  The  tube  is  then 
bent  at  right  angles  and  dips  into  a  solution  of  silver  nitrate.  The  flask 
should  be  very  gently  heated  by  being  placed  in  a  dish  of  warm  water,, 
and  air  is  slowly  blown  through  the  mixture  by  means  of  the  longer 
tube.  If  chloroform  is  present  the  stream  of  air  carries  it  off  in  the 
form  of  vapor,  and  as  it  traverses  the  heated  tube  it  is  decomposed, 
yielding  hydrochloric  acid  and  chlorine.  The  mixture  of  the  two  as  it 
comes  in  contact  with  the  piece  of  blue  litmus-paper  first  turns  it  red 
and  then  bleaches  it,  while  the  paper  impregnated  with  starch  paste  and 
potassium  iodide  is  colored  blue  from  the  formation  of  iodide  of  starch. 
As  the  gases  bubble  up  through  the  solution  of  silver  nitrate,  a  white 
precipitate  is  thrown  down,  insoluble  in  nitric  acid,  but  readily  dissolv- 
ing in  ammonia.  If  chloroform  is  absent,  however,  these  reactions  are 
not  observed. 

Resistance  to  Decomposition. — Chloroform  is  an  antiseptic  sub- 
stance, and  naturally,  therefore,  resists  decomposition  for  a  considerable 
period  of  time.  In  spite  of  its  volatility  it  remains  tenaciously  attached 
to  the  tissues  of  the  dead  body,  and  its  presence  has  been  demonstrated 
in  the  lungs  of  persons  who  have  died  from  its  effects,  several  months 
after  burial. 

CHLORAL. 

Pure  chloral  is  a  colorless,  oily  liquid  obtained  by  the  prolonged  action 
of  chlorine  on  alcohol.  Its  composition  is  represented  by  the  formula 
C2HC130.  When  brought  in  contact  with  water  it  unites  with  the 
latter,  producing  a  substance  which  is  the  chloral  of  the  United  States 
Pharmacopoeia  and  of  commerce.  To  distinguish  it  from  the  anhydrous 
liquid  chloral  it  is  often  termed  chloral  hydrate,  or,  more  properly, 
hydrous  chloral. 

The  chloral  of  commerce  is  a  crystalline  solid  of  neutral  reaction, 
slightly  volatile  at  ordinary  temperatures,  and  possessed  of  a  peculiar 
odor  and  disagreeable  taste.  It  is  easily  soluble  in  water,  alcohol,  and 
ether. 

Symptoms. — The  effects  of  chloral  are  very  similar  to  those  produced 
by  chloroform  when  taken  by  the  stomach.  It  is  not,  however,  as  decided 
an  irritant  as  chloroform,  and  therefore  does  not  usually  produce  the 


ALKALOIDAL  AND   OTHER   ORGANIC  POISONS.  469 

local  burning  pains  and  the  vomiting  occasioned  by  the  latter,  and  the 
symptoms,  moreover,  usually  come  on  rather  more  slowly.  Not  long 
after  taking  a  poisonous  dose  great  drowsiness  appears,  succeeded  by 
profound  sleep,  passing  into  coma ;  the  face  is  flushed  at  first,  but  after- 
ward becomes  pale  and  finally  cyanotic ;  the  breathing  is  stertorous,  the 
pulse  feeble,  and  death  ensues  sometimes  with,  and  sometimes  without, 
general  convulsions.  The  pupils  are  usually  contracted  and  insensible 
to  the  light,  but  occasionally  are  dilated.  The  temperature  falls,  and 
toward  the  close  the  extremities  are  markedly  cold. 

Fatal  Period. — Chloral,  like  chloroform,  usually  leads  somewhat 
slowly  to  a  fatal  termination,  death  rarely  occurring  before  the  lapse  of 
from  six  to  eight  hours.  One  case,  however,  is  recorded  of  a  fatal  issue 
in  half  an  hour,  and  another  in  an  hour. 

Fatal  Quantity. — The  smallest  recorded  quantity  that  has  produced 
death  is  ten  grains ;  this,  however,  is  exceptional,  but  a  number  of  cases 
are  reported  in  which  twenty,  thirty,  and  forty  grains  have  proved  fatal. 
On  the  other  hand,  large  doses,  such  as  five  and  six  drams,  have  been 
recovered  from. 

Treatment. — The  stomach  should  be  evacuated  promptly,  preferably 
by  use  of  the  stomach-pump  or  stomach-tube,  as  emetics  in  this  form  of 
poisoning  are  apt  to  be  unreliable.  The  patient  should  be  put  in  an  airy, 
well-ventilated  place,  but  should  be  kept  warm  by  artificial  heat.  The 
heart  and  respiration  should  be  stimulated  by  hypodermic  injections  of 
strychnine  and  ammonia,  and  by  the  use  of  electricity.  If  breathing 
threatens  to  cease,  artificial  respiration  should  be  resorted  to,  and  pure 
oxygen  should,  if  possible,  be  played  over  the  face  at  the  same  time. 

Post=mortem  Appearances. — These  are  neither  characteristic  nor 
constant,  those  most  usually  seen  being  congestion  of  the  lungs,  brain, 
spinal  cord,  and,  occasionally,  of  the  mucous  membrane  of  the  stomach 
and  bowels. 

Tests. — Chloral,  when  heated  with  an  alkaline  hydrate,  is  decom- 
posed,  chloroform  being  formed,  which  may  be  recognized  in  the  manner 
already  described  under  that  substance.  This  constitutes  the  test  com- 
monly employed  for  chloral. 

Detection  of  the  Poison. — The  material,  such  as  vomited  matter,  the 
contents  of  the  stomach,  or  one  of  the  organs,  as  the  liver,  kidneys,  or 
brain,  should  be  finely  comminuted,  rendered  neutral  in  reaction,  and 
placed  in  an  apparatus  such  as  is  described  under  chloroform.  A  test 
for  the  presence  of  chloroform  is  then  made,  and  if  this  is  found  negative 
the  material  is  rendered  alkaline  by  the  addition  of  potassium  hydrate 
solution  and  the  test  for  chloroform  repeated.  If  a  reaction  is  now  ob- 
tained the  presence  of  chloral  is  established. 

Resistance  to  Decomposition. — Chloral  is  a  strong  antiseptic,  and  is 
not  infrequently  used  as  a  preservative  agent,  It  undoubtedly,  therefore, 
would  strongly  resist  decomposition,  and  probably  might  be  detected  in 
the  body  a  considerable  period  after  death. 

CARBOLIC   ACID. 

Carbolic  acid,  known  also  as  phenol  and  phenyl  hydrate,  is  represented 

by  the  chemical  formula  C6H5OH.     It  is  found  in  commer hiefly  in 

two  forms :  crude  carbolic  acid,  a  reddish  or  brownish-red  liquid,  and 


470  J   SYSTEM   OF  LEGAL   MEDICLNE. 

pure  carbolic  acid,  a  crystalline  solid  at  ordinary  temperatures,  but  melt- 
ing easily  on  moderate  warming".  It  is  quite  volatile,  and  has  a  peculiar 
disagreeable  odor  and  a  burning  taste,  whiftb  is  somewhat  sweetish  when 
diluted.  It  takes  up  about  five  percent,  of  water  to  form  a  liquid,  which 
is  often  called  liquefied  or  ninety-five-percent,  carbolic  acid.  It  dissolves 
in  about  twenty  parts  of  water,  and  is  readily  soluble  in  alcohol,  ether, 
and  glycerine.  It  coagulates  albumen,  and  whitens  the  skin  or  mucous 
membrane  to  which  it  is  applied. 

Symptoms. — Carbolic  acid  has  a  dual  action  as  a  poison  :  first,  that 
of  a  local  irritant  or  escharotic  to  the  mouth,  throat,  and  stomach,  and 
second,  that  of  a  profound  sedative  to  the  nerve-centers  after  absorption. 
The  symptoms  usually  come  on  very  rapidly,  frequently  immediately  after 
the  poison  is  swallowed.  There  is  intense  burning  in  the  throat  and 
stomach,  attended  sometimes  by  vomiting,  although  this  is  often  entirely 
lacking.  Stupor  sets  in,  frequently  accompanied  by  delirium,  and  finally 
passing  into  coma.  The  pulse  is  generally  f  eeble  and  irregular,  the  breath- 
ing is  often  stertorous,  and  death  is  sometimes  preceded  by  convulsions. 

The  odor  of  carbolic  acid  is  usually  easily  perceived  in  the  breath, 
and  the  urine  has  a  greenish-brown  color,  becoming  of  a  marked  smoky 
hue  on- exposure  to  the  air. 

Carbolic  acid  has  not  infrequently  produced  serious  symptoms,  and 
even  death,  by  its  external  application. 

Period  when  Fatal. — Carbolic  acid  generally  acts  with  moderate 
rapidity,  death  occurring  in  from  two  to  four  hours,  and  one  case  is  re- 
corded of  death  within  three  minutes.  A  fatal  termination,  however,  is 
sometimes  long  delayed,  death  not  supervening  for  a  number  of  days. 

Fatal  Quantity. — The  smallest  recorded  fatal  dose  of  carbolic  acid 
is  one  dram,  and  numerous  cases  are  reported  of  death  from  two  drams 
and  upward. 

Treatment. — The  stomach  should  be  promptly  evacuated  by  the  use 
of  the  stomach-pump  or  stomach-tube,  and  the  organ  washed  out  with 
tepid  water.  Great  care  should  be  used  in  introducing  the  tube  into  the 
stomach,  for  the  acid  having  corroded  the  oesophagus,  there  is  danger 
of  its  perforation.  Emetics  are  generally  of  but  little  utility  on  account 
of  the  sedative  influence  of  the  poison  both  on  the  stomach  locally,  and 
upon  the  nervous  system  after  absorption.  After  evacuating  the  stomach, 
bland  mucilaginous  drinks  may  be  given,  and  soluble  sulphates,  such  as 
those  of  sodium  and  magnesium,  should  be  freely  exhibited,  so  as  to 
favor  the  conversion  of  the  carbolic  acid  into  conjugated  sulpho-com- 
pounds.  Morphine  may  be  administered  for  the  relief  of  pain,  and  in 
case  of  great  depression  ammonia  and  alcohol  are  useful.  The  patient 
should  be  kept  warm,  and  artificial  respiration  is  necessary  in  case 
breathing  threatens  to  cease. 

Post=mortem  Appearances. — The  odor  of  carbolic  acid  is  usually 
distinctly  observed  both  in  the  stomach  and  in  other  parts  of  the  body. 
The  mucous  membrane  of  the  mouth  and  throat  is  white,  and  that  of  the 
stomach  and  intestines  is  reddened  and  softened.  The  brain  is  gener- 
ally congested,  and  frequently  also  the  lungs,  liver,  and  kidneys.  The 
blood  is  dark  and  fluid.  Sometimes,  however,  no  abnormal  post-mortem 
appearances  are  observed. 

Tests. — In  addition  to  the  odor,  which  is  fairly  characteristic,  we 
have  a  number  of  tests,  of  which  the  following  are  among  the  best. 


3,    ui     yyxxx^ix    xxx^    "'"""'"5    "*  v,    uwv.u.g 


ALKALOIDAL  AND    OTHER   ORGANIC  POISONS.  471 

(a)  Bromine  Test. — If  bromine  water  is  added  in  excess  to  a  solution 
of  carbolic  acid,  a  yellowish  precipitate  is  thrown  down,  even  if  the  so- 
lution contains  only  one  part  to  50,000.  If  the  precipitate  is  collected, 
washed,  mixed  with  sodium  amalgam  and  water,  and  warmed,  the  odor 
•of  carbolic  acid  is  given  off  upon  acidifying  the  mixture  with  sulphuric 
acid. 

(b)  Hypochlorite  Test. — If  carbolic  acid  is  mixed  with  ammonia  water 
and  then  a  solution  of  a  hypochlorite  added,  a  blue  color  is  developed. 

(c)  Ferric  Chloride  Test. — Carbolic  acid  with  neutral  solution  of  ferric 
chloride  gives  a  permanent  blue  color. 

None  of  the  above  tests  are  entirely  characteristic  of  carbolic  acid,  a 
number  of  other  substances  responding  to  one  or  all  of  the  reactions. 
The  only  other  body,  however,  which  would  be  likely  to  be  confounded 
with  it  is  creosote.  This  behaves  with  the  above  tests  very  much  like 
•carbolic  acid,  but  the  two  ma}''  be  distinguished  by  the  fact  that  creosote 
when  mixed  with  collodion  does  not  coagulate  the  latter,  while  carbolic 
acid  does ;  and  the  blue  color  produced  by  the  action  of  ferric  chloride 
and  creosote  rapidly  changes  to  brown,  whde  that  developed  with  car- 
bolic acid  is  permanent. 

Detection  of  the  Poison. — The  parts  to  be  examined  should  be  finely 
subdivided,  mixed  with  water,  gently  acidulated  with  sidphuric  acid,  and, 
after  moderate  digestion,  filtered ;  the  filtrate  is  placed  in  a  retort  and 
subjected  to  distillation.  The  distillate  may  be  examined  directly  by 
the  tests  already  given,  but  if  the  amount  of  carbolic  acid  present  is 
small  it  is  better  to  shake  up  the  distillate  with  ether,  which  absorbs  the 
carbolic  acid  and  afterward  leaves  it  behind  upon  spontaneous  evapo- 
ration in  a  watch-glass  or  beaker.  The  residue  thus  obtained  may  be 
dissolved  in  a  small  amount  of  water,  and  the  solution  examined  by  the 
various  tests  given  above. 

In  addition  to  the  foregoing  there  is  a  very  large  number  of  other 
poisonous  organic  compounds ;  most  of  them,  however,  are  so  rare  Gl- 
are so  seldom  used  for  the  purposes  of  criminal  poisoning,  that  they 
possess  but  little  medico-legal  interest,  and  cannot  justly  claim  admission 
within  the  somewhat  narrow  limits  of  this  article.  A  few,  however,  of 
possibly  greater  importance  than  others,  may  be  briefly  mentioned. 

Croton  Oil. — When  taken  in  toxic  quantity  croton  oil  acts  as  a 
violent  gastro-intestinal  irritant,  and  the  symptoms  are  those  commonly 
•observed  in  poisoning  by  such  agents.  There  is  intense  burning  and 
pain  in  the  mouth,  throat,  stomach,  and  bowels,  accompanied  by  violent 
vomiting  and  purging,  slow  and  feeble  pulse,  cold  extremities,  profound 
prostration,  collapse,  and  death. 

Two  or  three  drops  of  the  oil  have  frequently  produced  distressing 
gastro-intestinal  irritation,  and  twenty  drops  have  occasioned  death. 

The  treatment  should  consist  of  prompt  evacuation  of  the  stomach, 
the  exhibition  of  demulcent  drinks,  and  the  administration  of  anodynes 
as  occasion  requires. 

The  post-mortem  appearances  are  those  usually  found  as  the  effect  of 
gastro-intestinal  irritants,  and  consist  chiefly  of  marked  inflammation  of 
the  stomach  and  intestines. 

The  detection  of  the  poison  is  accomplished  by  repeatedly  extracting 
the  contents  of  the  stomach  and  bowels  with  ether,  allowing  the  latter  to 


472  -4   SYSTEM  OF  LEGAL  MEDICINE. 

evaporate,  and  applying  a  small  particle  of  the  residue  to  the  inside  of 
the  arm.  If  eroton  oil  is  present  the  surface  will  be  blistered.  We  have- 
no  reliable  chemical  test  for  the  oil  when  present  in  the  small  quantity 
usually  found  in  toxicological  examinations. 

Cantharides,  or  Spanish  Fly. — The  symptoms  produced  by  a  poison- 
ous dose  of  cantharides  somewhat  resemble  those  occasioned  by  eroton 
oil,  both  substances  being  active  gastro-intestinal  irritants.  There  is 
great  burning  in  the  throat  and  stomach,  intense  thirst,  violent  vomit- 
ing, and  severe  diarrhoea;  the  mouth  and  throat  are  blistered,  the  sali- 
vary glands  swollen,  and  salivation  frequently  supervenes.  The  poison 
is  largely  eliminated  by  the  urine,  and  in  passing  through  the  urinary 
tract  intense  irritation  of  all  parts  of  these  organs  is  produced,  accom- 
panied by  severe  pain  in  the  back,  strangury,  and  bloody  urine.  As  the 
case  progresses  the  extremities  become  cold,  and  the  patient  sinks  into 
collapse,  followed  by  coma  and  death. 

Small  doses  of  the  drug,  like  a  single  fly,  may  occasion  intensely 
poisonous  symptoms,  but  twenty  or  thirty  grains  are  usually  necessary 
to  produce  fatal  effects.  Recovery,  however,  may  follow  quite  large 
quantities,  although  in  these  cases  distressing  after-effects  nearly  always 
persist  for  weeks  and  even  months. 

The  treatment  of  cantharides  poisoning  should  consist  of  promptly 
evacuating  the  stomach,  the  exhibition  of  demulcent  drinks,  allaying  the 
pain  with  morphine,  and  sustaining  the  patient  during  collapse  by  stim- 
ulants. 

The  post-mortem  appearances  embrace  marked  inflammation  of  the 
stomach  and  bowels,  with  destruction  of  the  mucous  membrane  in  spots, 
intense  reddening  and  congestion  of  the  kidneys,  and  injection  of  the 
bladder. 

In  making  an  examination  for  the  detection  of  the  poison  the  contents- 
of  the  stomach  and  bowels  should  first  be  carefully  examined  for  the 
presence  of  portions  of  the  insect,  which  are  often  found  if  the  crude 
drug  was  taken  ;  but  if  a  fluid  preparation  such  as  the  tincture  was  used,, 
parts  of  the  fly  would  naturally  not  be  discovered.  The  material  may 
be  examined  chemically  by  Dragendorff s  process  as  follows :  The  sus- 
pected substance  is  boiled  with  solution  of  potassium  hydrate  until  it  is 
of  uniform  fluid  consistence ;  the  mixture  is  then  acidified  and  mixed 
with  four  times  its  bulk  of  strong  alcohol,  heated,  and  filtered  hot ;  the 
filtrate  is  gently  warmed  to  expel  the  alcohol,  and  is  then  shaken  with 
chloroform ;  the  latter  is  allowed  to  evaporate,  and  leaves  behind  the 
active  principle  of  cantharides,  known  as  cantharidin.  The  residue 
should  be  dissolved  in  a  little  warm  oil  and  applied  to  the  breast,  the  in- 
side of  the  arm,  or  behind  the  ear,  when  blistering  will  be  produced  if 
cantharides  was  present. 

Camphor. — This  substance,  although  regarded  commonly  as  quite 
innocent,  if  taken  in  large  doses  is  capable  of  producing  severe  symptoms 
of  poisoning,  and  it  not  infrequently  has  occasioned  death.  In  toxic 
quantities  it  acts  as  a  local  irritant  to  the  gastro-intestinal  tract,  and  pro- 
duces first  stimulation,  and  subsequently  paralysis  of  the  nerve-centers. 

The  symptoms  vary  considerably,  according  to  the  dose  and  the  mode 
of  administration,  but  there  is  generally  pain  in  the  stomach,  accompa- 
nied by  vomiting,  dizziness,  cold  and  clammy  surface,  weak  pulse,  labored 
breathing,  coma,  and  convulsions. 


ALKALOIDAL  AND   OTHER   ORGANIC  POISONS.  473 

Thirty  grains  have  proved  fatal  to  a  child,  and  smaller  quantities 
have  occasioned  severe  symptoms  in  adults. 

The  treatment  should  consist  in  thorough  evacuation  of  the  stomach 
and  bowels,  and  the  use  of  anodynes  and  supporting  measures  as  needed. 

The  post-mortem  appearances  are  generally  limited  to  inflammation  of 
the  stomach  and  bowels,  and  injection  of  the  membranes  of  the  brain. 

The  contents  of  the  stomach  or  other  suspected  material  may  be 
examined  for  camphor  by  extracting  thoroughly  with  chloroform,  and 
allowing  the  latter  to  evaporate,  when  the  camphor  will  be  left  be- 
hind, and  can  be  readily  recognized  by  its  odor  and  its  other  physical 
properties. 

Cocculus  Indicus. — This  owes  its  poisonous  properties  to  the  pres- 
ence of  picrotoxin,  a  colorless,  crystalline  body,  of  intensely  bitter  taste, 
sparingly  soluble  in  water,  but  readily  soluble  in  alcohol,  ether,  and 
chloroform.  It  is  not  an  alkaloid,  having  no  nitrogen  in  its  composition, 
but  is  probably  a  glucoside.  Both  the  crude  drug  and  its  active  prin- 
ciple are  gastro-intestinal  irritants,  and  also  powerful  stimulants  of  the 
nerve-centers.  When  taken  in  poisonous  doses  they  occasion  vomit- 
ing, dizziness,  unconsciousness,  and  convulsions.  The  latter  in  some  re- 
spects bear  a  resemblance  to  those  produced  by  strychnine. 

The  treatment  should  consist  in  evacuating  the  stomach  thoroughly, 
and  if  convulsions  are  present,  in  the  administration  of  chloral  by  the 
mouth  or  chloroform  by  the  lungs. 

The  post-mortem  appearances  are  not  constant.  There  is  usually  some 
inflammation  of  the  stomach  and  congestion  of  the  membranes  of  the 
brain. 

The  contents  of  the  stomach,  or  other  suspected  material,  may  be 
examined  for  the  poison  by  thoroughly  exhausting  with  alcohol,  evapo- 
rating to  a  small  bulk,  and  extracting  the  residue  with  chloroform.  The 
latter  upon  evaporation  will  deposit  crystals  of  picrotoxin,  which  may 
be  recognized  by  its  physiological  effects  on  the  lower  animals,  and  also 
by  the  fact  that  when  mixed  with  an  excess  of  potassium  nitrate,  the 
mixture  moistened  with  a  little  sulphuric  acid,  and  strong  solution  of 
sodium  hydrate  added,  a  brick-red  color  is  developed. 


THE  TOXICOLOGICAL  IMPORTANCE  OF  PTOMAINES 
AND  OTHER  PUTREFACTIVE  PRODUCTS. 

BY 

VICTOR  C.  VAUGHAN,  M.D.,  Ph.D. 


Putrefaction  consists  of  the  splitting  up  of  complex  molecules  into 
simpler  ones  by  the  agency  of  micro-organisms.  Among  those  molecules 
which  result  from  the  action  of  bacteria,  certain  ones  are  basic  in  char- 
acter. These  are  known  as  ptomaines.  A  ptomaine  may,  therefore,  be 
denned  as  a  basic  product  of  putrefaction,  or  a  putrefactive  alkaloid. 
Ptomaines  have  been  called  animal  alkaloids,  but  this  is  a  misnomer, 
because  they  may  result  from  the  putrefaction  of  vegetable  as  well  as  of 
animal  substances.  Besides,  the  term  "  animal  alkaloid  "is  more  strictly 
applicable  to  those  basic  substances  which  result  from  the  chemical 
activity  of  the  cells  of  the  animal  body  wholly  independent  of  bacterial 
agency.  Like  the  vegetable  alkaloids,  ptomaines  may  be  volatile  or  non- 
volatile. All  contain  nitrogen ;  some  contain  oxygen,  while  others  do 
not.  The  latter  correspond  to  the  volatile  vegetable  alkaloids,  nicotine 
and  coniine,  and  the  former  correspond  to  the  fixed  alkaloids. 

Since  all  putrefaction  is  due  to  the  action  of  bacteria,  it  follows  that 
all  ptomanies  result  from  the  growth  of  these  micro-organisms.  The 
kind  of  ptomaine  formed  will  depend  upon  the  individual  bacterium 
engaged  in  its  production,  the  nature  of  the  material  being  acted  upon, 
and  the  conditions  under  which  the  putrefaction  proceeds,  such  as  the 
temperature,  amount  of  oxygen  present,  and  the  duration  of  the  process. 
Generally  speaking,  in  all  toxicological  research  the  tissue  under  exam- 
ination has  undergone  putrefactive  changes  in  the  absence  of  air.  There- 
fore those  products  which  are  formed  by  anaerobic  bacteria  are  the  ones 
which  concern  us  especially.  This  fact  seems  to  have  been  overlooked 
by  the  majority  of  toxicologists.  Its  importance  is  great,  and  it  renders 
worthless  the  great  number  of  experiments  which  have  been  made  upon 
tissues  allowed  to  decompose  in  the  presence  of  an  unlimited  air-supply. 
Bacteria  are  always  present  in  certain  portions  of  the  alimentary  canal 
and  in  certain  other  cavities  of  the  body.  The  death  of  the  host  does 
not  mean  the  death  of  these  bacteria.  On  the  contrary,  it  enables  them 
to  extend  their  growth  to  adjacent  tissues,  until  the  whole  of  the  cadaver 
may  be  involved. 

Ptomaines  are  present  probably  to  a  greater  or  less  extent  in  every 
organ  which  is  submitted  to  the  toxicologist  for  examination.  If  he  be 
ignorant  of  the  nature  of  these  substances,  he  may  mistake  them  for 

475 


47G  ^   SYSTEM  OF  LEGAL  MEDICINE. 

vegetable  alkaloids,  and  making  this  mistake,  lie  may  report  a  given 
poison  present  when  it  is  not  present,  and  thus  lead  to  the  conviction  of 
an  innocent  person.  This  whole  subject  needs  thorough  study.  It  is  a 
new  line  of  work,  which  has  not  been  followed  to  any  great  extent,  and 
the  amount  of  information  which  we  have  concerning  these  substances 
is  very  small  and  inadequate. 

It  must  not  be  understood  that  basic  substances  are  the  only  putre- 
factive products  which  may  interfere  with  the  tests  for  vegetable  alka- 
loids. Other  products  of  putrefaction  besides  those  which  are  basic  in 
character  must  also  be  taken  into  consideration ;  for  instance,  certain 
proteids,  notably  albumoses  and  peptones,  are  marked  reducing  agents, 
and  give  certain  color  reactions,  such  as  the  reduction  of  ferric  salts, 
which  may  lead  us  into  error.  Then  there  are  organic  acids,  some  of 
which  have  been  identified,  while  the  nature  of  others  remains  undeter- 
mined, which  may  lead  us  into  the  same  error.  It  is  the  purpose  of  this 
paper  to  point  out  the  few  facts  which  we  do  know  concerning  those 
putrefactive  substances,  which  may  seriously  modify  the  tests  which 
have  heretofore  been  considered  as  positive. 


THE   PURITY   OP   REAGENTS. 

One  of  the  first  things  to  be  ascertained  by  the  chemist  who  under- 
takes to  do  toxicological  work  is  the  purity  of  his  reagents.  Especially 
is  this  true  in  the  employment  of  alkaloidal  solvents.  The  writer  has 
found  a  number  of  samples  of  German  ether,  which  was  imported  on 
account  of  its  supposed  purity,  to  yield  on  spontaneous  evaporation  a 
residue  which  gave  several  of  the  alkaloidal  reactions,  and  a  few  drops 
of  which,  injected  under  the  skin  of  a  frog,  caused  paralysis  and  death 
within  a  few  hours.  In  the  use  of  ether  I  would  advise  that  500  c.c.  of 
this  reagent  be  allowed  to  evaporate  spontaneously,  and  the  residue,  if 
there  be  one,  be  examined  both  chemically  and  physiologically.  The 
basic  substance  which  is  found  in  some  samples  of  sulphuric  ether  is 
pyridine.  Commercial  alcohol  almost  invariably  contains  small  quanti- 
ties of  an  alkaloidal  substance  the  odor  of  which  is  similar  to  that  of 
nicotine  and  pyridine.  Solutions  of  this  substance  are  precipitated  by 
gold  chloride,  phospho-  wolf  ramie  aeid,  phospho-molybdic  aeid,  potassium 
iodide,  and  Meyer's  reagent,  but  not  by  platinum  chloride  or  tannic  acid. 
It  does  not  reduce,  or  reduces  feebly,  ferric  chloride.  From  one  sample 
of  alcohol  Guareschi  and  Mosso  obtained  a  base  which,  in  addition  to 
the  above  reactions,  did  give  a  precipitate  with  platinum  chloride.  Alco- 
hol may  be  freed  from  these  substances  by  distillation  over  tartaric  acid. 
Chloroform  sometimes  leaves  a  marked  residue  on  evaporation.  When 
this  is  the  case,  the  chloroform  should  be  washed  first  with  distilled 
water,  then  with  distilled  water  rendered  alkaline  with  potassium  car- 
bonate, then  dried  over  calcium  chloride,  and  distilled.  Petroleum  ether 
and  benzole  sometimes  contain  a  base  which  has  an  odor  similar  to  that 
of  trimethylamine  or  pyridine,  and  which  gives  a  precipitate  with  plati- 
num chloride,  crystallizing  in  octahedra.  Of  all  the  solvents  used  in  the 
extraction  of  vegetable  alkaloids,  amylic  alcohol  is  the  one  most  likely  to 
iead  the  chemist  into  serious  error.  This  fact  is  due  to  two  causes :  in 
the  first  place,  the  amylic  alcohol  itself  is  very  likely  to  contain  impuri- 


PTOMAINES  AND   OTHER  PUTREFACTIVE   PRODUCTS.  477 

ties — in  one  sample  Haitinger  found  as  much  as  .5  percent,  of  pyridine ; 
the  second  source  of  danger  in  amylic  alcohol  lies  in  the  fact  that  it  is  a 
ready  solvent  for  many  of  the  putrefactive  alkaloids.  For  this  reason 
the  amylic  alcohol  residue  is  probably  less  suitable  than  any  other  for  the 
application  of  color  tests  in  the  final  identification  of  poisons.  Amylic 
alcohol,  when  found  to  be  impure,  may  be  rectified  in  the  same  manner 
as  recommended  above  for  ethylic  alcohol. 

I  will  now  give  a  brief  account  of  those  substances  which  have  been 
found  to  resemble  in  their  reactions  the  vegetable  alkaloids. 


CONIINE. 

At  present  it  is  very  difficult,  probably  impossible,  for  the  chemist  to 
state  with  absolute  certainty  that  he  has  detected  true  coniine  in  the 
dead  body.  Before  he  can  do  this  even  with  a  reasonable  degree  of 
certainty,  the  symptoms  and  the  post-mortem  appearances  must  conform 
with  those  induced  by  the  vegetable  alkaloid,  the  analysis  must  be  made 
before  decomposition  sets  in,  and  the  amount  of  the  base  found  must  be 
sufficient  for  physiological  experiments  to  be  made  with  it. 

Brouardell  and  Boutmy  found  in  the  body  of  a  woman  who  had  died 
after  suffering  from  choleraic  symptoms  caused  by  eating  of  a  stuffed 
goose,  a  base  which  gave  the  odor  of  coniine  and  the  same  reactions 
with  gold  chloride,  iodine  in  potassium  iodide,  etc.,  as  coniine.  The 
same  base  was  found  in  the  remainder  of  the  goose.  This  substance  did 
not  give  the  red  coloration  with  the  vapor  of  hydrochloric  acid,  and  it 
did  not  form  butyric  acid  on  oxidation,  and  although  it  was  poisonous 
it  did  not  induce  in  frogs  the  symptoms  of  coniine  poisoning.  Selmi 
repeatedly  found  coniine-Hke  substances  iu  decomposing  animal  tissue. 
By  distilling  an  alcoholic  extract  from  a  cadaver,  acidifying  the  distillate 
with  hydrochloric  acid,  evaporating,  treating  the  residue  with  barium 
hydrate  and  ether,  and  allowing  the  ether  to  evaporate  spontaneously,  he 
obtained  a  residue  of  volatile  bases,  the  greater  part  of  which  consisted 
of  trimethylamine.  After  removing  this  base,  the  residue  had  the  odor 
of  the  urine  of  the  mouse.  Later,  Selmi  obtained  an  unmistakable  co- 
niine odor  from  a  chloroform  extract  of  the  viscera  of  a  person  who  had 
been  buried  six  mouths,  and  in  another  case  ten  months  after  burial. 
The  chloroform  residue  was  alkaline  in  reaction,  and  when  dissolved  in 
a  few  drops  of  water  and  allowed  to  evaporate  on  a  glass  plate  it  gave 
off  such  a  penetrating  odor  that  the  chemist  was  compelled  to  withdraw 
from  close  proximity  to  the  substance.  The  odor  imparted  to  the  hands 
in  testing  the  substance  with  the  general  alkaloidal  reagents  remained  for 
half  an  hour.  This  volatile  base  seemed  to  be  formed  by  the  spontaneous 
decomposition  of  other  ptomaines.  An  aqueous  solution  of  a  ptomaine 
obtained  by  Selmi  by  extraction  with  ether  according  to  the  Stas-Otto 
method  from  the  undecomposed  parts  of  a  cadaver  had  no  marked  odor, 
but  after  having  been  kept  for  a  long  time  in  a  sealed  tube,  it  not  only 
gave  off  a  marked  coniine  odor,  but  the  vapor  turned  red  litmus-paper 
blue.  Selmi  also  obtained  a  ptomaine  from  putrid  egg  albumen.  After 
converting  this  base  into  a  sulphate,  and  allowing  it  to  stand,  it  formed 
in  two  layers,  one  of  which  was  a  golden  yellow  liquid;  and  this,  on 
being  treated  with  barium  hydrate,  gave  off  ammonia,  and  later  the  odor 


478  J   SYSTEM  OF  LEGAL  MEDICINE. 

of  coniine.  Finding  tliat  butyric  and  acetic  acids  were  formed  by  the 
oxidation  of  this  base,  Selmi  concluded  that  he  had  real  coniine  or 
methylconiine,  and  that  it  was  formed  by  the  oxidation  of  certain  fixed 
ptomaines,  or  by  the  action  of  amido  bases  on  volatile  fatty  acids.  For 
these  reasons  Selmi  believed  in  the  bacterial  origin  of  coniine  or  closely 
allied  bases,  also  in  the  existence  of  a  "  cadaveric  coniine." 

In  a  criminal  trial  in  east  Prussia,  Sonnenschein  found  a  substance 
which  he  believed  to  be  the  alkaloid  of  the  water-hemlock,  but  Otto, 
Husemann,  and  others  believed  it  to  be  a  cadaveric  coniine.  Otto  says 
that  the  symptoms  reported  in  the  case  were  not  those  of  either  coniine 
or  cicuta.  This  base  was  obtained  six  weeks  after  the  exhuming-  of  the 
body,  which  had  been  buried  for  three  months.  It  had  the  odor  of 
coniine,  the  taste  of  tobacco,  and  gave  with  potassium  bichromate  and 
sulphuric  acid  the  odor  of  butyric  acid,  and  behaved  with  reagents  like 
coniine. 

The  most  celebrated  trial  in  which  a  putrefactive  coniine  has  figured 
was  the  Brandes-Krebs  investigation,  which  took  place  in  Braunschweig 
in  1874.  Two  chemists  obtained  from  the  undecomposed  parts  of  the 
body,  in  addition  to  arsenic,  an  alkaloid  which  they  pronounced  coniine. 
This  substance  was  referred  to  Otto  for  further  examination.  He  re- 
ported that  it  was  neither  coniine  nor  nicotine,  nor  any  vegetable  alka- 
loid with  which  he  was  acquainted.  He  converted  the  substance  into  an 
oxalate,  dissolved  it  in  alcohol,  evaporated  the  alcohol,  dissolved  the  resi- 
due in  water,  rendered  the  solution  alkaline  with  potash,  and  extracted 
the  base  with  petroleum  ether.  On  evaporation  of  the  petroleum  ether 
the  alkaloid  appeared  as  a  bright  yellow  oil,  which  had  a  strong,  unpleas- 
ant odor,  quite  different,  however,  from  that  of  coniine.  It  was  strongly 
alkaline,  and  had  an  intensely  bitter  taste.  At  ordinary  temperature 
it  was  volatile.  From  its  aqueous  solutions  it  was  precipitated  by  the 
chlorides  of  platinum,  mercury,  and  gold.  In  these  reactions  it  resem- 
bled nicotine,  from  which,  however,  it  differed  in  the  double  refracting 
and  crystalline  character  of  its  hydrochloride.  With  an  ethereal  solu- 
tion of  iodine  this  substance  did  not  give  the  Roussin  test  for  nicotine, 
but  instead  of  the  long,  ruby-red  crystals  there  appeared  small  dark- 
green  needle-shaped  crystals.  The  substance  was  found  to  be  highly 
poisonous.  Seven  centigrams  injected  subcutaneously  into  a  large  frog 
produced  instantaneous  death,  and  forty-four  milligrams  given  to  a 
pigeon  caused  a  similar  result.  On  account  of  its  poisonous  properties 
the  jury  of  medical  experts  decided  that  the  substance  was  a  vegetable 
alkaloid.  The  reason  for  this  decision  certainly  must  now  be  regarded 
as  wholly  inadequate.  We  know  that  some  of  the  most  highly  poisonous 
substances  are  found  among  putrefactive  products. 

In  examining  the  stomach  and  intestines  in  a  case  of  suspected  poi- 
soning, Liebermann  found  in  the  ether  extract  from  alkaline  solution  a 
brownish,  resinous  mass,  which  dissolved  in  water  to  a  turbid  solution, 
the  cloudiness  increasing  on  heating.  The  aqueous,  strongly  alkaline 
solution  of  this  substance  gave  the  following  reactions : 

First,  with  tannic  acid,  a  white  precipitate. 

Second,  with  potassium  iodide,  a  yellow  brown,  turning  to  dark-brown 
precipitate. 

Third,  with  chlorine  water,  a  marked  white  cloudiness. 

Fourth,  with  phospho-molybdic  acid,  a  yellow  precipitate. 


PTOMAINES  AND   OTHER  PUTREFACTIVE   PRODUCTS.  479 

Fifth,  with  potassio-mercuric  iodide,  a  white  precipitate. 

Sixth,  with  mercuric  chloride,  a  white  cloudiness. 

Seventh,  with  concentrated  sulphuric  acid  after  standing-,  a  reddish 
violet  coloration. 

Eighth,  with  concentrated  nitric  acid  after  evaporation,  a  yellowish  spot. 

This  substance  might  have  been  easily  confounded  with  coniine,  but 
the  odor  differed  from  that  of  the  vegetable  alkaloid.  Moreover,  the 
putrefactive  substance  did  not  distil  when  heated  on  the  oil-bath  to 
200°  C,  while  coniine  distils  at  135°  C.  Lastly,  the  putrefactive  sub- 
stance may  be  distinguished  from  coniine  by  the  non-poisonous  proper- 
ties of  the  former. 

NICOTINE. 

Schwanert,  in  examining  the  decomposing  intestines,  liver,  and  spleen 
of  a  child  which  had  died  suddenly,  perceived  a  peculiar  odor,  and  ob- 
tained in  the  ether  extract  from  alkaline  solution  small  quantities  of  a 
base  which  was  distinguished  from  nicotine  only  by  its  greater  volatility 
and  its  peculiar  odor.  Supposing  that  this  substance  was  produced  by 
decomposition,  and  in  order  to  ascertain  the  truth  of  this  supposition,  he 
took  the  organs  of  a  cadaver  that  had  lain  for  sixteen  days  at  a  temper- 
ature of  30°  C,  and  was  well  decomposed,  treated  this  with  tartaric  acid 
and  alcohol,  extracted  first  the  acid  solution  with  ether,  and  then  the 
alkaline  solution  with  the  same  reagent.  The  last-mentioned  extract 
gave  on  evaporation  the  same  substance  which  he  had  found  in  the 
organs  of  the  child.  The  residue  was  a  yellowish  oil,  having  an  odor 
somewhat  similar  to  propylamine,  and  was  alkaline  in  reaction,  and 
bitter,  but  uot  repulsive,  to  the  taste.  With  hydrochloric  acid  it  formed 
white  needles,  which  were  freely  soluble  in  water  and  soluble  with  diffi- 
culty in  alcohol.  These  crystals  dissolved  in  sulphuric  acid,  forming  a 
solution  which  was  at  first  colorless,  but  gradually  became  dirty  brown- 
ish yellow  and  grayish  brown  on  the  application  of  heat.  On  being 
warmed  with  sodium  molybdate,  a  splendid  blue  color  becoming  grad- 
ually green  was  produced.  Potassium  bichromate  and  sulphuric  acid 
gave  a  reddish  brown  passing  into  a  grass-green  color.  Nitric  acid  gave 
a  yellow,  and  tartaric  acid  solution  of  the  crystals  produced  on  the  addi- 
tion of  platinum  chloride  a  dirty  yellow  precipitate  of  small,  six-sided 
stars.  Gold  chloride  gave  a  pale -yellow  amorphous  precipitate ;  mercuric 
chloride  yielded  white  crystals ;  potassio-mercuric  iodide  a  dirty  white 
precipitate  ;  and  potassio-cadmic  iodide  yielded  no  result.  Tannic  aeid 
produced  onry  a  turbidity;  sodium  phospho-molybdate  gave  a  yellow 
flocculent  precipitate,  which  became  blue  on  the  addition  of  ammonia. 

Wolckenhaar  obtained  from  the  decomposing  intestines  of  a  woman 
who  had  been  dead  six  weeks,  by  extraction  with  ether  from  an  alkaline 
solution,  a  base  which  bore  a  close  resemblance  to  nicotine.  This  sub- 
stance, at  first  yellow,  on  being  exposed  to  the  air  gradually  became 
brownish.  It  had  a  strongly  alkaline  reaction,  and  gave  off  a  marked 
nicotine  odor.  It  was  soluble  in  all  proportions  in  water,  and  the  solu- 
tions, which  did  not  become  cloudy  on  the  application  of  heat,  had  no 
bitter  taste,  but  were  slightly  pungent.  The  peculiar  odor  did  not  dis- 
appear on  saturating  the  base  with  oxalic  acid.  The  hydrochloride  was 
brownish,  had  a  strong  odor,  and  became  moist  on  exposure  to  the  air. 


480  A  SYSTEM  OF  LEGAL  MEDLCINE. 

Under  the  microscope  it  showed  no  crystals,  differing  in  this  respect 
from  nicotine  hydrochloride.  It  differed  from  nicotine  also  in  its  reac- 
tions with  potassio-bismuthic  iodide,  gold  chloride,  iodine  solution,  mer- 
curic chloride,  and  platinum  chloride.  It  also  failed  to  give  the  Roussin 
test  for  nicotine.  Moreover,  it  could  not  be  identified  with  trimethylam- 
ine,  sparteine,  mercurialine,  lobeline,  or  other  fluid  and  volatile  bases. 


STRYCHNINE. 

In  a  criminal  prosecution  at  Verona,  Ciotta  obtained  from  the  body, 
which  had  only  slightly  decomposed,  an  alkaloid  which  gave  a  crystalline 
precipitate  with  iodine  in  hydriodic  acid,  a  red  coloration  with  hydriodic 
acid,  and  a  color  test  similar  to  that  of  strychnine  with  sulphuric  acid 
and  potassium  bichromate,  and  with  other  oxidizing  agents.  This  sub- 
stance was  strongly  poisonous,  but  did  not  produce  the  tetanic  convul- 
sions which  are  characteristic  of  strychnine.  Ciotta  pronounced  this 
substance  as  probably  identical  with  strychnine.  Portions  of  the  body 
were  subsequently  submitted  to  Selmi  for  his  opinion.  This  investigator 
found  the  substance  giving  the  above-mentioned  color  reactions  to  be 
amorphous,  and  that  it  had  only  the  presumption  of  a  bitter  taste,  while 
one  part  of  strychnine  in  fort}'  thousand  parts  of  water  is  intensely  bitter. 
Selmi  also  held  that  many  ptomaines  give  reactions  similar  to  strychnine 
with  iodine  in  hydriodic  acid,  and  with  hydriodic  acid  alone.  He  also 
held  that  the  physiological  properties  of  this  substance  were  such  that 
it  could  not  be  strychnine.  It  could  hardly  have  been  aspidospermine, 
which  reacts  with  sulphuric  acid  and  potassium  bichromate  similarly  to 
strychnine,  because  quebracho  bark,  in  which  this  alkaloid  is  found,  was 
not  at  that  time  used  as  a  medicine,  or  known  in  Italy. 

There  prevails  in  Lombardy  and  in  adjacent  countries  a  chronic  dis- 
ease known  as  pellagra.  In  1881  Lombardy  alone  furnished  fifty-six 
thousand  cases  of  this  disease.  The  symptoms  may  be  grouped  into 
three  classes:  first,  those  affecting  the  skin;  second,  those  manifesting 
themselves  in  disturbances  of  the  digest! ve  organs;  and  third,  symptoms 
referable  to  the  central  nervous  system.  The  skin  first  becomes  painful, 
then  red  and  swollen.  Soon  there  is  loss  of  appetite  and  repugnance  to 
food.  Then  a  severe  and  exhaustive  diarrhoea  sets  in.  Later,  delirium 
and  spinal  disturbances  manifest  themselves.  Muscular  weakness  and 
paraplegia  are  common  among  the  victims.  Post-mortem  examination 
shows  numerous  small  ulcers  in  the  skin  and  in  the  intestines,  also 
marked  histological  changes  in  certain  portions  of  the  spinal  cord. 
According  to  Paltauf  and  Heider,  this  disease  is  due  to  infection  of  the 
corn-meal,  eaten  by  these  people,  with  the  bacillus  maidis  Cuboni  and  the 
bacillus  mesentericus  fuscus.  These  germs  produce  certain  ptomaines, 
which  are  soluble  in  alcohol,  and  which  cause  the  disease  pellagra. 
Some  of  these  ptomaines  give  reactions  similar  to  those  of  strychnine, 
and  agree  with  this  vegetable  alkaloid  also  in  their  physiological  effects, 
producing  tetanic  spasms  in  animals.  As  early  as  1871  Lombroso  showed 
that  the  extract  from  moldy  corn -meal  produced  tetanic  convulsions  in 
animals.  In  1876  Brugnatelli  and  Zenoni  obtained  with  the  Stas-Otto 
method  from  this  moldy  meal  an  alkaloidal  substance  which  was  white, 
non-crystalline,  unstable,  and  insoluble  in  water,  but  readily  soluble. in 


PTOMAINES  AND    OTHER  PUTREFACTIVE   PRODUCTS.  481 

alcohol  and  ether.  With  sulphuric  acid  and  bichromate  of  potassium  it 
yields  a  color  reaction  very  similar  to  that  of  strychnine.  Lombroso  has 
named  the  poisonous  substance  found  in  this  moldy  meal  pellagrocine, 
but  this  is  really  a  mixture  of  ptomaines,  some  of  which  produce  narcosis 
and  paralysis,  and  others  produce  the  symptoms  of  nicotine  poisoning 
instead  of  the  spasms  caused  by  strychnine. 


ATROPINE. 

Ptomatropines  are  frequently  met  with  among  the  products  of  putre- 
faction. They  have  marked  mydriatic  properties.  To  this  class  belongs 
a  substance  observed  by  Ziilzer  and  Sonnenschein.  It  was  removed 
from  alkaline  solutions  by  ether,  and  formed  microscopic  crystals,  an 
.aqueous  solution  of  which  when  applied  to  the  conjunctiva  produced  a 
mydriatic  effect,  and  when  administered  internally  increased  the  action 
of  the  heart  and  arrested  the  movements  of  the  intestines.  Moreover, 
with  certain  alkaloidal  reagents,  such  as  platinum  chloride,  it  resembled 
atropine,  but  when  heated  with  sulphuric  acid  and  oxidizing  agents  it 
did  not  give  off  the  odor  of  blossoms,  Reuss's  test.  However,  Selmi 
found  ptomatropines  which,  with  sulphuric  acid  ami  oxidizing  agents, 
did  give  the  blossom  odor  as  distinctly  as  the  vegetable  atropine.  Some 
of  these  putrefactive  bases  also  developed  this  odor  spontaneously  after 
standing  for  two  or  three  days,  and  this  does  not  happen  with  atropine. 
The  odor  is  also  produced  with  the  ptomatropines  by  nitric  and  sulphuric 
acids  both  in  the  cold  and  on  the  application  of  heat,  while  these  acids  in 
the  cold  do  not  produce  the  odor  with  atropine. 

Ptomatropines  have  been  f<  >und  in  decomposing  fish,  corn-beef,  putrid 
game,  and  poisonous  sausage.  We  do  not  know  as  yet  whether  this  is  an 
individual  or  a  class  of  substances.  The  symptoms  are  markedly  like 
those  of  atropine.  The  fauces  become  dry,  the  gums  red  and  swollen, 
the  secretion  of  saliva  and  of  sweat  is  arrested,  the  muscles  of  deglutition 
are  partially  paralyzed,  there  is  marked  mydriasis,  paralysis  of  accommo- 
dation, ptosis,  and  strabismus.  In  some  instances  convulsions  appear. 
The  heart-beat  is  in  the  beginning  increased,  then  markedly  weakened. 
The  tongue  is  coated  and  the  bowels  become  constipated,  there  is  marked 
thirst,  diplopia,  and  general  weakness.  The  voice  may  be  wholly  lost. 
Death,  which  frequently  results,  is  caused,  according  to  Anrep,  by  paraly- 
sis of  the  heart.  Section  shows  venous  hyperemia  of  the  brain,  the  kid- 
neys, and  the  lungs,  swelling  of  the  pharynx,  oesophagus,  and  mucous 
membrane  of  the  stomach,  with  minute  hemorrhagic  points,  cloudy  swell- 
ing of  the  solitary  follicles  and  Peyer's  patches,  and  a  yellowish-brown 
•colored  degeneration  of  the  muscle  of  the  heart. 

There  is  some  question  as  to  whether  or  not  any  of  the  ptomatropines 
will  give  Vitali's  reaction.  According  to  Giotto  and  Spica,  certain  ptoma- 
tropines do  give  this  reaction.  Ptomatropines  are  probably  excreted  with 
the  urine  in  some  diseases. 

VERATRINE. 

Brouardell  and  Boutmy  obtained  from  a  corpse  which  had  lain  in 
water  for  eighteen  months,  and  a  large  portion  of  which  had  changed 
into  adipocere,  a  ptomaine  resembling  veratrine.     It  was  removed  from 


482  A    SYSTEM  OF  LEGAL  MEDICINE. 

alkaline  solutions  by  ether.  On  being  heated  with  sulphuric  acid  it 
became  violet.  With  a  mixture  of  sulphuric  acid  and  barium  peroxide 
it  became  in  the  cold  brick-red,  and,  on  being  heated,  violet.  With  boil- 
ing hydrochloric  acid  it  took  on  a  cherry-red  coloration.  However,  it 
differed  from  veratrine  inasmuch  as  it  reduced  ferric  salts  instantly,  and 
when  injected  into  frogs  subcutaneously  it  did  not  induce  in  them  the 
spasmodic  muscular  contractions  characteristic  of  veratrine. 

Bechamp  obtained  with  the  Stas-Otto  method  from  the  products  of 
the  pancreatic  digestion  of  fibrin  an  alkaloidal  body  which  gave  with 
sulphuric  acid  a  beautiful  carmine  red  similar  to  that  given  with  vera- 
trine. By  digesting  this  substance  with  gastric  juice  and  again  extract- 
ing, he  obtained  a  body  which  behaved  with  sulphuric  acid  similarly  to 
curarine. 

DELPHININE. 

In  1870  General  Gibbone,  an  Italian  of  prominence,  died  suddenly  at 
Rome.  His  servant  was  accused  of  having  poisoned  him.  Two  chemists 
of  some  reputation  reported  the  presence  of  delphinine  in  the  viscera. 
It  seemed  somewhat  improbable  that  the  servant  should  know  anything 
of  so  rare  a  substance,  or  that  he  should  have  been  able  to  obtain  it. 
However,  two  or  more  varieties  of  staphisagria  grow  in  southern  Italy, 
and  it  was  possible  that  the  servant  had  used  some  preparation  made  by 
himself  from  the  plant.  Selmi  was  called  upon  to  make  a  further  study 
of  this  supposed  alkaloid.  He  found  that  it  was  removed  from  alkaline 
solutions  by  ether.  When  heated  with  phosphoric  acid  it  became  redr 
and  when  brought  into  contact  with  sulphuric  acid,  reddish  brown.  In 
these  tests  the  substance  did  resemble  delphinine,  but  with  sulphuric 
acid  and  bromine  water,  also  with  Frohde's  reagent,  the  colorations 
characteristic  of  the  vegetable  product  failed  to  appear.  Moreover, 
Selmi  showed  that  delphinine  gave  the  following  reactions,  to  which  the 
suspected  substance  did  not  respond : 

First,  delphinine  dissolved  in  ether,  and,  treated  with  a  freshly  pre- 
pared ethereal  solution  of  platinum  chloride,  gives  a  white  flocculent 
precipitate,  which  is  insoluble  in  an  equal  volume  of  absolute  alcohol. 

Second,  delphinine  gives  precipitates  with  auro-sodium  hyposulphite, 
and  with  a  sulphuric  acid  solution  of  cupro-sodium  hyposulphite,  the 
latter  precipitate  being  soluble  in  an  excess  of  the  reagent. 

Finally,  Ciaccia  and  Vella  showed  that  while  delphinine  arrests  the 
heart  of  the  frog  in  diastole,  the  suspected  substance  arrested  it  in 
systole. 

DIGITALENE. 

Rorsch  and  Fassbender,  in  a  case  of  suspected  poisoning,  obtained 
with  the  Stas-Otto  method  a  substance  which  could  be  extracted  from 
acid  as  well  as  from  alkaline  solutions  by  ether,  and  which  gave  all  the 
general  alkaloidal  reactions.  They  were  unable  to  crystallize  either  ex- 
tract by  taking  it  up  with  alcohol  and  evaporating.  The  colorless  aque- 
ous solution  was  not  at  all  bitter.  The  precipitate  formed  with  phospho- 
molybdic  acid  dissolved  on  the  application  of  heat,  giving  a  green  solu- 
tion, which  became  blue  on  the  addition  of  ammonia     They  believed  that 


1'TOMAlNES  AND   OTHER  PUTREFACTIVE   PRODUCTS.  483 

this  substance  was  derived  from  the  liver,  because  fresh  ox  liver  treated 
in  the  same  manner  gave  them  a  substance  which  could  be  extracted 
with  ether  from  acid  as  well  as  from  alkaline  solutions.  Gunning  found 
the  same  substance  in  liver  sausage  from  which  poisoning  had  occurred. 
Rorsch  and  Fassbender  state  that  while  in  some  of  its  reactions  this  sub- 
stance resembled  digitaline,  it  could  be  distinguished  from  this  vegetable 
glucoside  by  the  failure  of  the  ptomaine  to  give  the  characteristic  bitter 
taste.  Trottarrelli  obtained  a  similar  substance  from  the  brain  of  a  man 
in  whose  abdominal  viscera  he  could  find  no  poison.  The  sulphate  of 
this  base  gave  on  evaporation  an  aromatic-smelling  and  astringent-tast- 
ing residue.  It  became  purple  with  sulphuric  acid  alone,  and  dark  red 
with  hydrochloric  and  sulphuric  acids.  On  frogs  this  ptomaine  showed 
no  toxic  effect. 

COLCHICINE. 

Baumert  found  in  a  suspected  case  of  poisoning,  twenty-two  months 
after  death,  a  substance  which  gave  many  of  the  reactions  for  colchicine. 
It  was  extracted  from  acid  solutions  with  ether,  to  which  it  imparted  a 
yellow  color.  On  evaporation  of  the  ether  a  yellow,  amorphous  sub- 
stance remained,  and  this  dissolved  in  warm  water  with  yellow  coloration. 
It  could  be  extracted  from  acid  solutions  also  by  chloroform,  benzol,  and 
amylic  alcohol,  but  not  by  petroleum  ether.  It  was  removed  with  much 
more  difficulty  from  alkaline  solutions. 

All  the  extracts  were  yellow,  and  left  on  evaporation  a  feebly  alka- 
line, bitter,  sharp-tasting,  amorphous  yellow  residue,  which  dissolved  in 
water  and  dilute  acids  incompletely,  forming  a  resin.  When  this  resin  was 
dissolved  in  dilute  sodium  hydrate,  and  the  solution  rendered  acid  by  sul- 
phuric acid,  the  same  reactions  were  obtained  as  with  the  original  extract. 

With  phospho-molybdic  acid,phospho-tungstic  acid,  potassio-bismuthic 
iodide,  potassio-mercuric  iodide,  iodine  in  potassium  iodide,  tannic  acid, 
and  gold  chloride,  this  substance  gave  the  same  reactions  which  were 
obtained  by  parallel  experiments  with  genuine  colchicine ;  thus,  the  tan- 
nic acid  precipitates  were  both  soluble  in  alcohol,  and  the  precipitates 
with  phospho-molybdic  acid  in  both  cases  became  blue  on  the  addition 
of  ammonium  hydrate. 

Concentrated  sulphuric  and  dilute  nitric  and  hydrochloric  acids  dis- 
solved the  supposed  colchicine  with  yellow  coloration.  Strong  nitric 
acid  (1.4  sp.  gr.)  colored  the  substance  dirty  red,  scarcely  to  be  called  a 
violet.  When  the  substance  was  purified  as  much  as  possible,  this  color 
became  a  beautiful  carmine  red.  The  addition  of  water  changed  the 
Ted  into  yellow,  and  caustic  soda  produced  a  dark,  dirty  orange. 

In  general,  in  the  above-mentioned  reactions  the  putrefactive  product 
agreed  with  the  real  colchicine,  but  the  former  gave  precipitates  with 
picric  acid  and  platinum  chloride,  while  the  latter  gave  no  precipitates 
with  these  reagents. 

In  1886  Zeisel  proposed  the  following  test  for  colchicine :  When  a 
l^drochloric  acid  solution  of  this  substance  is  boiled  with  ferric  chloride, 
it  becomes  green,  sometimes  dark  green  and  cloudy.  Now,  if  the  fluid 
be  agitated  with  chloroform,  the  chloroform  will  sink,  taking  up  the 
coloring  matter,  and  appearing  brownish,  granite  red,  or  dark,  and  the 
supernatant  fluid  clears  up  without  becoming  wholly  colorless. 


484  A   SYSTEM  OF  LEGAL  MEDICINE. 

Baumert  applied  this  test  to  both  colchicine  and  the  putrefactive 
product.  To  from  two  to  five  cubic  centimeters  of  the  suspected  solu- 
tion in  a  test-tube,  he  added  from  five  to  ten  drops  of  strong  hydrochloric 
acid  and  from  four  to  six  drops  of  a  ten-percent,  solution  of  ferric  chlo- 
ride, then  heated  the  mixture  directly  over  a  small  flame  until  it  was 
evaporated  to  half  its  volume  or  less.  In  the  presence  of  one  milligram 
of  colchicine  the  originally  bright-yellow  solution  became  gradually 
olive-green,  and,  on  further  concentration,  dark  green  and  cloudy.  Then, 
on  shaking  the  fluid  with  chloroform,  admitting  as  much  ah'  as  possible, 
the  chloroform  subsided,  taking  a  ruby -red  color  if  as  much  as  two  mil- 
ligrams of  colchicine  were  present,  and  a  bright  yellow  with  only  one 
milligram,  and  the  supernatant  fluid  became  of  a  beautiful  olive-green. 
When  ether,  petroleum  ether,  benzol,  carbon  disulphide,  or  amylic  alcohol 
was  substituted  for  the  chloroform,  the  coloration  did  not  appear.  From 
this  Baumert  infers  that  the  red  coloring  matter  is  either  wholly  soluble 
in  chloroform,  or  that  it  is  not  formed  until  the  chloroform  is  added. 

Baumert  found  this  test  of  great  value  in  deciding  whether  or  not 
the  substance  which  he  found  was  colchicine.  The  putrefactive  product 
did  not  respond  to  the  test. 

Some  of  this  substance  was  sent  to  Brieger,  who  decided  that  it  was 
not  a  base,  but  a  peptone-like  substance.  It  was  also  found  to  be  inert 
physiologically. 

Before  these  investigations  were  made  by  Baumert,  Liebermann  had 
found  the  same  or  a  similar  colchicine-like  substance  in  a  cadaver.  His 
description  differed  from  that  of  Baumert  only  in  regard  to  the  taste  of 
the  substance,  Liebermann  having  failed  to  observe  any  marked  taste 
in  the  body  which  he  found,  while,  as  has  been  stated,  Baumert  reported 
a  distinctly  bitter  taste. 

A  colchicine-like  substance  has  been  found  in  beer,  and  it  has  been 
suggested  that  it  was  this  which  the  above-mentioned  toxicologists 
found  in  the  bodies  which  they  examined ;  but  Liebermann  states  that 
the  man  whose  body  he  examined  had  been  a  total  abstainer  from  beer. 


MORPHINE. 

In  the  Sonzogna  trial  at  Cremona,  Italy,  the  expert  chemists  con- 
founded a  putrefactive  product  with  morphine.  Selmi,  who  was  ap- 
pointed by  the  government  to  investigate  the  case,  demonstrated  that 
the  chemists,  who  had  reported  the  presence  of  morphine,  were  in  error. 
This  substance  was  not  removed  from  either  alkaline  or  acid  solutions 
with  ether,  but  could  be  extracted  with  amylic  alcohol.  It  reduced  iodic 
acid,  but  in  its  other  reactions,  as  well  as  in  its  physiological  properties, 
it  bore  no  resemblance  to  morphine.  In  frogs  it  arrested  the  heart  in 
systole,  which  is  said  never  to  happen  in  poisoning  with  morphine.  It 
failed  to  give  both  the  ferric  chloride  and  the  Pellagri  tests. 

In  the  same  body  there  was  found  a  substance  which  was  extracted 
from  alkaline  solutions  with  ether,  and  which  gave  with  hydrochloric 
acid  and  a  few  drops  of  sulphuric  acid,  on  the  application  of  heat,  a  red- 
dish residue  similar  to  that  obtained  by  these  reagents  with  codeine,  but 
in  its  other  reactions  it  did  not  resemble  this  alkaloid. 

In  the  examination  of  a  stomach  and  part  of  a  liver,  sent  from  Lin- 


PTOMAINES  AND   OTHER  PUTREFACTIVE   PRODUCTS.  485 

coin,  Neb.,  the  writer,  following  the  method  of  Dragendorff,  obtained  in 
the  amylic  alcohol  extract  from  alkaline  solution  a  residue  which  gave 
with  more  or  less  distinctness  all  of  the  principal  color-tests  for  mor- 
phine ;  but  failing  to  obtain  crystals  which  could  be  identified  with  those 
of  this  alkaloid,  the  absence  of  morphine  was  reported.  Afterward  it 
was  quite  clearly  demonstrated  that  death  in  this  case  had  been  caused 
by  a  blow  upon  the  back  of  the  head  with  a  heavy  piece  of  iron. 

The  above-mentioned  facts  induced  the  writer  to  undertake  some 
experimental  studies  upon  this  point.  In  this  work  the  author  has  been 
greatly  aided  by  one  of  his  students,  E.  M.  Houghton.  The  results 
which  we  have  obtained  are  sufficient  to  convince  us  that  the  identifica- 
tion of  morphine  in  the  liver  and  other  organs  in  cases  of  suspected 
poisoning  is  beset  with  difficulties  not  provided  for  by  the  methods  now 
generally  employed. 

Since  the  substances  which  vitiate  the  morphine  tests  are  of  bacterial 
origin,  and  since  bacterial  products  vary  with  the  conditions  under 
which  the  germs  producing  them  grow,  it  is  essential  that  the  putre- 
factive changes  which  the  tissue  undergoes  before  the  tests  are  begun 
should  occur  under  the  conditions,  as  nearly  as  possible,  which  exist  in 
the  cadaver.  Neglect  of  this  point  has  undoubtedly  been  the  chief 
factor  in  securing  the  confidence  of  toxicologists  generally  in  the 
methods  of  Dragendorff  and  Stas-Otto.  Many  most  skillful  chemists 
have  carried  companion  portions  of  decomposed  tissue,  one  portion  with 
and  the  other  without  morphine,  through  the  processes  of  extraction 
recommended  by  Dragendorff,  and  have  obtained  satisfactory  results, 
finding  that  the  proper  residue  responds  to  the  color  tests  in  the  one  in- 
stance and  fails  to  do  so  in  the  other.  Tissues  have  been  thus  tested  in 
apparently  every  stage  of  putrefaction,  and  yet  the  results  have  been 
satisfactory  and  confirmatory  of  the  methods  now  generally  employed. 
There  is  one  point,  however,  which  has  been  constantly  overlooked.  The 
putrefaction  to  which  the  tissues  in  these  experiments  are  subjected  has 
been  aerobic,  while  that  occurring  in  the  dead  body  is  anaerobic ;  conse- 
quently the  putrefactive  products  are  not  the  same  in  the  two  cases. 
This  leads  us  to  state  that  iu  all  experimental  studies  of  the  value  of  the 
tests  for  morphine  in  decomposing  tissue,  the  decomposition  must  be 
allowed  to  proceed  in  the  absence  of  oxygen.  This  is  the  first  point. 
The  second  is  probably  of  equal  importance,  and  this  concerns  the  kind 
of  tissue  employed.  The  upper  portion  of  the  small  intestine  (and  the 
adjacent  tissue  after  death)  has  a  bacterial  flora  peculiar  to  itself.  These 
tissues  are  the  ones  quite  universally  examined  in  medico-legal  cases,  and 
consist  of  the  small  intestine  itself,  the  stomach,  the  liver,  the  pancreas, 
the  spleen,  and,  in  some  instances,  the  kidneys.  Of  course  the  bacteria 
present  in  the  small  intestines  during  life  may  after  death  extend  to 
all  the  abdominal  and  thoracic  viscera.  Since  the  liver  is  so  generally 
examined,  we  decided  to  ascertain  the  effects,  if  any,  of  the  putrefactive 
products  formed  in  this  organ,  decomposing  under  anaerobic  conditions, 
on  the  tests  for  morphine  carried  out  according  to  the  scheme  of  Drag- 
endorff. Recognizing  the  fact  that  arsenic  is  so  frequently  employed  in 
the  form  of  an  embalming  fluid,  it  was  thought  best  to  add  this  to  the 
liver.     The  experiment  is  detailed  in  the  following  statement : 

Five  kilograms  of  ox  liver  chopped  finely  and  mixed  with  two  grams 
of  arsenic  dissolved  in  caustic  potash,  was  placed  in  a  large  bottle.     The 


48G  ^   SYSTEM   OF  LEGAL   MEDICINE. 

bottle  was  closed  with  a  cork  and  sealed  with  paraffine.  A  glass  tube 
bent  at  a  right  angle  was  inserted  in  the  center  of  the  cork,  while  the 
other  end  of  the  tube  was  connected  by  means  of  a  short  piece  of  rubber 
tubing  with  a  Drechsel  wash-bottle.  The  other  arm  of  the  wash-bottle 
was  connected  with  a  receiver  filled  with  water.  The  rubber  connecting 
the  large  bottle  with  the  wash-bottle  was  supplied  with  a  clamp. 

During  the  first  fifteen  or  twenty  days  this  clamp  was  left  open,  and 
a  large  amount  of  gas  passed  through  the  wash-bottle  and  collected  in 
the  receiver.  After  the  above-mentioned  time,  which  varies  according 
to  temperature,  the  passage  of  gas  ceases  and  the  water  rises  in  the 
receiver,  absorbing  the  collected  gas.  When  this  occurred  the  bottle 
containing  the  tissue  and  the  wash-bottle  were  disconnected,  and  the 
clamp  on  the  rubber  tubing  was  closed.  By  this  time  the  chopped  liver 
has  become  sufficiently  fluid  to  absorb  the  gas  as  fast  as  it  is  formed, 
and  unless  the  bottles  are  disconnected  the  water  in  the  wash-bottle  may 
be  drawn  back  into  the  large  bottle. 

The  fermentation  was  allowed  to  continue  for  thirty  days,  counting 
from  the  beginning.  Then  the  contents  of  the  bottle,  decidedly  acid  in 
reaction,  and  giving  off  a  not  disagreeable  ethereal  odor,  were  poured 
into  a  large  dish.  A  considerable  portion  of  the  tissue  had  become  fluid 
by  this  time. 

One  kilogram  of  this  decomposed  tissue  was  placed  in  each  of  three 
evaporating-dishes,  and  these  were  marked  A,  B,  and  C.  To  B,  130 
milligrams  of  morphine  sulphate  was  added,  and  to  C  the  same  amount 
of  morphine,  together  with  .5  gram  each  of  indol,  skatol,  and  phenol. 
No  addition  was  made  to  A.  These  portions  were  carried  through  the 
manipulations  recommended  by  Dragendorff  ("  Die  gerichtlich-chemische 
Ermittelung  von  Giften,"  dritte  Auflage,  1888). 

To  each  100  c.c.  of  the  fluid  5  c.c.  of  dilute  (1 :  5)  sulphuric  acid  was 
added.  Then  500  c.c.  of  distilled  water  was  added  to  each  dish,  and 
these  were  kept  at  from  40°  to  50°  C.  for  eight  hours. 

Next,  each  portion  was  filtered  through  a  falten-filter  (No.  572  of 
Schleicher  &  Schull).  The  fluid  passed  through  quickly,  and  formed 
a  clear,  brownish  filtrate.  The  filtrates  were  evaporated  at  50°  C.  to 
600  c.c,  and  four  volumes  of  absolute  alcohol  were  added  to  each  por- 
tion. These  mixtures  were  allowed  to  stand  for  twelve  hours,  and  in 
each  a  brown  resinous  precipitate  formed.  After  filtration  the  alcohol 
was  removed  by  distillation.  A  fatty-like  residue  formed  in  each  flask 
on  the  removal  of  the  alcohol,  and  this  was  removed  by  filtration. 

The  acid  solutions  were  then  thoroughly  shaken,  each  with  four 
volumes  of  petroleum  ether.  The  ethereal  layers,  when  drawn  off  and 
evaporated  in  portions,  left  very  slight  residues. 

The  residues  from  A  and  B  gave  no  reactions  on  the  application  of 
the  color  tests  for  morphine  mentioned  below. 

The  residue  from  C  showed  minute  traces  of  indol  with  nitric  acid 
alone,  and  with  sulphuric  acid  containing  nitric. 

The  acid  solutions  were  next  shaken  with  benzol.  The  benzol  resi- 
dues gave  no  response  to  the  morphine  tests. 

Chloroform  was  then  employed  as  a  solvent,  The  residue  in  this  case 
gave  none  of  the  reactions. 

The  acid  solutions  were  now  rendered  alkaline  with  ammonium 
hydrate,  and   shaken   successively  with   petroleum   ether,  benzol,  and 


PTOMAINES  AND   OTHER   PUTREFACTIVE   PRODUCTS.  487 

chloroform.     None  of  the  residues  from  these  solvents  responded  to  the 
morphine  tests. 

The  alkaline  solutions,  having  been  subjected  to  the  above-mentioned 
processes  of  purification,  were  shaken,  each  with  five  volumes  of  aniylic 
alcohol.  The  shaking  was  frequently  repeated  during  the  afternoon, 
and  then  the  mixtures  were  placed  in  separators  and  allowed  to  stand 
for  eighteen  hours.  The  amylic  alcohol  extracts  evaporated  on  the 
water-bath  gave  the  following  reactions : 

Reagent.  ABC 

Nitric  acid All  gave  a  lemon-brown  color. 

Sulphuric  acid None  showed  any  change. 

Sulphuric  with  nitric  acid All  gave  a  lemon  yellow,  slowly  changing 

to  pink. 

Ferric  chloride All  gave  a  dirty  green. 

Iodic  acid All  promptly  reduced  the  iodic  acid. 

Frohde's  reagent All  gave  a  blue  color,  without  any  violet. 

Sulphuric  acid  and  cane-sugar All  became  brownish  red,  changing  to  a 

wine-red. 

Portions  of  the  amylic  alcohol  extract  allowed  to  evaporate  spontane- 
ously showed  the  same  reactions  as  those  given  above. 

The  remaining  portions  of  the  amylic  alcohol  solutions  were  now 
shaken  with  distilled  water  acidified  with  sulphuric  acid.  After  separa- 
tion, portions  of  the  amylic  alcohol  were  evaporated  and  subjected  to 
the  above-mentioned  tests,  with  negative  results  in  each  case.  This 
shows  that  amylic  alcohol  does  not  dissolve  from  acid  solutions  the  sub- 
stance or  substances  interfering  with  the  morphine  tests. 

The  acid  aqueous  solutions  of  A,  B,  and  C  were  again  rendered  alka- 
line with  ammonium  hydrate,  and  shaken  with  amylic  alcohol.  The 
residues  from  these  amjdic  alcohol  extracts  were  evaporated  and  sub- 
jected to  the  following  tests : 

Reagent.  ABC 

Nitric  acid All  became  lemon  yellow. 

Sulphuric  acid No  change  in  any. 

Sulphuric  acid  with  nitric  acid All  became  lemon  yellow. 

Ferric  chloride All  became  bluish  green. 

Iodic  acid All  promptly  reduced  iodic  acid. 

Frohde's  reagent All  became  blue,  with  a  faint  and  evanes- 
cent purple  in  B  and  C. 
Pellagri's  test  All  responded  promptly. 

The  above-mentioned  experiment,  which  has  been  repeated  with  no 
variation  in  results,  convinces  us  that  the  tests  for  morphine  by  follow- 
ing the  scheme  of  Dragendorff  are  altogether  untrustworthy.  Naturally 
the  question  arises,  What  is  the  nature  of  the  substance  or  substances 
which  give  these  color  reactions?  Quite  as  naturally  the  answer  that 
these  substances  consist  of  indol  and  its  derivatives  suggests  itself.  The 
probabilities  in  favor  of  this  answer  may  be  briefly  stated  as  follows : 

(1)  Germs  which  produce  indol  and  its  derivatives  are  native  and,  so 
far  as  we  know,  constant  representatives  of  the  bacterial  flora  of  the 
upper  portion  of  the  small  intestines.  There  are  many  indol-forming 
germs,  and  while  some  of  these  may  be  present  in  any  tissue,  they  are 
certainly  present,  in  health  and  in  disease,  during  life  and  after  death, 
in  the  small  intestines. 


488  ^   SYSTEM  OF  LEGAL  MEDLCLNE. 

(2)  Indol  and  its  derivatives  are  products  of  anaerobic  putrefaction^ 
and  this  accounts  for  the  fact  that  the  reactions  which  we  obtained  are 
not  familiar  to  those  toxicologists  who  have  experimented  with  tissue 
allowed  to  putrefj'-  in  the  presence  of  oxygen.  The  apparatus  which  we 
used  in  our  experimental  work  is  practically  the  same  as  that  employed 
by  E.  and  H.  Salkowski  ("Zeitschrift  f.  physiologische  Chemie,"  B.  8, 
S.  462)  in  the  preparation  of  indol.  Moreover,  in  the  preparation  of  indol 
the  same  peculiarity  in  the  evolution  of  gas  is  observed  as  in  our  work. 

It  was  on  account  of  our  belief  that  indol  and  its  derivatives  had  been 
in  some  instances  mistaken  for  morphine  that  we  were  led  to  add  these 
substances  to  C  in  our  experiment. 

We  have  obtained  several  samples  of  indol  and  skatol,  and  have 
compared  the  reactions  obtained  with  these  on  the  application  of  the 
color  tests  for  morphine. 

The  samples  of  indol  may  be  briefly  described  as  follows : 

No.  1. — Prepared  by  myself  from  decomposing  pancreas.  It  is  a 
brown,  granular  substance,  and  is  probably  not  chemically  pure.  This 
fact,  however,  does  not  unfit  this  sample  for  experiments  on  the  point 
under  consideration,  because  any  impurities  which  it  may  contain  origi- 
nated in  the  decomposing  tissue,  and.  may  be  present  in  the  same  sub- 
stance obtained  from  like  tissue. 

No.  2. — Obtained  from  Merck.  The  order  was  simply  for  "indol," 
without  any  specifications  whether  it  should  be  synthetic  or  putrefactive. 
It  is  brownish  red  in  color. 

No.  3. — Obtained  from  Schuchardt  and  ordered  as  synthetic  indol, 
which  it  undoubtedly  is.     This  sample  is  white  and  in  flakes. 

No.  4. — Obtained  from  Kahlbaum.  Putrefactive  indol  was  ordered, 
but  the  label  is  simply  "  indol."     This  sample  consists  of  white  flakes. 

These  samples  were  submitted  to  the  following  tests : 

Reagent.  No.  l.  No.  2.  No.  3.  No.  h.  ^SuWrnte?™ 

Nitric  acid Bluish  black  Reddish  brown.  Reddish  brown.    Reddish  brown.    Brownish  red, 

with  violet  passing  into 

border.  lemon  yellow. 

Sulphuric  acid  .  .  Yellowish  green.  Brown.  Greenish  yellow.  Brownish  red.       Faint  yellow. 

Sulphuric     with 
nitric  acid.  .  .  .  Same  as  with  nitric  acid  alone.  Brownish  red. 

Ferric  chloride. .  No  change  at  first,  but  all  become  greenish  blue.  Blue. 

Iodic  acid No  reduction.  Reduced. 

Frohde's  reagent  Reddish,  then      Reddish,  then  Reddish,  then       Reddish,  then       Purple,  then  blue, 

dark  blue.  greenish  blue.  greenish  blue.       greenish  blue. 

Two  samples  of  skatol  (No.  1  from  Schuchardt  and  No.  2  from  Kahl- 
baum) were  compared  with  morphine  with  the  following  results : 

Reagent.  No.  1.  No.  2.  Morphine  Sulphate. 

Nitric  acid All  become  lemon  yellow. 

Sulphuric  acid All  become  very  faintly  yellow. 

Sulphuric  with  nitric  acid.  .  .  All  become  more  of  a  red  than  with  nitric  acid  alone. 

Ferric  chloride No  change.  No  change.  Blue. 

Frohde's  reagent Green  to  blue.  Green  to  blue.  Purple  to  blue. 

Iodic  acid All  promptly  reduce  the  acid. 

While  it  would  be  comparatively  easy  to  distinguish  pure  morphine 
from  either  indol  or  skatol,  it  must  be  admitted,  from  the  results  of  the 
experiments  already  detailed,  that  the  separation  of  morphine  from  tis- 
sue, decomposing  in  the  absence  of  oxygen,  and  its  identification,  are, 


PTOMAINES  AND   OTHER  PUTREFACTIVE   PRODUCTS.  489 

by  the  methods  now  generally  employed,  so  uncertain  that  the  conscien- 
tious chemist  will  seek  for  methods  free  from  these  sources  of  error  be- 
fore he  gives  positive  testimony  of  the  presence  of  this  alkaloid. 

I  have  spoken  of  indol  and  its  derivatives  as  being  present  in  the 
decomposing  tissue,  and  it  should  be  stated  that  the  number  of  known 
indol  derivatives  is  by  no  means  small,  and  how  many  others  there  may 
be  which  remain  unknown,  no  one  can  tell.  Many  of  these  substances 
give  brilliant  color  reactions.  Indol  was  first  obtained  by  Bayer  by  the 
reduction  of  indigo.  Later,  Kiihne  and  Nencki  independently  obtained 
indol  with  skatol  by  the  putrefaction  of  albuminous  substances. 

There  has  been  some  difference  of  opinion  as  to  the  identity  of  the 
indol  obtained  by  putrefaction  and  that  which  results  from  the  reduction 
of  indigo.  According  to  Baumann  neither  indol  nor  skatol  originates 
directly  from  the  proteids,  but  both  arise  from  the  decomposition  of  a 
substance  soluble  in  ether  containing  alcohol.     Skatol  is  methyl  indol. 

Indoxyl  is  an  easily  decomposable  substance,  which  gives  some  strik- 
ing color  reactions,  among  which  may  be  mentioned  the  production  of 
indigo-blue  with  ferric  chloride  iu  the  presence  of  free  hydrochloric  acid. 
Skatol-carbonic  acid  is  another  product  of  putrefaction,  E.  and  H.  Sal- 
kowski  having  obtained  1.3  grams  from  2  kilograms  of  moist  fibrin 
after  twenty-six  days'  putrefaction.  Among  the  known  color  reactions 
of  this  substance,  Hoppe-Seyler  mentions  the  following : 

(1)  If  a  dilute  solution  of  this  acid  (1-1000)  be  treated  with  a  few 
drops  of  pure  hydrochloric  acid  of  1.2  specific  gravity,  and  then  with  a 
few  drops  of  potassium  nitrate  solution  (2  percent.),  a  cherry-red  colora- 
tion is  produced,  and  later  a  red  precipitate  falls. 

(2)  If  such  a  solution  be  mixed  with  an  equal  volume  of  hydrochloric 
acid,  and  then  a  few  drops  of  chloride  of  lime  solution  (£  percent.)  be 
added,  a  purple-red  color  is  produced. 

(3)  Treated  with  a  few  drops  of  hydrochloric  acid,  then  with  two  or 
three  drops  of  a  very  dilute  solution  of  ferric  chloride,  and  heated,  the 
mixture  becomes  intensely  violet  before  boiling. 

Skatol-carbonic  acid  is  non-volatile. 

Skatol-acetic  acid  has  been  obtained  by  Nencki  by  the  anaerobic 
putrefaction  of  serum-albumin.  The  aqueous  solutions  of  this  substance 
give  with  ferric  chloride  a  white  cloudiness,  which  on  warming  becomes 
brick-red,  and  in  more  concentrated  solution  fire-red. 

Both  indirubin  and  indigo-blue  may  be  formed  by  the  oxidation  of 
indol. 

Knowing  now  that  indol  and  its  derivatives  are  formed  in  anaerobic 
putrefaction,  and  that  in  Dragendorff's  scheme  for  the  separation  and 
identification  of  vegetable  alkaloids  these  substances  appear  in  the  resi- 
dues which  are  tested  for  morphine,  and  knowing  the  great  number  and 
variety  of  color  reactions  given  by  these  substances,  it  may  be  asked  how 
much  reliance  can  be  placed  on  the  color  tests  for  morphine? 

Besides  the  indol  bodies,  certain  other  substances  are  formed  in  the 
anaerobic  putrefaction  of  proteid  substances.  Among  these  are  certain 
aromatic  products  of  the  putrefaction  of  tyrosine.  The  following  may 
be  mentioned : 

(1)  Hydroparacumaric  acid  (para-oxyphenyl-propionic  acid).  This 
substance  gives  with  ferric  chloride  a  distinct,  but  evanescent,  blue  col- 
oration. 


490  ^   SYSTEM  OF  LEGAL  MEDICINE. 

(2)  Para-oxyphenyl-aeetic  acid.  This  substance  gives  with  ferric 
chloride  a  pale  grayish-violet,  which  soon  changes  to  a  dirty  green  color. 

Among  other  products  of  the  anaerobic  putrefaction  of  proteids  phe- 
nol and  parakresol  may  be  mentioned. 

Phenol  gives  with  ferric  chloride  a  violet  color. 

Parakresol  gives  with  ferric  chloride  a  blue  coloration. 

With  the  above-mentioned  substances  in  a  decomposing  liver,  and 
knowing  that  some  of  them  at  least  are  present  in  the  amylic  alcohol 
residue,  following  the  process  of  Dragendorff,  how  much  reliance,  may 
again  be  asked,  can  be  placed  on  the  color  reactions  of  morphine  ?  The 
conscientious  chemist  who  swears  that  he  will  tell  the  truth,  the  whole 
truth,  and  nothing  but  the  truth,  may  answer  this  question. 

POISONS  FORMED  IN  DECOMPOSING  TISSUE   IN  THE   PRESENCE   OF  ARSENIC. 

It  has  already  been  shown  that  the  presence  of  arsenic  does  not  in- 
terrupt the  anaerobic  putrefaction  by  which  those  substances  interfering 
with  the  reactions  for  morphine  are  formed.  Besides  this,  it  is  known 
that  certain  highly  poisonous  substances  may  be  obtained  from  the  bodies 
of  persons  who  have  been  embalmed  with  arsenic.  From  one  arsenical 
body  which  had  been  buried  for  fourteen  days,  Selmi  obtained,  bjr  ex- 
tracting with  ether  the  fluid  rendered  alkaline  with  baryta,  a  substance 
which  formed  in  needles  and  which  gave  crystalline  salts  with  acids. 
With  sulphuric  acid  it  gave  a  red  color ;  with  iodic  acid  and  sulphuric 
acid  it  liberated  free  iodine,  and  gave  a  violet  coloration  ;  with  nitric 
acid  it  gave  a  beautiful  yellow,  which  deepened  on  the  addition  of  caustic 
potash.  This  cadaver  was  apparently  well  preserved,  and  the  crystalline 
substance  obtained  from  it  was  found  to  be  highly  poisonous.  From  a 
second  arsenical  body  Selmi  obtained  by  the  same  process  a  larger  quan- 
tity of  a  most  virulent  poison. 

From  the  stomach  of  a  hog  which  had  been  preserved  in  a  solution 
of  arsenious  acid,  the  same  investigator  separated  an  arsenical  organic 
base.  This  substance  produced  symptoms  like  those  of  strychnia.  Also 
from  the  same  stomach  he  obtained  a  substance  which  produced  in  frogs 
torpor  and  paralysis. 

These  researches  throw  some  light  upon  a  most  interesting  and  curi- 
ous point  in  the  history  of  toxicology.  It  is  well  known  that  during  a 
certain  period  of  Italian  history  poisons  were  freely  used.  One  of  these 
was  sold  under  the  name  of  aqua  toffana,  while  another  was  known  as 
acquetta  di  Perugia.  Probably  many  other  similar  solutions  were  sold  to 
those  who  desired  to  rid  themselves  of  friends  or  foes.  There  seems  to 
have  been  some  diversity  in  the  method  of  preparation  used  by  those 
engaged  in  supplying  these  poisons.  Duclaux  states  that  one  of  these 
solutions  was  prepared  by  eviscerating  a  pig,  powdering  the  abdominal 
cavity  with  arsenic,  suspending  the  animal,  and  catching  the  drippings 
from  the  decomposing  tissue.  Kobert  states  that  another  preparation 
was  obtained  by  preserving  the  saliva  of  animals  poisoned  with  arsenic, 
and  allowing  this  fluid  to  undergo  putrefactive  changes.  It  will  be  seen 
that  by  either  of  these  methods  powerful  arsenical  ptomaines  may  have 
been  obtained.  It  will  also  be  evident  that  these  solutions  may  have  owed 
their  powerful  action  to  the  presence  of  toxicogenic  germs,  or,  in  other 
words,  death  ma}^  have  been  due  to  inoculation  rather  than  to  intoxication. 


PTOMAINES  AND   OTHER   PUTREFACTIVE  PRODUCTS.  491 

As  has  been  stated  in  giving  the  experimental  results  obtained  in  the 
tests  for  morphine,  anaerobic  germs  producing  considerable  quantities 
of  gas  were  found  in  the  liver.  Another  interesting  point,  which  needs 
further  study,  was  observed.  Some  of  the  putrefactive  fluid  resulting 
from  the  decomposition  of  the  chopped  liver  contained  a  considerable 
amount  of  arsenic.  This  fluid  was  placed  in  a  bottle  and  kept  in  the 
laboratory  for  six  months.  During  this  time  the  bottle  was  frequently 
opened.  Whenever  this  was  done  a  large  amount  of  gas  escaped  with 
almost  explosive  rapidity.  After  the  above-mentioned  time  it  was  de- 
cided to  estimate  the  amount  of  arsenic  in  the  fluid.  Upon  attempting 
to  do  this,  it  was  unexpectedly  found  that  the  fluid  contained  not  the 
slightest  trace  of  arsenic.  In  other  words,  the  arsenic  had  been  given 
off  from  the  fluid  in  the  form  of  a  gas.  It  was  supposed  at  first  that 
this  was  a  new  discovery ;  but  upon  looking  the  matter  up  it  was  found 
that  Hiinefeld,  in  the  early  part  of  the  present  century,  found  that  tis- 
sues impregnated  with  arsenic  gave  off  during  putrefaction  a  garlic  odor, 
and  that  later  arsenic  disappeared  wholly  from  such  tissue.  This  is  an 
interesting  fact,  and  one  which  needs  further  study. 

POISONS   FORJIED   DURING   PUTREFACTION. 

Methylguamdine. — This  base,  which  has  been  found  by  Brieger  and 
Bocklisch  in  decomposing  flesh,  is  highly  poisonous.  The  symptoms  are 
marked  by  dyspnoea,  muscular  tremor,  and  general  clonic  convulsions. 
Two  tenths  of  a  gram  administered  to  a  guinea-pig  produced  the  fol- 
lowing symptoms :  the  respiration  at  once  became  rapid,  and  in  a  few 
minutes  there  were  abundant  evacuations  of  the  bladder  and  bowels ; 
the  pupils  rapidly  dilated  to  the  maximum,  and  then  ceased  to  react; 
the  animal  became  motionless,  though  not  paralyzed;  dyspnoea  set  in, 
and  the  animal  died  in  convulsions  twenty  minutes  after  the  administra- 
tion of  the  poison.  Post-mortem  examination  showed  the  heart  to  be 
arrested  in  diastole,  the  intestines  filled  with  fluid,  the  bladder  contracted, 
the  cortex  of  the  kidney  kyperasmic,  but  the  papillae  of  the  kidneys  were 
surprisingly  pale. 

Tetanim,  tetanotoxine,  spasmotoxine,  and  tetanus  toxalbumins  have  been 
found  in  cultures  of  the  tetanus  bacillus.  These  substances  produce  vio- 
lent clonic  and  tonic  convulsions. 

Patoammine. — Selnii  obtained  this  substance  from  the  urine  of  patients 
suffering  from  progressive  paralysis,  also  of  those  with  interstitial  pneu- 
monia. The  substance  produces  convulsions,  and  probably  consists  of  a 
mixture  of  bases. 

Isoamylamine  has  been  found  in  yeast  which  has  undergone  putre- 
factive changes.  It  is  a  colorless,  strongly  alkaline  liquid,  possessing  a 
marked  but  not  disagreeable  odor.  It  is  a  highly  energetic  poison,  pro- 
ducing rigor,  convulsions,  and  death.  Four  milligrams  caused  the  death 
of  a  greenfinch  in  three  minutes. 

Ethyhndiamin  has  been  found  in  a  cancerous  stomach.  It  produces 
uninterrupted  convulsions. 

EthyUdendiamin. — This  substance  was  obtained  from  putrid  fish  by 
Brieger,  and  was  found  to  induce  dyspnoea  and  dilatation  of  the  pupils. 

Trimethylendiamin. — This  substance  is  present  in  cultures  of  the  com- 
ma bacillus.     It  produces  convulsions. 


492  A   SYSTEM  OF  LEGAL  MEDICINE. 

Iii  the  urine  of  men  with  epilepsy  Ferre  found  a  substance  which 
produces  convulsions  similar  to  those  of  strychnia.  From  like  urine 
'Griffiths  has  isolated  a  base. 

With  the  germs  obtained  from  the  bodies  of  women  dead  with  puer- 
peral eclampsia,  Gerdes  has  obtained  a  highly  poisonous  substance  which 
produces  convulsions. 

Tyrotoxicon. — This  substance,  first  obtained  by  the  writer  in  poison- 
ous cheese,  and  subsequently  in  poisonous  ice-cream,  milk,  and  certain 
milk  products,  is  a  highly  active  poison.  Small  doses  cause  in  kittens 
retching,  vomiting,  and  purging.  Similar  doses  in  man  produce  like 
symptoms,  together  with  marked  constriction  of  the  fauces.  Fatal  doses 
in  man  cause  dilatation  of  the  pupils,  rapid  breathing,  hurried  pulse,  and 
depression  of  temperature. 

Mytilotoxine. — This  substance,  found  in  poisonous  mussels,  produces 
paralysis,  resembling  curare  in  its  action. 

Fugm,  found  in  the  roe,  liver,  stomach,  and  intestines  of  certain  fish, 
has  a  curare-like  action. 

Ptomo-muscarines  are  frequently  found  in  decomposing  matter. 

Newrine,  found  in  decomposing  tissue  after  five  or  six  days,  also  has 
an  action  similar  to  that  of  curare. 

According  to  Lustgarten,  there  is  found  in  the  dead  skin  resulting 
from  severe  burns  a  substance  which  produces  symptoms  similar  to  those 
of  muscarine. 

Adamkiewicz  has  obtained  a  substance  which  he  believes  to  be  the 
.active  agent  in  the  production  of  cancer,  and  to  which  he  has  given  the 
name  of  cancroin.  He  also  proposes  that  this  agent  be  used  in  the  treat- 
ment of  cancer,  following  the  theory  employed  by  Koch  in  the  treatment 
of  consumption.     The  substance  is  probably  identical  with  neurine. 

Susotoxine,  a  base  isolated  by  Novy  from  cultures  of  the  hog  cholera 
bacillus,  first  retards,  then  increases,  and  finally  again  retards,  respiration. 
Convulsive  tremors  occur  at  frequent  intervals.  A  hundred  milligrams 
produced  death  in  a  young  rat,  when  given  subcutaneous^,  in  an  hour 
.and  a  half. 

Ckolin,  found  frequently  in  decomposing  tissue,  produces  muscarine- 
like  symptoms.  It  must  be  given,  however,  in  large  doses  in  order  to 
produce  poisonous  effects.  Brieger  found  that  the  fatal  dose  for  a  rab- 
bit weighing  one  kilogram  is  about  half  a  gram. 

Mydatoxine  was  first  obtained  by  Brieger  from  putrid  human  viscera. 
It  produces  paroxsyinal  convulsions,  diarrhoea,  and  dyspnoea. 

Gadinine,  which  may  be  present  in  human  faeces,  is  mildly  poisonous, 
requiring  from  one  half  to  one  gram  to  kill  a  guinea-pig. 

Typhotoxine  is  produced  by  the  Eberth  germ  of  typhoid  fever.  Its 
action  has  been  studied  only  on  mice  and  guinea-pigs.  It  produces  at 
first  slight  salivation  with  increased  respiration.  The  animals  lose  con- 
trol over  the  muscles  of  the  trunk  and  extremities,  and  fall  down  help- 
less upon  their  sides.  The  pupils  become  strongly  dilated  and  cease  to 
react  to  light.     Death  follows  in  from  one  to  two  days. 

Mydaleine  is  present  in  putrefying  cadaveric  organs,  such  as  the  liver 
and  spleen.  It  has  the  peculiar  property,  when  injected  subcutaneously, 
of  causing  a  marked  rise  in  temperature,  sometimes  as  much  as  two 
degrees. 


THE  MEDICAL  JURISPRUDENCE  OF  LIFE  INSURANCE 

BY 

BRANDEETH   SYMONDS,  A.M.,  M.D. 


History. — The  growth  of  life  insurance  during  the  past  hundred  years 
is  one  of  the  most  striking  features  of  the  period.  The  amounts  invested 
have  become  enormous ;  the  amounts  which  the  companies  have  con- 
tracted to  pay  to  their  policy-holders  are  stupendous.  On  the  1st  of 
January,  1893,  there  were  sixty  life  insurance  companies  organized  under 
the  laws  of  the  different  States.  The  total  assets  of  these  companies 
amounted  to  over  $919,000,000.  The  insurance  which  they  had  in  force 
reached  the  gigantic  total  of  over  $4,897,000,000.  This  is  greater  than 
the  debt  of  any  country  in  the  world.  The  mind  cannot  grasp  the  mag- 
nitude of  the  operations  involved  in  the  handling  of  this  colossal  trust- 
fund.  For  in  nearly  all  the  companies  which  are  mutual,  or  which  share 
their  profits  largely  with  the  policy-holders,  these  assets  can  be  regarded 
only  as  a  fund,  set  aside  by  the  policy-holders,  intrusted  to  the  care  of 
the  companies,  returnable  to  the  policy-holders  at  the  end  of  a  given 
time,  or  to  their  heirs  in  the  event  of  their  prior  death.  It  is  therefore 
very  much  to  the  interest  of  the  policy-holders  that  the  companies  be 
well  managed  in  all  respects.  That  they  have  been  so  in  the  past  is  well 
shown  by  the  rapid  progress  life  insurance  has  made  in  the  last  thirty 
years.  During  that  time  the  life  insurance  companies  reporting  to  the 
department  of  the  State  of  New  York  have  increased  their  assets  from 
$37,000,000  to  $903,000,000 ;  the  amount  of  insurance  in  force  has  in- 
creased from  $183,000,000  to  $4,199,000,000.  While  the  United  States 
has  been  the  seat  of  the  greatest  expansion  of  life  insurance,  other  coun- 
tries have  to  some  extent  shared  in  its  growth.  In  fact,  the  whole  civil- 
ized world  has  participated ;  but  this  is  especially  true  of  Great  Britain 
and  her  colonies. 

The  Anglo-Saxon  race  can  claim  the  credit  both  of  originating  life  in- 
surance and  of  carrying  it  to  its  present  magnificent  proportions.  We 
are  told  by  Francis  {Annals  and  Anecdotes  of  Life  Insurance)  that  mutual 
insurance  associations  were  known  in  Great  Britain  soon  after  the  Con- 
quest. "The  necessity  of  providing  for  casualties  by  mutual  assistance 
— in  other  words,  insurance  on  its  broadest  and  most  rational  basis — was 
practiced  in  the  Saxon  guild,  the  origin  of  which  was  very  simple.  Every 
freeman  of  fourteen  being  bound  to  find  sureties  to  keep  the  peace,  cer- 
tain neighbors,  composed  of  ten  families,  became  bound  for  one  another, 
either  to  produce  any  one  of  the  number  who  should  offend  against  the 
Norman  law,  or  to  make  pecuniary  satisfaction  for  the  offense.     To  do 

493 


494  A   SYSTEM  OF  LEGAL  MEDICINE. 

this  they  raised  a  fund  by  mutual  payments,  which  they  placed  in  one 
common  stock.  This  was  pure  mutual  assurance."  Further  on  he  gives 
extracts  from  the  by-laws  of  these  ancient  friendly  societies.     Thus : 

"  4.  If  any  one  take  away  the  life  of  a  member,  his  reparatory  fine 
shall  not  exceed  eight  pounds ;  but  if  he  obstinately  refuse  to  make  rep- 
aration, then  shall  he  be  prosecuted  by  and  at  the  expense  of  the  whole 
societjr ;  and  if  any  individual  undertake  the  prosecution,  then  each  of 
the  rest  shall  bear  an  equal  share  of  the  expense.  If,  however,  a  member 
who  is  poor  kill  any  one,  and  compensation  must  be  made,  then,  if  the 
deceased  was  worth  twelve  hundred  shillings,  each  member  shall  con- 
tribute half  a  mark ;  but  if  the  deceased  was  a  hind,  each  member  shall 
contribute  two  ora3 ;  if  a  Welchman,  only  one." 

"  7.  If  a  member,  being  at  a  distance  from  home,  shall  die  or  fall  sick, 
his  fellow-members  shall  send  to  fetch  him,  either  alive  or  dead,  to  what- 
ever place  he  may  have  wished,  or  be  liable  to  the  stated  penalty ;  but  if 
a  member  shall  die  at  home,  eveiy  member  who  shall  not  go  to  fetch  his 
corpse,  and  every  member  who  shall  absent  himself  from  his  obsequies, 
shall  forfeit  a  sextarius  of  honey." 

Among  the  rules  of  St.  Catherine's  Guild  he  gives  the  following : 

"  If  a  member  suffer  from  fire,  water,  robbery,  or  other  calamity,  the 
guild  is  to  lend  him  a  sum  of  money  without  interest.  If  sick,  or  infirm 
through  old  age,  he  is  to  be  supported  by  his  guild  according  to  his  con- 
dition. If  a  member  falls  into  bad  courses,  he  is  first  to  be  admonished, 
and  if  found  to  be  incorrigible  he  is  to  be  expelled.  Those  who  die  poor, 
and  cannot  afford  themselves  burial,  are  to  be  buried  at  the  charge  of 
the  guild." 

These  were  very  humble  beginnings,  and  it  was  long  before  there 
were  any  further  developments.  Other  varieties  of  insurance,  especially 
marine,  grew  slowly  into  favor.  It  was  all  done  by  individual  under- 
writers ;  the  rates  were  high  and  the  term  was  short.  There  was  insur- 
ance effected  at  that  time  for  ransoming  sailors  and  pilgrims  in  case  of 
capture  by  Turks,  but  there  were  no  data  upon  which  to  make  scientific 
life  calculations.  The  census  was  faulty,  and  the  mortality  register  did 
not  contain  the  ages  of  the  dead. 

In  1693  Halley  published  the  first  table  which  showed  the  probabilities 
of  hiving,  at  every  age.  This  was  founded  on  the  death-registers  of 
Breslau  in  Silesia,  as  that  was  the  only  place  where  the  ages  of  the  dead 
were  recorded.     Even  this  was  not  used  for  many  years. 

A  few  years  prior  to  this,  Graunt  made  some  very  shrewd  guesses  as 
to  the  expectation  of  life,  which  were  founded  on  the  London  bills  of 
mortality.  As  these  bills  did  not  give  the  ages  of  the  dead,  we  can  attach 
no  scientific  value  to  the  results.  The  causes  of  death  stated  in  these 
bills  of  mortality  are  very  quaint,  and  indicative  of  the  state  of  medicine 
at  that  time.  Who  would  recognize  croup  as  "  the  rising  of  the  lights  "  ? 
The  resemblance  of  hydrocephalus  to  "  horseshoe  head  "  is  a  little  closer 
when  it  is  remembered  how  this  disease  separates  the  bones  of  the  head 
and  makes  the  coronal  suture  look  a  little  like  a  horseshoe. 

Long  before  this,  in  the  beginning  of  the  third  century,  Ulpianus  con- 
structed a  table  of  the  expectation  of  life  for  the  calculation  of  annuities 
under  the  Falcidian  law  of  inheritance.  "We  do  not  know  upon  what  these 
tables  were  founded,  for  the  census,  which  was  taken  by  the  Romans  every 
five  years,  did  not  in  itself  furnish  sufficient  data.     The  number  of  births 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  495 

and  deaths  and  the  ages  at  death  must  be  known  also,  and  we  are  rea- 
sonably sure  that  the  Romans  made  no  record  of  these.  The  tables  of 
Ulpianus  compare  favorably  with  some  of  the  earlier  English  tables,  but 
with  improved  methods  of  calculation  and  a  greater  extent  of  data  the 
more  recent  tables  show  a  much  greater  average  longevity.  On  the  other 
hand,  it  is  quite  possible  that  human  life  has  lengthened  its  days  since 
those  times.    Many  students  in  this  subject  have  come  to  this  conclusion. 

Toward  the  end  of  the  eighteenth  century  Dr.  Price  constructed  three 
mortality  tables,  the  Northampton,  the  Chester,  and  the  Swedish  National 
tables.  Of  these  three  the  Northampton  is  by  far  the  least  accurate, 
owing  to  a  curious  cause  which  was  not  appreciated  by  Dr.  Price.  In 
the  town  of  Northampton  there  were  a  large  number  of  Baptists  who  did 
not  believe  in  infant  baptism.  In  that  way  the  ratio  of  births  to  the 
christenings  was  reduced  to  such  an  extent  that  the  population  of  the 
town  was  thought  to  be  stationary,  whereas  in  reality  it  was  constantly 
increasing.  Hence  the  table  made  the  average  lifetime  in  the  town  to  be 
six  years  less  than  we  can  reasonably  suppose  it  was  then,  and  thirteen 
less  than  it  is  now.  Unfortunately,  this  table  was  the  one  which  many 
insurance  companies  adopted,  probably  for  the  very  reason  that  it  was 
more  favorable  to  them  and  discriminated  against  the  policy-holder.  Of 
late  years  it  has  been  entirely  dropped  by  insurance  companies,  who  now 
depend  chiefly  upon  tables  constructed  from  the  combined  mortality  ex- 
perience of  several  companies. 

The  most  elaborate  work  in  this  line  is  the  English  Life  Tables  con- 
structed by  Dr.  Farr.  These  are  three  in  number.  The  first  is  founded 
on  the  census  of  1841  and  the  death  records  for  that  year.  The  second 
is  based  on  the  same  census,  but  includes  the  death  records  for  three  pre- 
ceding and  three  subsecpient  years.  The  English  Life  Table  No.  III.  in- 
cludes also  the  census  of  1851  and  the  death  records  for  seventeen  years. 
From  the  same  data  Dr.  Farr  has  constructed  a  table  of  Healthy  Lives, 
using  for  this  purpose  only  those  districts  in  which  the  mortality  was 
seventeen  or  less  per  mille  per  annum.  To  give  some  idea  of  the  enor- 
mous labor  involved  in  these  computations,  it  is  stated  that  the  ages  of 
over  fifty  million  living  persons  and  of  over  six  million  deaths  enter  into 
the  calculations. 

The  first  life  insurance  policy  of  which  we  have  legal  record  is  dated 
June  18, 1583.  It  was  on  the  life  of  William  Gibbons,  for  twelve  months 
from  that  date.  It  was  underwritten  by  a  number  of  individuals  at  the 
enormous  rate  of  eight  pounds  percent.  The  insured  died  on  May  29, 
1584,  and  payment  was  resisted  on  the  ground  that  the  twelve  months 
referred  to  were  lunar  months  of  twenty-eight  days.  Tins  was  promptly 
<  tverruled  in  the  courts.  Prior  to  this  there  was  insurance  for  ransoming 
sea-captains  and  pilgrims,  and  very  probably  on  ordinary  lives.  Annui- 
ties certainly  were  granted  to  individuals  before  this,  but  the  rates  were 
enormous.  The  highest  expectation  of  life  at  this  time  was  held  to  be 
seven  }^ears,  and  it  was  considered  to  be  the  same  for  all  ages.  The  profits 
of  the  insurer  under  these  circumstances  were  very  great,  and  amounted 
to  the  grossest  usury. 

In  1699  the  earliest  project  for  mutual  life  insurance  was  devised.  It 
was  called  "  The  Society  of  Assurance  for  Widows  and  Orphans."  In 
many  respects  it  resembled  quite  closely  some  of  the  modern  assessment- 
associations.     There  was  an  entrance  fee  of  five  shillings,  and  an  assess- 


496  A  SYSTEM  OF  LEGAL   MEDLCINE. 

merit  of  five  shillings  more  on  the  death  of  each  member.  This  would 
have  given  five  hundred  pounds  when  the  full  membership  of  two  thou- 
sand was  obtained.  The  applicant  had  to  furnish  a  certificate  of  his  age, 
and  also  had  to  make  affidavit  that  he  knew  of  no  illness  which  afflicted 
him,  and  that  he  was  in  a  good  state  of  health.  He  had  to  appear  in 
person  before  the  trustees,  and  might  be  rejected  by  them.  As  there 
was  no  medical  examination,  death  within  six  months  after  issuing  the 
policy  did  not  avail.  There  were  clauses  providing  for  the  forfeiture  of 
the  policy  in  case  of  death  by  the  hands  of  justice.  Military,  naval,  and 
seafaring  risks  were  excluded,  and  in  case  of  members  dying  in  violation 
of  any  of  these  provisos,  the  policy  was  forfeited.  Forfeiture  also  oc- 
curred in  case  the  subscriber  did  not  pay  his  assessment  within  seven 
days  after  notice.  This  scheme  was  certainly  very  ingenious,  and  ought 
to  have  given  satisfaction ;  but,  like  most  of  these  plans,  the  death-rate 
probably  increased  in  a  few  years,  the  assessments  rolled  up  and  became 
too  numerous.  It  lived  but  a  few  years,  and,  so  far  as  we  know,  died  a 
natural  death  about  1711. 

In  1706  a  charter  was  granted  to  the  "Amicable  Society  for  a  Per- 
petual Assurance  Office."  This  is  the  first  life  insurance  compan}'-  of 
which  we  have  any  very  definite  information,  and  which  sustained  the 
strain  of  early  years.  It  was  a  purely  mutual  company ;  the  rates  were 
very  high,  and  were  the  same  for  all  ages  between  twelve  and  forty-five. 
They  did  not  accept  risks  outside  those  ages.  The  annual  income  after 
deducting  expenses  was  divided  yearly  among  the  representatives  of 
those  who  had  died  during  the  past  year.  This  was  of  course  a  most  in- 
equable arrangement.  In  some  years  the  mortality  was  light,  and  the 
individual  return  was  proportionally  large ;  but  the  next  year  it  might 
be  just  the  reverse.  This  was  modified  in  later  years,  but  not  very  suc- 
cessfully. The  inherent  faults  of  the  scheme  were  too  great,  and  the  old 
Amicable  finally  succumbed  in  1866,  after  an  existence  of  one  hundred 
and  sixty  years.  It  was  then  absorbed  by  the  Norwich  Union  Life.  It 
is  sometimes  said  that  the  Hand-in-Hand  and  the  Sun  offices  were  founded 
before  the  Amicable.  This  is  true,  but  they  both  started  out  as  fire  in- 
surance companies,  and  did  no  life  business  until  many  years  after  the 
Amicable  had  been  established. 

It  may  be  amusing  to  note  some  of  the  other  features  of  this  period. 
It  was  a  time  when  gambling  was  rife  in  all  classes  of  society,  and  the 
South  Sea  Bubble  was  swelling.  There  was  a  company  for  suppressing 
thieves  and  robbers  and  for  insuring  all  persons  and  goods  from  the 
same ;  a  company  for  insuring  against  losses  they  shall  sustain  by  ser- 
vants, thefts,  etc. ;  an  insurance  company  for  horses  dying  natural  deaths, 
stolen,  or  disabled ;  for  assurance  of  female  chastity ;  insurance  from 
house-breakers ;  insurance  from  highwaymen  ;  insurance  from  lying ;  in- 
surance from  death  from  drinking  geneva :  rum  insurance.  The  forego- 
ing is  a  very  imperfect  list  of  these  schemes,  which  amounted  to  nothing 
in  the  end.  Real  life  insurance  had  to  go  through  a  feeble  infancy  and 
an  overfed  childhood  before  it  reached  its  present  vigorous  youth. 

In  1720  two  proprietary  companies  were  started,  the  Royal  Exchange 
and  the  London  Assurance.  These  first  confined  their  attentions  ex- 
clusively to  fire  and  marine  insurance,  but  in  1721  their  charters  were 
amended  so  as  to  permit  them  to  write  risks  on  lives.  They  did  a  small 
business,  at  heavy  rates,  and  nearly  all  of  it  was  for  short  terms  of  a 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  497 

year  or  less.  Few  people  could  afford  the  luxury  longer,  when  it  cost 
£5  5s.  per  year  for  £100  of  insurance.  Some  years  later  Thomas  Simp- 
son showed  that  on  the  basis  of  Halley's  Breslan  table  it  was  possible  to 
construct  a  table  of  life  expectation  for  every  age,  and  soon  after  James 
Dodson  actually  did  this.  These  results  attracted  much  attention.  Finally 
a  number  of  gentlemen  formed  themselves  into  a  purely  mutual  life  insur- 
ance company,  which  still  survives  in  England  under  its  original  title  of 
"  The  Equitable  Society  for  the  Assurance  of  Life  and  Survivorship." 
They  endeavored  to  obtain  a  charter  from  Parliament,  but  this  was  frus- 
trated through  the  objections  of  the  Royal  Exchange  and  the  London 
Assurance.  The  Royal  Exchange  stated  with  ingenuous  simplicity  that  it 
was  a  very  poor  business  and  that  the  expenses  ate  up  all  the  profits.  But 
as  the  new  company  required  no  capital,  being  purely  mutual,  they  over- 
came this  by  drawing  up  a  deed  of  settlement,  which  was  finally  enrolled 
in  17G5,  three  years  after  the  first  policy  had  been  issued.  At  first  the 
•outcome  was  very  doubtful,  and  Francis  says  that,  in  order  to  give  an 
appearance  of  strength  and  age  to  the  delicate  infant,  they  called  the 
twenty-fifth  policy  the  two  hundred  and  seventy-fifth.  The  premiums 
were  at  first  fifty  percent,  to  one  hundred  percent,  higher  than  those 
charged  at  present ;  but  by  the  end  of  the  century  they  had  been  very 
much  reduced.  The  "  Old  Equitable "  is  still  alive  and  flourishing, 
although  in  a  very  conservative  way.  To  it  we  must  bow  as  being  the 
first  real  representative  of  modern  life  insurance. 

While  life  insurance  was  fostered  and  encouraged  in  England  by  law 
and  custom,  the  reverse  was  the  case  on  the  Continent.  In  the  end  of 
the  seventeenth  and  the  beginning  of  the  eighteenth  century,  ordinances 
forbidding  the  insurance  of  lives  of  persons  were  issued  in  the  Nether- 
lands, in  Genoa,  Amsterdam,  and  Rotterdam,  and  in  1681  Louis  XIV. 
issued  a  similar  one  in  France.  The  result  has  been  that  life  insurance 
rather  languished  throughout  the  rest  of  Europe  until  within  late  years. 
But  now  it  has  become  a  fixed  institution  there,  and  a  great  volume  of 
life  insurance  is  written  in  most  of  Europe,  a  considerable  part  of  which 
is  done  by  American  companies. 

It  is  necessary  to  say  a  word  about  the  tontine  plan,  which  has  been 
revived  in  a  very  modified  form.  This  owes  its  name  to  Lorenzo  Tonti, 
who  lived  during  the  seventeenth  century.  His  original  plan  was  as 
follows :  A  certain  number  of  persons  clubbed  together  a  specified  sum 
(without  reference  to  age  or  sex),  and  at  the  expiration  of  each  year  the 
interest  of  this  fund  was  divided  among  the  subscribers  who  were  living, 
and  so  on  from  year  to  year,  until  the  last  survivor  received  the  whole 
of  the  interest.  After  the  death  of  the  last  survivor  the  principal  reverted 
to  the  founders  of  the  scheme,  i.e.,  the  State,  for  their  own  use.  This 
termination  sufficed  to  kill  the  original  plan,  and  it  was  soon  altered  so 
that  the  entire  original  sum  was  received  by  the  last  surviving  member. 
Even  on  this  basis  it  was  too  great  a  speculation,  and  never  had  much  pop- 
ular support.  The  results  that  were  obtained  in  some  of  these  tontines 
were  almost  fabulous.  One  was  started  in  1689,  the  subscription  being 
300  livres.  The  last  survivor  of  this,  in  1726,  was  a  widow  of  ninety- 
six  years  of  age,  and  she  received  an  income  from  it  of  73,500  livres. 

At  the  present  time  all  purely  tontine  methods  in  life  insurance  have 
been  dropped.  There  are,  however,  methods  by  which  the  insured  allows 
•all  his  profits  from  early  lapses,  compound  interest,  etc.,  to  accumulate 


498  ^   SYSTEM   OF  LEGAL  MEDICINE. 

for  a  number  of  years,  usually  ten,  fifteen,  or  twenty,  and  then  receives 
the  whole  of  it  in  one  dividend.  This  is  more  befitting  than  the  usual 
yearly  dividend  in  many  respects,  for  it  tends  to  equalize  the  inequalities 
which  affect  that  system  by  reason  of  a  heavy  mortality  one  year  and  a 
light  one  the  next.  The  so-called  semi-tontine  system  is  the  one  adopted 
by  a  large  proportion  of  insurers  in  this  country. 

LEGAL. 

Before  entering  upon  the  discussion  of  the  medico-legal  features  of 
this  question,  it  is  necessary  to  elaborate  a  little  some  of  the  purely  legal 
points.  This  must  be  done  very  briefly,  and  only  things  of  importance 
can  be  touched  upon.  Any  extended  discussion  would  be  quite  unbe- 
coming on  the  part  of  the  writer. 

A  contract  of  insurance  has  been  defined  as  "  an  agreement  by  which 
one  party,  for  a  consideration  (which  is  usually  paid  in  money,  either  in 
one  sum  or  at  different  times  during  the  continuance  of  the  risk),  prom- 
ises to  make  a  certain  payment  of  money  upon  the  destruction  or  injury 
of  something  in  which  the  other  party  has  an  interest."  {Commonwealth 
vs.  Wetherbee,  105  Mass.  149,  160.)  This  definition  has  been  adopted  in 
many  cases  of  life  insurance,  and  can  be  considered  as  generally  accepted. 
Courts  have  erred  at  times  in  regarding  this  contract  as  governed  by 
different  rules  from  ordinary  contracts,  but  it  is  now  usually  held  that 
the  same  principles  apply  to  it  as  to  other  agreements  involving  pecuniary 
obligations.  There  is  this  difference,  however,  that  in  the  case  of  any 
ambiguity  in  the  contract  of  insurance,  the  construction  most  unfavorable 
to  the  insurer  will  be  adopted.  This  is  right,  for  it  happens  that  the  in- 
surer is  the  one  that  makes  up  the  printed  contract  used  in  nearly  all 
cases.  Hence,  since  it  is  his  language  which  is  used,  it  should  be  turned 
against  him  if  it  is  at  all  doubtful  in  its  meaning.  There  are  three  parties 
to  these  contracts :  the  insurer,  who  nowadays  is  practically  always  a 
company  or  association ;  the  insured,  who  is  the  person  applying  and 
examined ;  and  the  beneficiary,  who  is  the  person  to  whom,  or  to  whose 
legal  representatives,  the  amount  d^^e  at  the  death  of  the  insured  is  to  be 
paid.     It  is  of  course  possible  for  the  insured  to  be  also  the  beneficiary. 

Insurance  corporations  may  be  divided  into  three  classes,  stock, 
mutual,  and  mixed.  The  first  has  for  its  basis  a  capital  stock.  It  ordi- 
narily issues  policies  at  lower  premium  rates  than  the  others.  None  of 
its  profits  are  divided  among  the  policy-holders,  but  all  go  to  the  stock- 
holders. In  mutual  companies  the  insured  themselves  are  the  members 
of  the  company,  and  receive  their  share  of  the  surplus  premiums  over 
and  above  those  necessary  for  the  payment  of  losses  and  expenses.  In 
mixed  companies  a  certain  proportion  of  the  profits  is  paid  to  the  stock- 
holders and  the  remainder  distributed  among  the  insured. 

Warranties  and  Representations. — The  applicant  is  required  by 
most  companies  to  warrant  the  truth  of  the  statements  made  by  him  in 
his  application  for  insurance.  In  the  case  of  a  warranty  the  validity  of 
his  policy  depends  upon  the  accuracy  of  his  statements,  and  any  falsity 
in  them  will  prevent  the  liability  of  the  insurer  from  taking  effect.  A 
warranty  forms  a  part  of  the  contract,  and  if  not  strictly  complied  with 
the  whole  contract  is  rendered  void,  even  if  the  mistake  is  entirety  im- 
material and  innocent,     Furthermore,  it  makes  no  difference  what  the 


THE  MEDICAL  JUIUSPIWDENCE   OF  LIFE  INSURANCE.  499 

object  of  the  insurer  was  in  asking  the  question,  or  even  whether  he  had 
any  object. 

In  some  cases  the  statements  of  the  applicant  are  not  certified  in  such 
a  manner  as  to  constitute  a  warranty.  They  then  become  representa- 
tions, and  are  divided  into  two  classes,  material  and  immaterial.  The 
former  are  those  on  which  the  insurer  relies  in  making  his  contract. 
"  But  in  many  cases  where  the  language  of  the  contract  is  regarded  as 
insufficient  to  create  a  warranty,  it  is  regarded  as  sufficient  to  create  an 
agreement  that  a  statement,  of  itself  immaterial,  is  to  be  regarded  as 
material ;  that  is  to  say,  as  a  material  representation.  This  commonly 
happens  in  the  case  of  an  answer  made  to  a  specific  inquiry  made  b}^  the 
insurer,  the  fact  of  his  asking  it  being  regarded  as  sufficient  to  show 
that  he  regards  the  answer  as  a  material  representation,  and  the  assent 
of  the  insured  that  it  be  so  regarded  is  sufficiently  shown  by  his  making 
the  answer."  Material  representations  must  be  untrue  in  some  material 
particular  to  avoid  the  contract.  Their  materiality  does  not  depend  upon 
their  ultimate  influence  on  the  risk  or  their  relation  to  the  cause  of  loss. 
It  depends  upon  the  effect  it  has  on  the  judgment  of  the  party  who  as- 
sumes the  risk  at  the  time  he  assumes  it.  Even  if  the  loss  should  occur 
from  circumstances  totally  unconnected  with  the  fact  materially  misrep- 
resented, the  policy  is  void.  The  insurer,  had  he  known  the  true  state 
of  affairs,  might  then  have  declined  the  risk  or  charged  a  higher  premium. 

Many  of  these  points  are  so  cai*efully  considered  in  the  decision  in 
the  case  of  Campbell  vs.  Life  Insurance  Co.,  98  Mass.  381,  that  it  is  worth 
our  while  to  quote  somewhat  extensively  from  it.  "  A  warranty,  in  in- 
surance, enters  into  and  forms  part  of  the  contract  itself.  It  defines, 
by  way  of  particular  stipulation,  description,  condition,  or  otherwise,  the 
precise  limits  of  the  obligation  which  the  insurers  undertake  to  assume. 
No  liability  can  arise  except  within  those  limits.  In  order  to  charge  the 
insurers,  therefore,  every  one  of  the  terms  which  define  their  obligation 
must  be  satisfied  by  the  facts  which  appear  in  proof.  From* the  very 
nature  of  the  case,  the  party  seeking  his  indemnity,  or  payment  under 
the  contract,  must  bring  his  claim  within  the  provision  of  the  instrument 
he  is  undertaking  to  enforce.  The  burden  of  proof  is  upon  the  plaintiff 
to  present  a  case  in  all  respects  conforming  to  the  terms  under  which 
the  risk  was  assumed.  It  must  be  not  merely  a  substantial  conformity, 
but  exact  and  literal ;  not  only  in  material  particulars,  but  in  those  that 
are  immaterial  as  well. 

"  A  representation  is,  on  the  other  hand,  in  its  nature,  no  part  of  the 
contract  of  insurance.  Its  relation  to  the  contract  is  usually  described 
by  the  term  '  collateral.'  It  may  be  proved,  although  existing  only  in 
parol  and  preceding  the  written  instrument.  Unlike  other  verbal  nego- 
tiations, it  is  not  merged  in  nor  waived  by  the  subsequent  writing.  This 
principle  is  peculiar  in  some  respects  to  insurance,  and  rests  upon  other 
•considerations  than  the  rule  which  admits  proof  of  verbal  representations 
to  impeach  written  contracts  on  the  ground  of  fraud.  Representations 
to  insurers,  before  or  at  the  time  of  making  a  contract,  are  a  presentation 
of  the  elements  upon  which  to  estimate  the  risk  proposed  to  be  assumed. 
They  are  the  basis  of  the  contract;  its  foundation  on  the  faith  of  which 
it  is  entered  into.  If  wrongly  presented,  in  any  respect  material  to  the 
risk,  the  policy  that  may  be  issued  thereupon  will  not  take  effect.  To 
enforce  it  would  be  to  apply  the  insurance  to  a  risk  that  was  never  pre- 


500  J   SYSTEM  OF  LEGAL  MEDICINE. 

sented.  But  when  the  insurer  seeks  to  defeat  a  policy  on  this  ground, 
his  position  in  court  is  essentially  different  from  that  which  he  may  hold 
upon  a  policy  containing  a  like  description  of  the  risk  as  one  of  its  terms. 
It  is  sufficient  for  the  plaintiff  to  show  fulfillment  of  all  the  conditions 
of  recovery  which  are  made  such  by  the  contract  itself.  The  burden  is 
then  thrown  upon  the  defendant  to  set  forth  and  prove  the  collateral 
matters  upon  which  he  relies.  .  .  . 

"  When  statements  or  engagements  on  the  part  of  the  insured  are 
inserted  or  referred  to  in  the  policy  itself,  it  often  becomes  difficult  to 
determine  to  which  class  they  belong.  If  they  appear  on  the  face  of 
the  policy,  they  do  not  necessarily  become  warranties.  Their  character 
will  depend  on  the  form  of  expression  used,  the  apparent  purpose  of  the 
insertion,  and  sometimes  upon  the  connection  or  relation  to  other  parts 
of  the  instrument.  If  they  are  contained  in  a  separate  paper,  referred 
to  in  such  a  manner  as  to  make  it  a  part  of  the  contract,  the  same  con- 
siderations of  course  will  apply ;  but  if  the  reference  appears  to  be  for  a. 
special  purpose,  and  not  with  a  view  to  import  the  separate  paper  into 
the  policy  as  a  part  of  the  contract,  the  statements  it  contains  will  not 
thereby  be  changed  from  representations  into  warranties.  It  is  perhaps 
needless  to  add  that  verbal  representations  can  never  be  converted  into 
warranties  otherwise  than  by  being  afterward  written  into  the  policy. 

"  In  considering  the  question  whether  a  part  of  the  contract  is  a. 
warranty,  it  must  be  borne  in  mind,  as  an  established  maxim,  that  war- 
ranties are  not  to  be  created  nor  extended  by  construction.  They  must 
arise,  if  at  all,  from  the  fair  interpretation  and  clear  intendment  of  the 
words  used  by  the  parties.  When,  therefore,  from  the  designation  of 
such  statements  as  '  statements '  or  as  '  representations/  or  from  the  form 
in  which  they  are  expressed,  there  appears  to  be  no  intention  to  give 
them  the  force  and  effect  of  warranties,  they  will  not  be  so  construed. 

"  The  application  is,  in  itself,  collateral  merely  to  the  contract  of  in- 
surance. Its  statements,  whether  of  facts  or  of  agreements,  belong  to- 
the  class  of  representations.  They  are  to  be  so  construed,  unless  con- 
verted into  warranties  by  force  of  a  reference  to  them  in  the  policy,  and 
a  clear  purpose,  manifested  in  the  papers  thus  connected,  that  the  whole 
shall  form  one  entire  contract.  When  the  reference  to  the  application 
is  expressed  to  be  for  another  purpose,  or  when  no  purpose  is  indicated 
to  make  it  a  part  of  the  policy,  it  will  not  be  so  treated."  In  a  later 
trial  in  the  same  case  it  was  held  (98  Mass.  402) :  "  It  is  true  that  a  rep- 
resentation need  not,  like  a  warranty,  be  strictly  and  literally  complied 
with,  but  only  substantially  and  in  those  particulars  which  are  material 
to  be  disclosed  to  the  insurers  to  enable  them  to  determine  whether  they 
will  enter  into  the  contract ;  and  that,  where  the  question  of  the  materi- 
ality of  such  particulars  depends  upon  circumstances,  and  not  upon  the- 
construction  of  any  writing,  it  is  a  question  of  fact  to  be  determined  by 
the  jury.  But  where  the  representations  upon  which  the  contract  of 
insurance  is  based  are  in  writing,  their  interpretation,  like  that  of  other 
written  instruments,  belongs  to  the  court,  and  the  parties  may,  by  the 
frame  and  contents  of  the  papers,  either  by  putting  representations  as 
to  the  quality,  history,  or  relations  of  the  subject  insured  into  the  form 
of  answers  to  specific,  questions,  or  by  the  mode  of  referring  to  them  in 
the  policy,  settle  for  themselves  that  they  shall  be  deemed  material ;  and 
when  they  have  done  so,  the  applicant  for  insurance  cannot  afterward 


THE  MEDICAL   JUEISFIiUDENCE   OF  LIFE  INSURANCE.  501 

be  permitted  to  show  that  a  fact  which  the  parties  have  thus  declared  to 
be  material  to  be  truly  stated  to  the  insurers,  was  in  fact  immaterial, 
and  thereby  escape  from  the  consequences  of  making  a  false  answer  to 
such  a  question." 

In  the  case  of  Price  vs.  Life  Insurance  Co.,  17  Minn.  473,  some  excel- 
lent definitions  are  given  in  very  simple  and  concise  language.  "  So  far 
as  the  questions  presented  by  the  case  at  bar  are  concerned,  it  is  suffi- 
cient to  define  a  warranty  in  insurance  to  be  a  part  of  the  contract  evi- 
denced by  the  policy,  and  a  binding  agreement  that  the  facts  stated  are 
strictly  true.  A  representation  in  insurance  may,  for  the  purpose  of 
this  case,  be  defined  to  be  a  statement  in  regard  to  a  material  fact  made 
by  the  applicant  for  insurance  to  the  insurer  with  reference  to  a  pro- 
posed contract  of  insurance.  As  representations  simply,  they  are  not 
a  part  of  the  contract  of  insurance.  And  though  expressly  referred  to 
in  the  policy,  so  as  to  become  a  part  of  the  written  contract,  they  may 
not  become  warranties.  And  even  if  it  be  made  by  the  very  terms  of 
the  policy,  as  in  the  case  at  bar,  an  express  condition  of  the  contract  of 
insurance  that  if  such  representations  are  found  to  be  untrue  the  policy 
shall  be  nidi  and  void,  they  do  not  necessarily  lose  their  character  as  rep- 
resentations and  become  warranties,  though  the  effect  of  such  express 
condition  may  be  to  make  them  conclusively  material. 

"It  is  sufficient  if  representations  be  substantially  true,  while  a 
warranty  must  be  strictly  complied  with.  A  false  warranty,  therefore, 
avoids  a  policy,  while  a  false  representation  (not  fraudulent)  does  not 
avoid  a  policy  unless  it  relates  to  something  which  is  material  in  fact,  or 
is  made  material  by  the  contract  of  the  parties.  Warranties,  then,  are 
conditions  precedent,  so  that  their  truth  must  be  pleaded  by  the  assured, 
upon  whom,  of  course,  the  burden  of  proving  the  same  rests,  whereas 
the  falsity  of  representations  is  matter  of  defense  to  be  pleaded  by  the 
insurer." 

In  both  the  preceding  cases  it  is  assumed  that  the  burden  of  proving 
the  truth  of  a  warranty  rests  upon  the  insured.  This  is  not  the  opinion 
usually  held,  and,  as  a  ride,  it  may  be  said  that  the  burden  of  proof  of  a 
breach  of  warranty  rests  upon  the  insurer.  For,  considering  the  number 
of  warranties  in  any  application,  their  positive  proof  would  be  out  of 
the  question  on  the  part  of  the  insured,  and  woidd  throw  an  overwhelm- 
ing task  upon  the  beneficiaries  of  every  policy. 

In  England,  where  the  doctrine  of  warranties  apparently  originated, 
it  is  construed  quite  as  strictly  as  in  this  country.  In  the  case  of 
Anderson  vs.  Fitzgerald,  4  H.  L.  484,  it  wras  carried  to  the  House  of  Lords 
and  very  thoroughly  discussed.  In  this  case  the  policy  contained  the 
proviso  that  "  if  any  circumstance  material  to  this  insurance  shall  not 
have  been  truly  stated,  or  shall  have  been  misrepresented  or  concealed, 
or  any  false  statements  made  to  the  company  in  or  about  the  effecting 
of  this  insurance,"  the  policy  should  be  null  and  void.  The  applicant 
answered  in  the  negative  the  questions,  "  Did  any  of  the  party's  near 
relatives  die  of  consumption  or  any  other  pulmonary  complaint?"  and 
"  Has  the  party's  life  been  accepted  or  refused  at  any  office  ? "  It  was 
proven  that  his  negative  answers  were  both  false.  The  House  of  Lords 
held  that  the  proviso,  above  quoted,  covered  all  statements,  whether 
material  or  immaterial,  whether  false  by  design  or  through  ignorance. 

A  similar  decision  wTas  rendered  by  the  Supreme  Court  of  the  United 


502  A   SYSTEM  OF  LEGAL   MEDICINE. 

States  in  the  case  of  Jeffries  vs.  Life  Insurance  Co.,  22  Wall.  47.  In  the 
policy  it  was  agreed  that  "  the  statements  and  declarations  made  in  the 
application,  and  on  the  faith  of  which  it  is  issued,  are  in  all  respects  true, 
and  without  the  suppression  of  any  fact  relating  to  the  health  or  cir- 
cumstances of  the  insured,  affecting  the  interests  of  the  company." 
The  applicant  stated  that  he  was  single,  and  that  he  had  made  no  appli- 
cation to  any  other  company.  Both  of  these  statements  were  proven  to 
be  false.  It  was  held  as  follows :  "  It  is  contended,  also,  that  the  false 
answers  in  the  present  case  were  not  to  the  injury  of  the  company,  that 
they  presented  the  applicant's  case  in  a  less  favorable  light  to  himself 
than  if  he  had  answered  truly.  Thus  to  the  inquiry,  'Are  you  married 
or  single  ? '  when  he  falsely  answered  that  he  was  single  he  made  himself 
a  less  eligible  candidate  for  insurances  than  if  he  had  truly  stated  that  he 
was  a  married  man ;  that,  although  he  deceived  the  company  and  caused 
it  to  enter  into  a  contract  that  it  did  not  intend  to  make,  it  was  deceived 
to  its  advantage,  and  made  a  more  favorable  bargain  than  was  supposed. 

"  This  is  bad  morality  and  bad  law.  None  may  do  evil  that  good 
may  come.  No  man  is  justified  in  the  utterance  of  a  falsehood.  It  is 
an  equal  offense  in  morals,  whether  committed  for  his  own  benefit  or 
that  of  another.  .  .  . 

"  The  statements  need  not  come  up  to  the  degree  of  warranties.  They 
need  not  be  representations  even,  if  this  term  conveys  the  idea  of  an 
affirmation  having  any  technical  character.  '  Statements  and  declarations ' 
is  the  expression  ;  what  the  applicant  states  and  what  the  applicant  de- 
clares. Nothing  can  be  more  simple.  If  he  makes  any  statement  in  the 
application,  it  must  be  true.  If  he  makes  any  declaration  in  the  appli- 
cation, it  must  be  true.  The  faithful  performance  of  this  agreement  is 
made  an  express  condition  to  the  existence  of  a  liability  on  the  part  of 
the  company. 

"  There  is  no  place  for  the  argument  that  the  false  statement  was  not 
material  to  the  risk,  or  that  it  was  a  positive  advantage  to  the  company 
to  be  deceived  by  it.  It  is  the  distinct  agreement  of  the  parties  that  the 
company  shall  not  be  deceived  to  its  injury  or  to  its  benefit.  The  right 
of  an  individual  or  corporation  to  make  an  unwise  bargain  is  as  complete 
as  that  to  make  a  wise  bargain.  The  right  to  make  contracts  carries 
with  it  the  right  to  determine  what  is  prudent  and  wise,  what  is  unwise 
and  imprudent,  and  upon  that  point  the  judgment  of  the  individual  is 
subject  to  that  of  no  other  tribunal.  The  case  in  hand  affords  a  good 
illustration  of  this  principle.  The  company  deems  it  wise  and  prudent 
that  the  applicant  shall  inform  it  truly  whether  he  has  made  any  other 
application  to  have  his  life  insured.  So  material  does  it  deem  this  infor- 
mation that  it  stipulates  that  its  liability  shall  depend  upon  the  truth  of 
the  answer.  The  same  is  true  of  its  inquiry  whether  the  party  is  mar- 
ried or  single.  The  company  fixes  this  estimate  of  its  importance.  The 
applicant  agrees  that  it  is  thus  important  by  accepting  the  test.  It 
would  be  a  violation  of  the  legal  rights  of  the  company  to  take  from  it 
its  acknowledged  power  thus  to  make  its  opinion  the  standard  of  what 
is  material,  and  to  leave  that  point  to  the  determination  of  the  jury." 

While  the  language  of  insurance  contracts  has  been  made  more  and 
more  stringent,  the  tendency  of  both  judge  and  jury  has  been  toward  a 
very  liberal  construction  of  them,  with  all  the  odds  in  favor  of  the  in- 
sured.   They  seize  upon  the  slightest  turn  or  twist  of  phraseology  which 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  503 

will  enable  them  to  convert  a  sentence  apparently  intended  for  a  war- 
ranty into  a  representation.  They  say,  with  much  truth,  that  these  con- 
tracts are  drawn  up  by  the  insurer  and  the  language  used  in  them  is 
carefully  considered  beforehand.  If  there  is  the  slightest  ambiguity  any- 
where, it  must  be  construed  to  the  benefit  of  the  insured,  who  usually 
signs  the  application  without  noticing  the  printed  declarations  on  it. 
He  knows  that  he  will  not  have  to  pay  anything  until  he  gets  the  policy, 
and  when  he  reads  that  he  is  not  apt  to  observe  that  the  application  is 
made  a  part  of  it.  This  liberal  tendency  of  the  courts  is  well  brought 
•out  in  the  following  case  of  Clapp  vs.  Massachusetts  Benefit  Association, 
14G  Mass.  519 : 

"  The  seven  rulings  requested  by  the  defendant  are  based  upon  the 
theory  that  it  was  entitled  to  a  verdict  if  the  answers  of  Clapp  in  refer- 
ence to  such  matters  were  in  fact  untrue,  although  made  honestly  and 
in  good  faith.  Whether  it  was  so  entitled  or  not  must  depend  upon  the 
■construction  to  be  given  to  the  acknowledgment  or  certificate  which  was 
subscribed  by  the  deceased  as  part  of  the  application,  and  which  from 
its  language  must  be  held  to  have  controlled  and  governed  the  answers 
to  which  it  referred. 

"  This  acknowledgment,  as  it  is  termed,  is  as  follows :  '  I,  Edward  A. 
•Clapp,  of  West  Manchester,  county  of  Essex,  State  of  Massachusetts,  do 
hereby  warrant  each  and  all  of  the  foregoing  particulars  and  statements 
to  be  true  to  the  best  of  my  knowledge  and  belief,  and  that  I  have  not, 
in  this  application  for  above-named  contract,  concealed  or  withheld  any 
material  circumstance  or  information  concerning  the  past  or  present 
state  of  my  health  or  habits  of  life ;  and  I  do  hereby  acknowledge,  con- 
sent, and  agree  that  any  untrue  or  fraudulent  statement  made  above,  by 
me  or  any  one  else,  or  to  any  medical  examiner  of  said  Massachusetts  Ben- 
efit Association,  or  any  concealment  of  facts  by  me  or  any  one  else,  may 
forfeit  and  cancel  all  rights  to  any  benefit  under  the  above-named  contract.' 

" .  .  .  Undoubtedly  the  acknowledgment  may  grammatically  be  sep- 
arated into  two  parts :  the  first  a  warranty  that  the  statements  made  are 
true  according  to  the  best  of  the  applicant's  knowledge  and  belief,  and 
the  second  an  agreement  that  any  untrue  or  fraudulent  statement  may 
forfeit  the  contract.  But,  if  susceptible  of  such  a  grammatical  construc- 
tion, it  can  hardly  have  been  intended  that  it  should  have  been  thus 
understood.  Nor  would  it  be  a  natural  construction,  and  one  that  would 
suggest  itself  to  an  applicant.  He  would  not  suppose  that,  while  he  was 
■only  required  to  warrant  that  his  answers  were  true  according  to  his 
'  knowledge  and  belief,'  his  certificate  or  policy  was  to  be  forfeited  if  an 
answer  honestly  made  should  prove  in  fact  untrue.  The  language  used 
in  the  form  of  acknowledgment  does  not  suggest  any  idea  so  much  in 
the  nature  of  a  contradiction  as  this. 

"  These  forms  are  prepared  by  the  insurer  with  great  care  and  great 
minuteness  of  detail.  They  are  often  signed  in  comparative  haste ;  and 
if  the  association  had  intended  to  impose  a  forfeiture  of  his  certificate 
upon  the  applicant  because  of  an  untrue  statement,  while  it  had  only  re- 
quired him  to  warrant  that  his  statements  were  true  to  the  best  of  his 
knowledge  and  belief,  a  contract  so  anomalous  should  have  been  clearly 
expressed.  It  must  be  presumed  that  the  defendant  prepared  its  forms 
of  application  and  certificate  with  the  intention  both  of  protecting  itself 
against  fraud  and  of  securing  the  just  rights  of  the  assured  under  a  valid 


504  J   SYSTEM  OF  LEGAL  MEDICINE. 

contract.  It  is  reasonable  that  its  words  should  be  construed  against 
itself,  rather  than  in  such  a  manner  that  one  dealing  with  it  should  by 
any  ambiguity  be  deceived  as  to  his  rights. 

"  The  defendant  urges  that  the  words  '  untrue  or  fraudulent/  used  in 
the  disjunctive,  and  thus  expressing  different  states  of  things,  show  that 
by  the  use  of  the  first  word  it  was  intended  that  the  poliejr  should  be 
avoided  if  any  material  thing  was  untrue,  although  stated  without 
fraudulent  intent.  The  connection  in  which  the  word  is  used  shows 
otherwise.  In  following  the  earlier  clause,  it  means  a  statement  which 
is  untrue  in  opposition  to  the  sense  in  which  it  has  been  promised  that 
it  shall  be  true.  Again,  while  in  strictness  a  statement  is  untrue  which 
is  not  in  precise  conformity  with  the  facts,  yet  in  a  more  general  sense 
the  word  '  true '  is  often  used  as  a  synonym  of  honest  or  sincere,  without 
evasion  or  fraud.  Such  is  the  sense  in  which  it  is  used  in  the  acknowl- 
edgment. .  .  . 

"  The  case  was  presented  by  the  defendant  on  the  theory  that  it  was 
entitled  to  a  verdict  if  Clapp's  answers  were  shown  in  any  material  re- 
spect to  be  untrue.-  This  was  rejected  by  the  presiding  judge,  who  held 
that  it  must  be  shown  also  that  such  statements  were  known  or  believed 
to  be  untrue.  ...  In  each  request  for  a  ruling,  the  defendant  omitted 
the  element  of  Clapp's  knowledge  and  belief.  This  was  the  point  of 
conflict  between  its  contention  and  the  position  taken  by  the  presiding 
judge,  who  throughout  his  instructions  insisted  that  not  only  must  the 
answers  of  Clapp  be  proved  untrue,  but  that  they  were  so  according  to- 
his  knowledge  and  belief."  The  Supreme  Court  of  Massachusetts  held 
that  the  judge  was  right  in  giving  these  instructions,  and  overruled  all 
the  exceptions  of  the  defendant. 

These  extracts  are,  I  think,  sufficient  to  show  the  distinctions  be- 
tween warranties,  material  representations,  and  immaterial  representa- 
tions. At  the  same  time  it  must  be  repeated  that  the  more  recent  deci- 
sions show,  if  not  a  favoritism,  certainly  a  decided  sympathy  with  the 
insured.  Furthermore,  even  if  the  court  holds  that  any  given  arrange- 
ment of  words  makes  the  statements  of  the  applicant  warranties,  it  is 
still  within  the  province  of  the  court  to  define  what  is  warranted  in 
most  cases.  Here  a  great  deal  of  latitude  is  allowed.  Thus  the  ques- 
tion, "  Have  you  always  been  temperate  ? "  has  been  held  to  refer  to  the 
habitual  use  of  alcoholics,  and  hence  an  occasional  intemperance  was- 
regarded  as  no  falsification.  One  judge  has  even  gone  so  far  as  to  say 
that  an  attack  of  delirium  tremens  was  not  incompatible  with  an  affirma- 
tive answer  to  this  question. 

Incomplete  and  Omitted  Answers. — If  there  is  no  specific  inquiry 
by  the  insurer  as  to  any  fact,  the  omission  of  the  applicant  to  state  it 
does  not  necessarily  invalidate  the  policy,  unless  the  omission  was  inten- 
tional, and  the  fact  material  in  itself.  This  is  right,  for  the  insurers 
regularly  ask  all  the  questions  which  they  think  will  have  a  bearing  on 
the  risk  except  those  for  which  they  rely  upon  their  own  independent 
means  of  information.  When  an  answer  to  any  question  appears  to  be 
complete,  although  in  reality  it  is  incomplete,  the  omission  will  avoid 
the  contract,  if  it  is  that  of  a  material  statement.  Thus  in  the  case  of 
Cazenove  vs.  Life  Insurance  Co.,  3  Bigelow's  Life  and  Ace.  Cases  202,  213, 
it  was  held  that  "  an  answer  may  in  one  sense  be  said  to  be  true,  namely,, 
if  as  much  as  it  does  state  is  not  untrue,  but  it  may  nevertheless  be  sub- 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  505. 

stantially  an  untrue  statement.  I  think  that  this  answer  is  untrue ;  just 
as  when  a  man  is  asked  how  old  he  is,  and  he  says  he  is  thirty,  and  as  he 
is  that,  and  something  more  than  that,  it  may  be  said  in  a  sense  that  the 
answer  is  true.  However,  in  a  case  of  this  sort  I  think  it  is  trifling  to  say 
that  it  is  a  true  answer,  if  something  more  is  to  be  added  to  make  it  true." 

If,  however,  the  question  appears  on  its  face  to  be  answered  imper- 
fectly or  not  at  all,  and  there  are  no  further  steps  taken  by  the  insurer 
to  make  the  applicant  complete  the  answer,  this  partial  or  entire  omis- 
sion does  not  avoid  the  contract.  Here,  too,  the  courts  are  very  liberal 
in  construing  any  ambiguity  to  the  detriment  of  the  insurer.  Thus  in  the 
case  of  Life  Insurance  Co.  vs.  Raddin,  120  U.  S.  183,  the  Supreme  Court 
of  the  United  States  held  as  follows :  "  The  twenty-eighth  printed  ques- 
tion in  the  application  consists  of  four  successive  inquiries,  as  follows : 
'  Has  any  application  been  made  to  this  or  to  any  other  company  for 
assurance  on  the  life  of  the  party?  If  so,  with  what  result?  What 
amounts  are  now  assured  on  the  life  of  the  party,  and  in  what  compa- 
nies ?  If  already  assured  in  this  company,  state  the  number  of  the  policy.' 
The  only  answer  written  opposite  this  question  is  '$10,000,  Equitable 
Life  Assurance  Society.' 

"  The  question  being  printed  in  very  small  type,  the  answer  is  written 
in  a  single  bine  midway  of  the  opposite  space,  evidently  in  order  to  pre- 
vent the  ends  of  the  letters  from  extending  above  or  below  that  space ; 
and  its  position  with  regard  to  that  space,  and  to  the  several  interroga- 
tories in  the  question,  does  not  appear  to  us  to  have  any  bearing  upon 
the  question  and  effect  of  the  answer. 

"  But  the  four  interrogatories,  grouped  together  in  one  question,  and 
all  relating  to  the  subject  of  other  insurance,  would  naturally  be  under- 
stood as  all  tending  to  one  object — the  ascertaining  of  the  amount  of 
such  insurance.  The  answer,  in*  its  form,  is  responsive  not  to  the  first 
and  second  interrogatories,  but  to  the  third  interrogatory  only,  and  fully 
and  truly  answers  that  interrogatory  by  stating  the  existing  amount  of 
prior  insurance  and  in  what  company,  and  thus  renders  the  fourth  inter- 
rogatory irrelevant.  If  the  insurers,  after  being  thus  truly  and  fully  in- 
formed of  the  amount  and  place  of  the  prior  insurance,  considered  it 
material  to  know  whether  any  unsuccessful  applications  had  been  made 
for  additional  insurance,  they  should  either  have  repeated  the  first  two 
interrogatories,  or  have  put  further  questions.  The  legal  effect  of  issu- 
ing a  policy  upon  the  answer  as  it  stood  was  to  waive  their  right  of  re- 
quiring further  answers  as  to  the  particulars  mentioned  in  the  twenty- 
eighth  question,  to  determine  that  it  was  immaterial  for  the  purposes  of 
their  contract  whether  any  unsuccessful  applications  had  been  made,  and 
to  estop  them  to  set  up  the  omission  to  disclose  such  applications  as  a 
ground  for  avoiding  the  policy.  The  insurers,  having  thus  conclusively 
elected  to  treat  that  omission  as  immaterial,  coidd  not  afterward  make  it 
material  bjr  proving  that  it  was  intentional." 

This  reasoning  is  certainly  drawn  out  to  a  very  fine  point,  and  the 
decision  seems  hardly  fair  to  the  company.  In  the  case  of  Mutual  Aid 
Society  vs.  White,  100  Pa.  St.  12,  the  ruling  on  a  very  similar  condition 
of  affairs  was  practically  the  reverse  of  this.  There  was  one  question 
arranged  like  this : 

"  (a)  Are  you  married  ?     

"  (b)  Give  name  of  consort.     Widdower." 


506  ^   SYSTEM  OF  LEGAL  MEDICINE. 

It  was  proven  that  he  had  a  wife  living  at  the  time  of  the  application, 
from  whom  he  was  separated.  The  appellate  court  ruled  that  there  was 
no  ambiguity  about  the  reply,  as  it  was  evidently  responsive  to  both 
questions,  and  bad  spelling  is  so  common  as  not  to  count  against  the 
answer.  It  constituted  a  material  misrepresentation,  and  therefore  the 
judgment  of  the  lower  court  was  reversed. 

Superfluous  Answers. — The  insured  is  not  bound  by  immaterial 
statements  made  by  himself  which  are  not  responsive  to  any  question 
put  by  the  insurer,  even  though  his  statements  are  held  to  be  warranties. 
In  the  case  of  Buell  vs.  Life  Insurance  Co.,  5  Bigelow's  Life  and  Ace.  Cases 
473,  the  question  was  asked :  "  Has  father,  mother,  brother,  or  sister  of 
the  party  died,  or  been  afflicted  with  consumption,  or  any  disease  of  the 
lungs,  or  insanity  ?  If  so,  state  full  particulars  of  each  case."  The  answer 
was :  "  No.  Father  died  from  exposure  in  water ;  age,  fifty-eight."  It  was 
proven  and  admitted  that  the  father  had  died  before  the  age  of  thirty ; 
but  the  court  held  that  "  the  falsity  complained  of  in  the  answer  consists 
only  in  reference  to  the  age  at  which  the  father  died.  This  certainly  was 
not  inquired  of  in  the  question,  unless  we  are  to  find  it  in  that  part  of  it 
which  reads,  '  If  so,  state  full  particulars  in  each  case.'  ...  I  think  the 
question  fairly  means,  not  whether  the  father,  etc.,  had  died  from  any  dis- 
ease, or  from  any  cause,  but  whether  he  had  died  of,  or  been  afflicted  with, 
consumption,  or  any  disease  of  the  lungs,  or  insanity.  This  being  the  fair 
import  of  the  question,  '  No'  was  a  complete  answer  to  it,  and  the  remain- 
der of  the  answer  was  uncalled  for  and  not  responsive  to  the  question. 
But  suppose  that  be  so;  defendant  claims  that  it  is  nevertheless  an  an- 
swer of  some  sort,  and  therefore  an  important  part  of  the  contract.  The 
reply  to  that  is  that  the  declaration  which  relates  to  the  answers  to  the 
questions  to  be  made  by  the  plaintiff,  and  which  it  was  agreed  should  be 
made  part  of  the  contract,  must  be  construed  to,  and  does  mean  such  an- 
swers as  are  responsive  to  the  questions,  and  such  as  may  be  called  for  by 
the  defendant,  and  that  it  does  not  cover  such  answers  as  may  be  volun- 
teered and  irrelevant,  and  that  amount  to  mere  representations.  .  .  .  The 
part  of  the  answer  in  question  in  this  case,  in  reference  to  the  age  of  the 
father  at  death,  being  a  mere  representation,  does  not  constitute  a  defense, 
unless  it  appears  to  have  been  material  as  well  as  false." 

Beneficiary. — In  the  beginning  of  the  last  century  it  was  the  custom 
in  England  to  effect  insurance  upon  lives  in  which  neither  the  insurer 
nor  the  insured  had  any  interest.  These  policies  were  properly  nothing 
but  wagers.  The  amounts  bet  were  very  large,  and  the  subjects  often 
were  very  absurd.  Thus  as  late  as  1777  there  were  very  large  gambling 
assurances  as  to  whether  the  so-called  Chevalier  d'Eon  was  a  man  or  a 
woman.  This  extraordinary  man  had  been  sent  to  St.  Petersburg,  on 
some  confidential  diplomatic  mission,  disguised  as  a  woman.  He  retained 
the  dress  for  some  time  after  he  returned  to  France.  When  he  went  to 
England  he  assumed  that  of  a  man,  but  it  was  there  decided  in  an  action 
before  Lord  Mansfield  {Da  Costa  vs.  Jones,  Cowp.  729)  that  he  was  a 
woman.  Soon  after  this  he  returned  to  France,  but  under  the  orders  of 
the  Court  of  Saint-Germain  he  was  compelled  to  wear  female  garb.  He 
did  this  until  he  died  in  1810,  when  it  was  thoroughly  established  by 
post-mortem  investigation  that  he  was  a  man. 

The  practice  of  wager  policies  grew  to  such  serious  proportions  that 
finally  it  was  forbidden  by  an  act  of  Parliament.    (14  George  III.,  c.  48.) 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  507 

This  enacted  that  "  no  insurance  shall  be  made  on  the  life  of  any  person, 
or  any  event  whatsoever,  where  the  person  on  whose  account  such  policy 
shall  be  made  shall  have  no  interest ;  or  by  gaming  or  wagering ;  and  that 
every  such  insurance  shall  be  null  and  void. 

"  It  shall  not  be  lawful  to  make  any  policy  on  the  life  of  any  person, 
or  any  other  event,  without  inserting  in  the  policy  the  name  of  the  per- 
son interested  therein,  or  for  whose  use  or  whose  account  such  policy  is 
so  made. 

"  Where  the  insured  has  an  interest  in  such  life  or  event,  no  greater 
sum  shall  be  received  than  the  amount  of  the  interest  of  the  insured  in 
such  life  or  event." 

This  has  been  followed  by  similar  statutes  in  this  and  other  States. 
The  doctrine  that  the  beneficiary  must  have  an  insurable  interest  in  the 
life  of  the  person  assured  is  rather  an  anomaly.  It  has  been  held  that 
the  lack  of  an  insurable  interest  was  contrary  to  public  policy ;  but  it  is 
more  than  likely  that  this  idea  arose  from  the  statutes  bearing  upon  the 
subject.  However,  it  must  be  considered  as  an  established  principle  now 
and  accepted  until  it  is  overruled.  It  is  difficult  to  state  just  what  con- 
stitutes an  insurable  interest.  Two  well-known  definitions  are  as  follows : 
"  All  which  it  seems  necessary  to  show,  in  order  to  take  the  case  out  of 
the  objection  of  being  a  wager  policy,  is,  that  the  insured  has  some  in- 
terest in  the  life  of  the  cestui  que  vie;  that  his  temporal  affairs,  his  just 
hopes  and  well-grounded  expectations  of  support,  of  patronage,  and  ad- 
vantage in  life  will  be  impaired ;  so  that  the  real  purpose  is  not  a  wager, 
but  to  secure  such  advantages  supposed  to  depend  on  the  life  of  another. 
Perhaps  it  would  be  difficult  to  lay  down  any  general  rule  as  to  the 
nature  and  amount  of  interest  which  the  assured  must  have.''  (Chief- 
Justice  Shaw,  in  Loomis  vs.  Eagle  Co.,  6  Gray  (Mass.)  39G,  399.) 

"  It  is  not  easy  to  define  with  precision  what  will  in  all  cases  consti- 
tute an  insurable  interest,  so  as  to  take  the  contract  out  of  the  class  of 
wager  policies.  It  may  be  stated  generally,  however,  to  be  an  interest, 
arising  from  the  relations  of  the  party  obtaining  the  insurance,  either  as 
creditor  of  or  surety  for  the  assured,  or  from  ties  of  blood  or  marriage  to 
him,  as  will  justify  a  reasonable  expectation  of  advantage  or  benefit  from 
the  continuance  of  his  life.  It  is  not  necessary  that  the  expectation  of 
advantage  or  benefit  should  always  be  capable  of  pecuniary  estimation." 
(Justice  Field,  in  Warnocl-  vs.  Davies,  104  U.  S.  775.) 

The  distinctions  drawn  in  the  cases  are  sometimes  very  fine ;  but 
generally  they  tend  to  follow  the  above  definitions.  A  wife  has  an  in- 
surable interest  in  the  life  of  her  husband  (Baker  vs.  Insurance  Co.,  43 
N.  Y.  283),  and  the  validity  of  the  policy  will  survive  a  divorce  (Insur- 
ance Co.  vs.  Schafer,  94  U.  S.  457).  A  husband  has  ordinarily  an  insur- 
able interest  in  the  life  of  his  wife,  and  a  father  in  that  of  his  minor 
son ;  but  not  necessarily  a  son  in  the  life  of  his  father,  nor  a  nephew  in 
the  life  of  his  uncle ;  but  a  sister  can  be  the  beneficiary  of  her  brother. 
(Insurance  Co.  vs.  France,  94  U.  S.  561.) 

A  creditor  has  an  insurable  interest  in  the  life  of  a  debtor.  If  a 
policy  is  taken  out  in  good  faith  and  assigned  to  a  creditor,  it  has  been 
held  that  it  still  remained  valid  even  if  the  insurable  interest  of  the  as- 
signee ceased  to  exist.  Thus  in  the  case  of  Olmstead  vs.  Keyes,  85  N.  Y. 
593,  it  was  held  that :  "  The  rule,  as  gathered  from  these  authorities,  is 
that  where  one  takes  out  a  policy  upon  his  own  life  as  an  honest  and 


508  ^   SYSTEM  OF  LEGAL  MEDICINE. 

hona  fide  transaction,  and  the  amount  insured  is  made  payable  to  a  person 
having  no  interest  in  his  life,  or  where  such  a  policy  is  assigned  to  one 
having'  no  interest  in  the  life,  the  beneficiary  in  the  one  case  and  the  as- 
signee in  the  other  may  hold  and  enforce  the  policy  if  it  was  valid  in  its 
inception,  and  the  policy  was  not  procured  or  the  assignment  made  as  a 
contrivance  to  circumvent  the  law  against  betting,  gaming,  and  wager- 
ing policies." 

On  the  other  hand,  it  has  been  held  that  a  creditor  has  no  interest  in 
the  policy  beyond  the  amount  of  his  claim.  This  was  the  view  taken  in 
the  case  of  Gammack  vs.  Lewis,  15  Wall.  643.  The  same  court  on  the 
case  of  WarnocJc  vs.  Dairies,  104  U.  S.  775,  held  that:  "If  there  be  any 
sound  reason  for  holding  a  policy  invalid  when  taken  out  by  a  party  who 
has  no  interest  in  the  life  of  the  assured,  it  is  difficult  to  see  why  that 
reason  is  not  as  cogent  and  operative  against  a  party  taking  the  assign- 
ment of  a  policy  upon  the  life  of  a  person  in  which  he  has  no  interest. 
The  same  ground  which  invalidates  the  one  should  invalidate  the  other, 
so  far  at  least  as  to  restrict  the  right  of  the  assignee  to  the  sums  actually 
advanced  by  him." 

In  May  on  insurance,  vol.  i.,  p.  199,  the  opinion  is  given  that :  "  Upon 
the  whole,  it  is  not  improbable  that,  when  the  point  is  distinctly  taken, 
it  will  be  held  that  when  the  contract,  at  its  inception,  is  based  upon  a 
substantial  interest,  and  in  good  faith  is  entered  into  for  the  protection 
of  that  interest,  it  is  not  objectionable  as  a  wager  contract,  and  may  be 
enforced  though  the  interest  may  have  ceased  at  the  time  of  the  death. 
And  this  the  more  probable,  as  while  such  a  rule  will  keep  the  door  shut 
against  mere  gambling  and  speculation,  it  will  tend  to  encourage  what  is 
now  almost  universally  regarded  as  a  provident  contract,  securing  not 
only  an  indemnity  in  case  of  loss,  but  the  means  of  presently  increasing 
capital,  and  a  not  disadvantageous  mode  of  investment." 

One  of  the  most  extraordinary  cases  in  which  the  question  of  a 
beneficiary  entered  occurred  a  few  years  ago.  Toward  the  end  of  1877 
Benjamin  Hunter  took  out  $10,000  in  one  company  and  large  amounts 
in  two  others  on  the  life  of  John  Armstrong.  A  few  weeks  later,  while 
Armstrong  was  going  home  one  night,  he  was  attacked  by  some  one  in 
the  streets  of  Camden,  N.  J.,  and  received  several  blows  on  the  head, 
from  the  effects  of  which  he  died  two  days  later.  No  motive  could  be 
assigned  for  the  crime  until  the  existence  of  these  policies  was  found  out, 
Then  Hunter  was  suspected,  arrested,  and  finally  convicted  of  murder  in 
the  first  degree,  for  which  he  was  hanged.  Between  the  time  of  his 
conviction  and  execution  he  assigned  the  policies  over  to  the  widow  of 
Armstrong.  She  of  course  received  them  subject  to  all  the  equities  be- 
tween the  original  parties.  Suit  was  then  brought  against  the  insurers, 
and  a  verdict  was  given  in  her  favor.  On  appeal  it  was  held  (117  U.  S. 
597, 598)  that :  "  The  theory  of  the  defense  is,  that  the  purpose  of  Hunter  in 
obtaining  the  insurance  was  to  cheat  and  defraud  the  company.  In  sup- 
port of  that  position,  evidence  that  he  effected  insurance  upon  the  life 
of  Armstrong  in  other  companies  at  or  about  the  same  time,  for  a  like 
fraudulent  purpose,  was  admissible.  A  repetition  of  acts  of  the  same 
character  naturally  indicates  the  same  purpose  in  all  of  them ;  and  if, 
when  considered  together,  they  cannot  be  reasonably  explained  without 
ascribing  a  particular  motive  to  the  perpetrator,  such  motive  will  be  con- 
sidered as  prompting  each  act.     A  creditor  has  an  insurable  interest  in 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  509 

the  life  of  his  debtor,  and  may  very  properly  procure  an  insurance  upon 
it  for  an  amount  sufficient  to  secure  his  debt ;  but  if  he  takes  out  policies 
in  different  companies  at  or  near  the  same  time,  and  thus  increases  the 
insurance  far  beyond  any  reasonable  security  for  the  debt,  an  inquiry  at 
once  arises  as  to  his  motive,  and  it  may  be  considered  as  governing  him 
in  each  insurance.  .  .  .  The  evidence  offered  that  Hunter  obtained  the 
insurance  in  other  companies  on  the  life  of  Armstrong  at  or  near  the 
same  time  was,  under  these  authorities,  clearly  admissible.  It  tended  to 
establish  the  theory  of  the  defendant  that  the  insurance  obtained  in  this 
case  was  obtained  by  Hunter  upon  the  premeditate  purpose  to  cheat  and 
defraud  the  company.  Especially  would  it  have  had  that  effect  if  fol- 
lowed by  proof  of  the  manner  of  the  death  of  Armstrong. 

"  But  independently  of  any  proof  of  the  motives  of  Hunter  in  obtain- 
ing the  policy,  and  even  assuming  that  they  were  just  and  proper,  he 
forfeited  all  rights  under  it  when,  to  secure  its  immediate  payment,  he 
murdered  the  assured.  It  would  be  a  reproach  to  the  jurisprudence  of 
this  country  if  one  could  recover  insurance  money  payable  on  the  death 
of  a  party  whose  life  he  had  feloniously  taken.  As  well  might  he  recover 
insurance  money  upon  a  building  that  he  had  willfully  fired." 

MEDICO-LEGAL. 

As  a  preliminary  to  the  discussion  of  the  relations  of  legal  medicine 
to  life  insurance,  it  seems  advisable  to  tell  in  a  few  words  the  plan  which 
has  been  adopted  in  the  subsequent  pages.  In  this  way  the  relations  of 
the  individual  parts  to  the  whole  subject,  and  also  their  comparative  im- 
portance, can  be  shown.  And  a  certain  coherency  between  the  different 
topics  will  be  established. 

The  opening  section  is  devoted  to  a  very  brief  review  of  the  duties  of 
the  medical  examiner,  and  a  short  statement  of  the  value  of  medical 
selection.  In  the  section  following  this  are  discussed  the  questions  as  to 
what  constitutes  medical  attendance  and  medical  attendant.  Next  is 
taken  up  the  definition  of  "  sound  health."  And  immediately  after  this 
comes  the  correlated  idea  as  to  what  constitutes  "freedom  from  disease." 
This  topic  is  first  discussed  in  its  general  aspects,  and  then  following  this 
discussion  are  a  number  of  diseases,  each  of  which  has  been  the  subject 
of  judicial  comment.  These  are  treated  individually.  Next  is  taken  up 
a  very  important  subject,  namely,  the  habits  of  the  insured  in  regard  to 
alcohol,  opium,  and  other  narcotics.  This  is  treated  at  considerable 
length,  both  on  the  legal  and  the  medical  sides.  It  has  seemed  advisable 
to  insert  it  here,  immediately  after  the  discussion  of  health  and  disease, 
on  account  of  its  marked  influence  on  both  these  conditions.  The  next 
topic  taken  up  is  that  of  the  family  record  and  its  manifestations  of 
heredity. 

The  remaining  topics  have  less  cognate  relation  to  the  main  subject. 
But  medical  questions  enter  more  or  less  into  their  discussion,  and  med- 
ical selection  is  somewhat  affected  by  the  statements  in  the  applications 
regarding  them.  So  they  do  not  come  amiss  in  this  relation.  The  first  of 
these  topics  has  reference  to  the  occupation,  and  then  comes  the  subject 
of  the  residence,  and  that  of  the  age  immediately  follows.  The  amount 
of  other  insurance  that  an  applicant  has  frequently  affects  the  acceptance 
of  the  risk,  and  of  still  more  importance  is  the  question  referring  to  pre- 


510  A   SYSTEM  OF  LEGAL  MEDICINE, 

vious  rejections.  These  are  both  discussed  shortly.  Last,  but  by  no 
means  least,  is  the  very  important  topic  of  suicide  in  its  relations  to  life 
insurance.  This  is  discussed  fully  aud  at  length.  These  have  seemed  to 
be  the  only  subjects  which  can  be  properly  included  under  the  title  we 
have  chosen. 

The  Examiner. — Since  we  hope  that  many  medical  examiners  for  life 
insurance  companies  will  honor  this  article  by  reading  it,  it  has  seemed 
right  to  us  to  preface  it  by  a  few  words  concerning  their  duties  and  the 
value  of  medical  selection  in  eliminating  unfit  risks.  "  It  is  a  truism  to 
remark  that  the  whole  fabric  of  life  insurance  depends  upon  the  fidelity, 
the  learning,  and  the  skill  of  medical  men.  When  a  company  is  formed, 
a  lawyer  may  carefully  draw  its  charter  and  its  by-laws,  and  formulate 
the  contracts  upon  which  it  is  willing  to  enter ;  the  actuary  may  accu- 
rately estimate  the  risks  to  be  encountered,  the  rate  of  interest  to  be  ex- 
pected, and  the  loading  necessary  to  cover  expenses ;  the  executive  may 
organize  with  skill  and  economy  the  working  force  and  the  agents  in 
the  field  ;  but  unless  the  medical  examiner  does  his  duty  in  barring  out 
undesirable  risks  and  accepting  only  those  who  may  reasonably  be  ex- 
pected to  live  out  the  theoretical  expectation  of  life,  the  company  is  pre- 
destined to  loss  and  ruin.  He  stands  as  a  sentinel  at  the  gate  to  prevent 
the  ingress  of  those  who  would  only  destroy  the  structure,  and  upon  his 
vigilance  and  care  depend  its  continued  existence.  Any  lapse  from  the 
strict  performance  of  duty,  any  concealment  of  facts  which  the  company 
should  know  in  order  to  estimate  property  the  risk  to  be  assumed,  and 
any  approval  of  doubtful  lives  from  motives  of  personal  friendship  or 
unwillingness  to  incur  local  enmities,  is  to  admit  a  traitor  to  make  a 
breach  in  the  growing  edifice  which  may  easily  result  in  its  total  down- 
fall." {Tlie  Chronicle,  1893,  p.  326.)  And  it  can  be  said  that  the  medical 
examiner  seldom  fails  in  the  high  trust  reposed  in  his  integrity  and  fidel- 
ity. He  becomes  the  confidential  adviser  of  the  company,  and  shows 
toward  it  the  utmost  good  faith  in  nearly  all  cases. 

Oftentimes  he  sacrifices  lifelong  friendships  to  do  the  almost  thankless 
task  of  rejecting  an  unsuitable  applicant.  It  is  seldom  an  applicant  is 
so  unsound  as  to  die  within  a  short  time  after  rejection,  for  in  that  case 
he  is  usually  so  palpably  sick  that  he  does  not  dare  to  apply  for  insur- 
ance. Hence  the  examiner  gets  the  approval  of  no  one  for  rejecting  the 
case,  for  it  is  buried  at  the  home  office  along  with  thousands  of  others, 
and  the  applicant  and  agent  usually  have  opportunity,  for  a  year  or  tw<  >. 
to  revile  and  upbraid  the  examiner.  And  when  the  rejected  candidate 
finally  dies  within  a  time  far  short  of  his  expectation,  the  medical  exam- 
iner rarely  gets  his  credit  for  it  from  the  officers  of  the  company,  for 
they  seldom  hear  of  it.  This  is  his  own  fault,  and  he  should  endeavor  to 
correct  it.  For  the  sake  of  his  own  reputation  he  should  report  the 
deaths  of  all  his  rejected  cases  to  the  home  office.  Furthermore,  it  would 
prove  of  great  scientific  value  to  the  company.  But  the  examiner  prob- 
ably thinks  that  the  damage  already  done  in  his  immediate  circle  cannot 
be  rectified,  and  he  does  not  care  to  take  the  extra  trouble  to  notify  the 
company. 

It  is  said,  sometimes  in  jest  but  occasionally  in  earnest,  that  a  life  in- 
surance company  would  be  better  off  if  the  medical  examination  were 
abolished  and  applicants  taken  without  examination ;  that  the  reduction 
in  expense  would  more  than  counterbalance  the  increased  loss  from  the 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  5H 

higher  mortality.  Those  who  advance  this  view  seem  to  do  so  on  the 
supposition  that  the  effect  of  abolishing  medical  selection  would  be  to 
bring  the  death-rate  up  to  the  average  at  large  of  the  population,  and 
they  seem  to  think  that  it  could  go  no  higher ;  but  there  is  every  reason 
to  believe  that  it  would.  Would  not  "the  halt,  the  maimed,  and  the 
blind"  come  swarming  to  the  doors  of  any  insurance  company  which 
did  away  with  medical  examinations  ?  Would  not  those  over  whom  the 
family  physician  had  shaken  his  head  come  rushing  up  to  join  the  throng 
before  it  was  too  late  ?  And  equally  would  not  those  who  knew  they 
were  in  good  health  keep  awa}^  from  such  an  institution,  as  one  avoids  a 
pest-house  ?  The  net  result  of  two  such  forces  would  be  that  in  a  short 
time  the  company  would  be  composed,  not  of  average  risks,  but  of  in- 
valids, of  those  who  had  been  rejected  by  other  companies,  of  those  only 
who  knew  they  were  unsound.  How  long  could  any  company  stand 
such  a  strain  ? 

The  great  value  of  medical  selection  is  well  shown  in  the  following 
tables.  {Assurance  Magazine,  vol.  xxiii.,  page  285.)  The  actual  rates  of 
mortality  in  them  were  taken  from  the  experience  of  ten  assurance  com- 
panies in  Scotland.  The  computed  rates  of  mortality  were  based  upon 
the  deaths  registered  in  Scotland  during  the  ten  years,  1855-64.  For 
the  benefit  of  those  to  whom  the  actuarial  science  is  a  terra  incognita, 
we  will  say  that  the  cases  are  grouped  according  to  the  number  of  years 
they  have  been  insured,  and  not  according  to  their  age.  The  year  0 
refers  to  the  first  six  months  of  insurance. 

The  importance  of  selection  for  the  first  two  or  three  years  is  well 
shown  in  the  following  table  of  deaths  from  all  causes : 


Tears 

of 

Actual  Rates 

Computed  Rates 

Actual  Deaths  to 

Assurance. 

of  Mortality. 

of 

'  Mortality. 

100 

Computed. 

0 

.004592 

.012809 

35.85 

1 

.007622 

.013166 

57 .  90 

2 

.009894 

.013705 

72.19 

3 

.011498 

.014206 

80.94 

4 

.013161 

.014759 

89.17 

5 

.013079 

.015290 

85.54 

6 

.014254 

.015929 

89.49 

7 

.014893 

.016613 

89.65 

8 

.015342 

.017301 

88.68 

9 

.016296 

.018010 

90.49 

It  has  also  been  said  that  those  who  can  afford  to  pay  for  insurance 
are  naturally  a  better  class  of  risks  than  the  average  population,  and 
hence  the  diminished  mortality,  after  two  or  three  years  of  insurance,  is 
due  to  natural,  and  not  medical,  selection.  Fortunately,  Dovey  has  pre- 
pared other  tables  which  enable  us  to  refute  this.  Some  diseases  will 
show  very  slightly  the  effects  of  selection,  while  there  are  others  in  which 
its  theoretical  value  cauuot  be  questioned.  In  the  first  group  naturally 
belong  the  zymotic  diseases.  There  is  nothing  in  a  medical  examination 
which  would  show  any  capacity  for  restraining  the  development  of  such 
diseases  and  preventing  a  fatal  termination.  We  are  not,  therefore, 
surprised  to  find  in  the  table  devoted  to  this  class  that  the  actual  mor- 
tality surpasses  the  computed  mortality  in  the  first  year,  and  remains 
ahead  of  it  for  the  remaining  eight  years.  Dovey  makes  the  suggestion 
that  this  is  probably  due  to  the  fact  that  a  larger  proportion  of  the  in- 


512 


A   SYSTEM  OF  LEGAL  MEDICINE. 


sured  come  from  towns  than  from  the  country,  and  cities  are  well  known 
to  be  more  troubled  with  this  class  of  diseases.  A  similar  result  is  to  be 
noticed  in  the  table  devoted  to  the  diseases  of  the  digestive  organs.  If 
applicants  wish  to  minimize  their  symptoms,  an  examiner  will  naturally 
reject  only  those  cases  in  which  a  disease  of  this  class  is  so  far  advanced 
that  it  affects  the  applicant's  general  health  and  gives  rise  to  objective 
manifestations.  For  this  reason  we  find  that  the  actual  mortality  in  cases 
dying  of  some  disease  of  the  stomach  is  below  the  computed  for  one  and 
a  half  years  only;  and  after  that  it  practically  equals  or  surpasses  it- 
Let  us  turn  now  to  the  other  group  of  diseases,  in  which  we  would 
naturally  expect  to  find  much  value  from  the  medical  selection.  Among 
these  diseases  the  most  marked  results  would  be  seen  in  cardiac  and 
tuberculous  lesions.  In  both  the  examination  is  usually  thorough, 
heredity  plays  an  important  part  which  is  given  due  weight,  and  the 
previous  history  of  rheumatism,  hemoptysis,  etc.,  helps  materially  in  ex- 
cluding undesirable  risks.  In  other  words,  we  would  reasonably  expect 
to  find  the  full  value  of  medical  selection  manifested,  and  we  are  not 
disappointed.  The  accompanying  tables  speak  so  well  for  themselves 
that  further  comment  on  them  is  unnecessary : 


TUBERCULAR   DISEASES. 


Years 

of 

Actual  Bates 

Computed  Bates 

Actual  Deaths  to 

Assurance. 

of  Mortality. 

of  Mortality. 

100 

Computed* 

0 

.000374 

.003750 

9.97 

1 

.000981 

.003672 

26.72 

2 

.001915 

.003668 

52.21 

3 

.002109 

.003619 

58.27 

4 

.002031 

.003569 

56.91 

5 

.001968 

.003518 

55.94 

6 

.002351 

.003460 

67.79 

7 

.002154 

.003408 

63.20 

8 

.001956 

.003356 

58.28 

9 

.002010 

.003306 

60.93 

HEART  DISEASE. 

Years 

of 

Actual  Bates 

Computed  Bates 

Actual  Deaths  to 

Assurance. 

of  Mortality. 

of  Mortality. 

100 

Computed. 

0 

.000198 

.000917 

21.59 

1 

.000436 

.000980 

44.49 

2 

.000657 

.001049 

62.63 

3 

.000764 

.001121 

68.16 

4 

.000990 

.001197 

82.72 

5 

.000738 

.001272 

58.02 

6 

.001228 

.001358 

89.83 

7 

.001100 

.001440 

76.38 

8 

.001422 

.001525 

93.24 

9 

.001274 

.001612 

79.03 

These  observations  of  Dovey  are  reinforced  by  the  following  extract 
from  an  essay,  "  On  the  Effects  of  Selection,"  by  Mr.  Emory  MeClintock : 
"  Concerning  medical  selection  in  general,  all  known  statistics  go  to  show 
that  it  exerts  a  most  important  influence  in  favor  of  the  office  during  the 
first  years  of  insurance.  That  part  of  its  influence  which  is  conspicuous 
in  varying  the  earlier  percentages  is  due  to  the  rejection  of  diseased 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  513 

lives.  It  must  not  be  forgotten  that  another,  and  perhaps  equally  im- 
portant, function  of  medical  selection  is  to  repel  members  of  short-lived 
families,  who  are  themselves  in  fair  health.  The  beneficial  effect  of  such 
action  continues  for  many  years.  Those  who  say  hastily  that  medical 
selection  does  no  good  after  five  years  of  insurance,  and  that  therefore 
any  one  may  be  taken  without  examination,  provided  the  office  assumes 
no  risk  until  after  five  years  have  expired,  take  upon  themselves  a  most 
.serious  responsibility." 

The  duties  of  a  medical  examiner  are  to  a  considerable  extent  clerical. 
He  must  record  the  answers  of  the  applicant  with  care  and  fidelity.  The 
omission  to  answer  any  question  always  costs  much  time  and  trouble. 
No  matter  how  unimportant  he  thinks  any  question  is,  he  must  see  that  its 
.answer  is  put  down.  If  the  applicant  gives  the  history  of  any  disease  or 
injury,  all  the  essentials  must  be  carefully  inquired  into  and  recorded.  If 
an  applicant  makes  any  statements  to  the  medical  examiner  and  he  advises 
and  directs  the  applicant  to  modify  them,  in  so  advising  he  may  act  as  the 
agent  of  the  company,  and  the  latter  is  then  estopped  from  subsequently 
setting  up  the  falsity  of  the  statements,  thus  modified,  as  a  breach  of  war- 
ranty. {Flynn  vs.  Life  Assurance  Soe.,  78  N.Y.  568.)  This,  of  course,  sup- 
poses that  there  is  no  collusion  between  the  applicant  and  the  examiner. 

The  examiner  should  allow  himself  but  little  latitude  in  judging  what 
is  important  or  unimportant.  This  particular  case  may  be  the  subject 
■of  a  future  trial,  and  every  detail  then  necessary.  The  applicant  may 
have  made  statements  to  other  companies  which  conflict  with  what  he  is 
now  teUing.  He  may  say  now  that  his  rheumatism  was  muscular,  while 
before  he  said  it  was  articular.  But  his  cross-examination  must  be  con- 
ducted with  tact  and  adroitness,  so  carefully  and  quietly  that  it  is  re- 
garded by  the  applicant  as  a  conversation  only.  For  he  is  now  on  a 
totally  different  footing  from  that  on  which  he  is  when  he  seeks  the  phy- 
sician's professional  aid.  Now  he  will  mitigate  any  sickness  and  speak 
of  its  consequences  lightly.  An  attack  of  petit  mat  will  become  a  little 
vertigo ;  he  forgets  that  he  has  to  get  up  two  or  three  times  to  pass  his 
water.  It  is  the  examiner's  business  to  get  the  true  facts.  In  order  to 
do  this  it  is  of  great  importance  to  insist  upon  the  rule  that  no  third 
person  be  present  at  the  interview.  People  will  often  make  confession  of 
some  detrimental  circumstance  to  the  doctor  alone,  when  nothing  would 
induce  them  to  utter  a  word  on  the  subject  to  any  one  else. 

A  few  words  must  be  said  about  proofs  of  loss  and  certificates  of 
death.  It  would  seem  reasonable  to  assume  that  the  plaintiff  in  a  suit 
upon  a  policy  to  recover  from  the  company  would  be  bound  to  some  ex- 
tent by  the  statements  made  in  the  proofs  of  death.  Such  was  the  view 
taken  in  the  case  of  Life  Insurance  Co.  vs.  Newton,  22  "Wall.  32.  "They 
were  intended  for  the  action  of  the  company,  and  upon  their  truth  the 
•company  had  a  right  to  rely.  Unless  corrected  for  mistake,  the  insured 
was  bound  by  them.  Good  faith  and  fair  dealing  required  that  she 
should  be  held  to  representations  deliberately  made,  until  it  was  shown 
that  they  were  made  under  a  misapprehension  of  the  facts,  or  in  igno- 
rance of  material  matters  subsequently  ascertained." 

In  the  ease  of  Keels  vs.  Reserve  Fund  Association,  29  Fed.  Rep.  198, 
this  misinformation  was  pleaded,  and  in  consequence  the  beneficiary  was 
allowed  to  prove  that  the  death  had  occurred  from  accident,  although  the 
proofs  of  death  made  it  to  be  the  result  of  suicide. 


514  J-   SYSTEM  OF  LEGAL  MEDICINE. 

In  the  case  of  Goldschmidt  et  at  vs.  Life  Insurance  Co.,  102  N.  Y.  48G, 
to  the  proofs  of  death  were  added  copies  of  the  verdict  of  the  coroner's 
jury  and  of  the  evidence  presented  to  it,  as  was  required  by  the  company. 
The  verdict  of  the  coroner's  jury  was  that  the  insured  came  to  his  death 
by  suicide  by  means  of  potassium  cyanide.  The  claimant,  in  the  proof 
of  death,  said :  "  We  do  not  admit  that  there  was  any  such  inquest,  ver- 
dict, or  evidence,  and  we  deny  that  the  purported  finding-  of  such  alleged 
jury  was  true  or  well  founded,  and  we  deny  the  fact  alleged  to  have  been 
found  by  such  jury,  and  we  deny  the  truthfulness  of  the  alleged  evidence 
on  which  said  verdict  is  said  to  be  based."  The  court  held  that  the  ver- 
dict of  the  coroner's  jury  was  of  value  in  drawing  attention  to  a  possible 
mode  of  death,  but  that  it  was  in  no  sense  binding  upon  the  plaintiff ;  in 
fact,  it  did  not  even  throw  the  burden  of  proof  upon  them,  but  that  it 
was  necessary  for  the  company  to  prove  that  the  insured  died  by  suicide. 

Similarly  the  company  is  not  bound  by  proofs  of  death  which  it  re- 
ceives, even  though  it  does  not  question  them  at  the  time.  Thus  in  the 
case  of  Grotty  vs. Life  Insurance  Co.,  144  U.  S.  621,  it  was  said:  "Nor  is 
the  fact  that  the  proofs  were  received  by  the  insurance  company  without 
question  an  admission  on  its  part  of  the  truth  of  all  the  matters  stated 
therein.  The  purpose  of  proofs  of  death  in  life  insurance  and  proofs  of 
loss  in  fire  insurance  cases  is  to  put  the  company  in  possession  of  the 
facts  concerning  the  death  or  loss,  as  claimed  by  the  beneficiary  or  in- 
sured, upon  which  it  is  to  base  its  determination  as  to  making  or  refus- 
ing payment ;  and  when  it  receives  such  proof  without  question,  it  is  an 
admission  on  its  part  that  they  are  in  form  sufficient,  but  not  that  all  the 
facts  stated  therein  are  true.  The  policy  in  this  case  called  for  proofs  of 
death  ;  and  the  company  by  its  answer  admitted  that  satisfactory  proofs 
had  been  furnished.  The  fact  that  in  the  blank  it  had  prepared  and 
sent  to  be  filled  out  it  asked  many  questions  which  were  answered  by 
the  claimant,  and  the  proofs  thus  made  were  received  without  objection, 
did  not  prevent  the  company  from  challenging  in  court  the  truth  of  any 
fact  stated  therein,  essential  to  the  plaintiff's  right  of  recovery,  and  did 
not  amount  to  an  admission  on  its  part  respecting  such  fact." 

Medical  Attendance. — There  are  two  questions  of  considerable  im- 
portance in  life  insurance,  which  must  be  treated  together  on  account  of 
their  close  relationship  to  each  other.  These  are :  What  constitutes  a 
family  physician ?  and,  What  is  included  in  the  term  medical  attendance  ? 
The  decisions  have  varied  much,  and  frequently  on  small  technical  points, 
so  that  it  will  be  necessary  to  study  each  case  separately. 

In  the  case  of  Price  vs.  Life  Insurance  Co.,  17  Minn.  473,  the  definition 
of  family  physician  was  discussed  at  length.  The  twenty-fifth  question 
in  the  application  was,  "  Name  and  residence,  of  the  family  physician  of 
the  party,  or  of  one  whom  the  party  has  usually  employed  or  con- 
sulted?" The  answer  was,  "Have  none."  The  majority  of  the  court 
held  as  follows :  "  The  phrase  family  physician  is  in  common  use,  and 
has  not,  so  far  as  we  are  aware,  any  technical  signification.  As  used  in 
this  instance,  and  for  the  purpose  of  the  testimony  appearing  in  this  case, 
the  chief -justice  and  myself  are  of  the  opinion  that  it  may  be  sufficiently 
defined  as  signifying  the  physician  who  usually  attends  and  is  consulted 
by  the  members  of  a  family  in  the  capacity  of  a  physician.  We  employ 
the  word  '  usually,'  both  because  we  do  not  deem  it  necessary  to  constitute 
a  person  a  family  physician  (as  the  phrase  is  used  in  this  instance)  that 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  515 

he  should  invariably  attend  and  be  consulted  by  the  members  of  a  family 
in  the  capacity  of  a  physician,  and  because  we  do  not  deem  it  necessary 
that  he  should  attend  and  be  consulted  as  such  physician  by  each  and 
all  members  of  a  family.  For  instance,  the  testimony  in  this  case  shows 
that  at  the  time  when  the  application  for  insurance  was  made  the  family 
of  Richard  Price  consisted  of  himself,  his  wife,  and  three  or  four  chil- 
dren. We  think  that  a  person  who  usually  attended  and  was  consulted 
by  the  wife  and  children  of  Richard  Price  as  a  physician  would  be  the 
family  physician  of  Richard  Price  in  the  meaning  of  the  above,  twenty- 
fifth  interrogatory,  although  he  did  not  usually  attend  on  and  was  not 
usually  consulted  as  a  physician  by  Richard  Price  himself." 

McMillen,  J.,  did  not  agree  with  this  part  of  the  opinion,  and  said, 
with  a  great  deal  of  propriety,  that  a  man  might  have  one  physician  for 
his  family  and  another  for  himself ;  and  that,  according  to  the  opinion 
above  given,  he  would  be  obliged  to  withhold  the  name^of  his  personal 
physician.  This  would  certainly  be  contrary  to  the  intent  of  the  ques- 
tion^ In  concluding  he  says  (p.  497):  "I  think  the  phrase,  as  used  in 
this  instance,  means  the  physician  who  usually  attends  and  is  consulted 
by  all  or  most  of  the  members  of  the  family  of  the  person  whose  life  is 
assured,  and  that  the  person  thus  assured,  if  he  has  medical  attendance, 
must  be  one  of  the  members  attended  by  such  physician."  This  defini- 
tion seems  a  more  reasonable  one  than  that  which  prevailed. 

In  the  case  of  Cushman  vs.  Life  Insurance  Co.,  70  N.  Y.  72,  the  insured 
stated  in  his  application  that  Dr.  P.  was  his  "  usual  medical  attendant," 
but  in  the  proofs  of  death  Dr.  O.  stated  that  he  had  been  "  attendant  phy- 
sician "  upon  Cushman  for  the  preceding  five  years,  covering  the  period 
of  the  former  declaration.  It  was  held  that  this  did  not  falsify  the  state- 
ment in  the  application,  for  "  a  party  may  have  several  '  attending  physi- 
cians'  and  one  'usual  medical  attendant.'"  Furthermore,  Cushman  was 
not  responsible  for  the  statements  made  by  Dr.  O. 

If  the  company  accepts  any  ambiguous  or  incomplete  answer  concern- 
ing medical  attendance,  and  on  the  strength  of  it  issues  a  policy,  it  must 
abide  the  consequences.  It  cannot  then  plead  that  this  ambiguity  or 
incompleteness  estops  the  insured  from  recovering.  Thus  in  the  case  of 
Higgins  vs.  Life  Insurance  Co.,  74  N.  Y.  6,  the  question  in  the  application 
was,  "  Name  and  residence  of  the  family  physician  of  the  party,  or  of  one 
whom  the  party  has  usually  employed  or  consulted  ? "  The  answer  was, 
"  Refer  to  Dr.  A.  T.  Mills,  Corning,  N.  Y."  It  was  proven  that  the  in- 
sured had  occasionally  consulted  another  physician,  but  for  no  serious 
ailment,  and  to  110  greater  extent  than  he  had  Dr.  Mills.  It  was  held 
that  the  answer  above  given  did  not  affirm  a  fact,  and  so  did  not  consti- 
tute a  warranty.  It  was  further  held  that  the  answer  was  indefinite  and 
not  responsive  ;  that  the  company,  having  issued  a  policy  on  the  strength 
of  it,  showed  that  they  were  satisfied  with  it.  This  is  a  fair  vieAv.  and 
one  that  will  commend  itself  to  eveiy  lover  of  accuracy.  The  defense 
was  a  pure  quibble,  and  had  very  properly  no  standing  in  court  on  this 
point. 

As  regards  what  is  comprised  under  the  term  medical  attendance, 
the  decisions  are  varying  and  conflicting.  It  would  seem  as  if  the  term 
ought  to  include  all  medical  advice  sought  for  by  a  person  from  a  physi- 
cian, whether  that  advice  consisted  in  the  administration  or  prescribing 
of  medicines,  the  use  of  instruments  or  other  applications,  or  simply  the 


516  A   SYSTEM  OF  LEGAL  HEDLCLNE. 

regulation  of  the  diet  or  other  hygienic  measures.  Many  a  real  disease  is 
improved  by  the  simple  regulation  of  the  diet  without  the  use  of  a  single 
drug.  Notice  how  frequently  sugar  disappears  from  the  urine  after  the 
elimination  of  starches  and  sugars  from  the  dietary,  and  without  other 
treatment.  It  is  not  at  all  uncommon,  in  some  forms  of  Bright's  disease,, 
for  albumen  to  disappear  when  the  individual  is  put  on  a  restricted  diet, 
such  as  milk,  with  the  addition  of  some  simple  mineral  water  which 
cannot  be  properly  called  a  drug.  On  this  point  we  are  in  accord  with 
a  number  of  decisions.  In  the  case  of  Cobb  vs.  Benefit  Association,  153 
Mass.  176,  the  question  in  the  application  was,  "  Have  you  personally  con- 
sulted a-  physician,  been  prescribed  for,  or  professionally  treated,  within 
the  past  ten  years?"  The  answer  was,  "No."  The  wording  of  the  dec- 
laration and  proposal  was  such  that  the  court  held  that  all  the  statements 
of  the  insured  were  rexu'esentatioiis,  made  material  by  express  agreement 
that  they  were  "  full,  complete,  and  accurate."  This  being  decided,  the 
court  then  held  with  reference  to  the  question  above  stated  as  follows : 
"  The  plaintiff  further  contended  that  the  question  referred  to  in  the  ap- 
plication should  be  construed  as  referring  to  a  specific  disease,  and  that 
if  the  insured  had  consulted  or  been  prescribed  for  by  a  physician  for  a 
pain  that  did  not  amount  to  a  disease,  his  answer  to  this  question  would 
not  prevent  the  plaintiff  from  recovering.  The  presiding  judge  declined 
to  instruct  the  jury  in  accordance  with  this  contention,  and  instructed 
them  that  if  the  insured,  being  as  he  supposed  in  need  of  a  physician, 
went  to  one  for  the  purpose  of  consulting  him  as  to  what  was  the  mat- 
ter with  him,  and  had  an  interview,  answering  such  inquiries  as  the 
physician  deemed  pertinent,  receiving  aid,  advice,  or  assistance  from  him,, 
that  the  insured  consulted  a  physician  within  the  meaning  of  the  inter- 
rogatory ;  and  further,  that  if  they  found  that  he  went  to  a  physician 
for  the  purpose  of  procuring  aid  and  assistance  from  the  physician  as 
such,  and  the  physician  prescribed  a  remedy,  or  treated  him  profession- 
ally, either  by  giving  him  a  prescription  or  by  administering  hypodermic 
injections  of  morphine  (of  which  there  was  some  evidence),  then  he  was 
professionally  treated  within  the  meaning  of  the  interrogatory,  or  pro- 
fessionally prescribed  for.  This  ruling  seems  to  us  correct.  .  .  .  Even 
if  the  insured  had  only  visited  a  physician  from  time  to  time  for 
temporary  disturbances  proceeding  from  accidental  causes,  the  defendant 
had  a  right  to  know  this,  in  order  that  it  might  make  such  further  inves- 
tigation as  it  deemed  necessary.  By  answering  the  question  in  the  nega- 
tive, the  applicant  induced  the  defendant  to  refrain  from  doing  this." 

A  very  similar  conclusion  was  reached  in  the  case  of  Life  Insurance 
Co.  vs.  McTague,  49  N.  J.  L.  587.  In  an  application  for  the  restoration  of 
a  lapsed  policy,  the  applicant  averred  that  he  had  not  "  consulted  or  been 
prescribed  for  by  a  physician  "  since  the  policy  was  issued.  It  was  held 
that  these  averments  were  warranties,  and  it  was  proven  that  he  had  con- 
sulted a  physician,  who  had  prescribed  for  a  "  cold."  The  Appellate  Court 
in  delivering  its  opinion  (p.  592)  says  : 

"  The  Common  Pleas,  in  their  opinion  before  us,  declare  that  this 
fact  did  not  show  the  representation  to  have  been  false,  because  it  did 
not  appear  what  sort  of  a  prescription  the  doctor  gave,  whether  one  com- 
pounded by  a  druggist  or  made  up  of  some  common  remedy.  But  it  is 
obvious  that  this  circumstance  cannot  be  of  the  least  importance  in  de- 
termining the  truth  or  the  falsity  of  the  representation  in  question.    That 


THE  MEDICAL   JURISPRUDENCE   OF  LIFE  INSURANCE.  517 

representation  did  not  aver  a  condition  of  health,  or  that  it  was  requisite 
or  proper  to  consult  a  physician.  It  averred  that  he  had  not  consulted 
a  physician  or  been  prescribed  for  by  a  physician.  The  fact  found  con- 
tradicted this  averment,  whether  the  consultation  and  prescription  related 
to  a  real  disease  or  an  apprehension  of  disease.  Indeed,  so  material  does 
such  a  representation  seem  to  be  to  the  contract  proposed  by  the  applica- 
tion, that,  in  my  judgment,  if  made  falsely  and  knowingly  it  would  avoid 
the  contract.  But  the  materiality  of  the  representation  in  this  case  is 
not  in  question,  for,  as  we  have  seen,  its  truth  is  warranted.  Its  falsity 
appears  from  the  fact  found." 

Another  point  seems  correctly  viewed  iii  the  case  of  Cushman  vs.  Life 
Insurance  Co.,  70  N.  Y.  72  :  "  To  constitute  a  medical  attendance,  it  is  not 
requisite  that  a  physician  should  attend  a  patient  at  his  home ;  an  attend- 
ance at  his  own  office  is  sufficient." 

On  the  other  hand,  we  have  some  decisions  of  an  entirely  different 
tenor,  so  liberal  in  their  scope  as  to  make  one  aghast  at  the  elasticity  of 
a  language  which  will  permit  such  strains.  In  the  case  of  Brown  vs.  Life 
Insuranct  Co.,  6~>  Mich.  30G,  the  policy  was  issued  in  1883.  In  the  appli- 
cation was  the  question,  "Name  of  the  physician  who  last  attended  life 
proposed,  and  when  ? "  The  answer  was,  "  Dr.  H.,  nine  or  ten  years  ago." 
At  the  trial  Dr.  CI.  testified  that  he  had  seen  her  professionally  at  her  house 
five  times  in  two  months  in  1880  ;  Dr.  S.  had  attended  her  professionally 
several  times  in  one  month  in  1881 ;  and  Dr.  Y.  X.  had  seen  her  fourteen 
times  at  his  office  in  the  time  between  October,  1882,  and  May,  1883. 
Against  all  this  testimony  the  court  held  as  follows :  "As  these  questions 
and  answers  ought  to  be  construed  liberally  in  favor  of  the  assured,  I  am 
of  the  opinion  that  the  mere  calling  into  a  doctor's  office  for  soine  medicine 
to  relieve  a  temporary  indisposition,  not  serious  in  its  nature,  could  in  >t 
be  considered  an  attendance  by  a  physician  wdthin  the  meaning  of  this 
question,  nor  would  the  calling  at  the  home  for  the  same  purpose  be  so 
regarded.  The  jury  should  have  been  instructed  that  the  attendance  of 
the  physician  must  have  been  an  attendance  upon  the  assured  for  some 
disease  or  ailment  of  importance,  and  not  for  an  indisposition  of  a  day 
or  so,  trivial  in  its  nature,  and  such  as  all  persons  are  liable  to  who  are 
yet  considered  to  be  in  sound  health  generally." 

In  the  case  of  Life  Insurance  Co.  vs.  Schultz,  73  111.  586,  the  insured 
gave  a  negative  answer  to  the  question,  "  Has  the  party  employed  or  con- 
sulted, individually,  any  physician  ?  Please  answer  this  yes  or  no.  When 
yes,  please  give  name  or  names  and  residence." 

This  would  seem  to  be  about  as  direct  and  unequivocal  a  question  as 
could  be  put.  It  was  entirely  free  from  the  uncertainty  inhering  in  the 
terms  family  physician  or  usual  medical  attendant.  It  would  seem  to 
refer  distinctly  to  the  employment  of  any  physician  for  any  cause  by 
the  insured  within  a  time  limited  only  by  his  capacity  for  remembering. 
It  was  proven  that  the  insured,  about  one  year  prior  to  his  examination, 
had  a  large  axillary  abscess,  which  confined  him  to  his  bed  for  about  a 
week,  and  that  he  was  attended  several  times  by  a  physician  for  this 
condition.  Under  these  circumstances  it  would  seem  to  any  reasonable 
mind  that  the  answer  to  the  above  question  was  a  direct  falsification. 
Of  course  the  jury  gave  the  usual  verdict,  and  on  appeal  it  was  held : 
"By  the  particular  form  of  the  question,  the  mind  is  naturally  directed 
to  a  time  recent,  and  well  might  be  to  the  subject-matter  in  connection 


518  ^   SYSTEM  OF  LEGAL   MEDICINE. 

with  which  the  question  is  asked,  namely,  the  application  for  a  life  insur- 
ance, and  fitness  as  a  subject  of  insurance,  and  the  question  not  unnatu- 
rally might  he  understood  as  an  inquiry  whether  the  party  had  employed 
or  consulted  a  physician  with  reference  to  having  his  life  insured.  The 
auxiliary  '  have/  as  here  used,  serves  to  denote  a  tense,  grammatically, 
which  expresses  an  action  past,  and  often  that  which  is  just  past  and 
completed.  To  allow  the  interrogatory,  as  pxit,  to  have  reference  to 
any  accomplished  event  wholly  disconnected  with  the  application,  and 
which  may  have  taken  place  in  any  previous  period  of  time  then  fully 
completed',  would  be  to  sajr  that  it  covered  the  whole  period  of  the  ap- 
plicant's life.  To  give  any  such  effect  to  the  interrogatory  would  be  to 
make  it  extremely  misleading  to  the  applicant.  We  are  of  the  opinion 
the  question  was  not  sufficiently  definite  and  specific  as  regards  time,  to 
warrant  the  finding  of  a  breach  of  warranty  upon  this  point,  from  the 
fact  of  the  insured  having  employed  a  physician  six  months  or  a  year 
and  a  half  before,  in  the  way  as  testified."  This  case  is  particularly 
flagrant,  as  there  was  considerable  medical  testimony  to  show  that  the 
applicant  died  of  pyaemia,  which  certainly  might  have  had  some  connec- 
tion with  this  abscess.  This  would  seem  to  belong  to  that  rare  class  of 
cases  in  which  judicial  liberty  has  become  license. 

In  the  case  of  BiUebar  vs.  Life  Insurance  Co.,  69  N.  Y.  256,  a  ruling 
was  made  which  was  directly  opposed  to  the  doctrines  we  have  stated  in 
the  section  on  partial  and  incomplete  answers.  In  the  application  the 
following  questions  and  answers  are  given : 

UQ.  Has  the  party  had,  during  the  past  ten  years,  any  sickness  or 
disease  ?  If  so,  state  particulars,  and  the  name  of  the  physician  or  phy- 
sicians who  prescribed  or  who  were  consulted. 

"A.  Nine  years  ago  had  an  attack  of  typhoid  fever. 

UQ.  Have  you  employed  or  consulted  any  physician  for  yourself  or 
your  f amily  ?     If  so,  give  name  or  names  and  residence. 

"A.  Dr.  Paine,  Putnam,  Conn.,  nine  years  ago ;  he  is  now  dead." 

It  was  proven  that  one  year  prior  to  examination  the  applicant  had 
had  an  hemoptysis  for  which  he  was  attended  by  a  physician ;  and  an- 
other physician  testified  that  he  treated  insured  and  his  Avife  only  a  few 
weeks  before  the  application  for  insurance.  In  spite  of  this  the  Court 
of  Appeals  stated  that :  "  It  was  not  said  that  he  had  no  other  physician, 
and  if  a  fuller  and  more  precise  answer  was  desired  the  defendant  should 
have  exacted  it.  It  was  full  and  complete  so  far  as  it  went.  If  a  question  is 
not  answered  there  is  no  warranty  that  there  is  nothing  to  answer.  And 
so  in  the  case  of  a  partial  answer,  the  warranty  cannot  be  extended  beyond 
the  answer.  Fraud  ma}r  be  predicated  upon  the  suppression  of  truth, 
but  breach  of  warranty  must  be  based  upon  the  affirmation  of  something 
not  true.  Here  there  was  no  warranty  that  the  answer  stated  the  names 
of  all  the  physicians  whom  he  had  employed  or  consulted  at  any  time.  It 
is  true  that  in  the  agreement  annexed  to  the  application  it  is  said  that  the 
answers  are  warranted  to  be  full.  But  what  was  intended  by  these  words, 
and  what  had  the  assured  a  right  to  suppose  was  intended  by  them? 
AVas  it  intended  that  the  insured  should  lose  the  benefit  of  his  policy, 
after  parting  with  his  money,  if  he  omitted  innocently  or  inadvertently 
to  give  the  name  of  every  physician  who  at  any  time  had  been  employed 
for  himself  or  for  his  family  in  any  illness,  however  temporary  or  trill- 
ing?    The  circumstances  under  which  the  words  were  used  forbid  such 


THE  MEDICAL   JURISPRUDENCE   OF  LIFE  INSURANCE.  519 

a  construction.  The  assured  had  answered  many  questions  calling-  for 
minute  information  on  many  subjects,  and  for  the  substantial  truth  of 
his  answers  he  was  responsible.  The  other  thing  to  be  provided  against 
was  the  suppression  of  the  truth,  and  hence  in  the  agreement  there  is  a 
warranty  that  the  answers  are  full,  and  that  no  material  circumstance 
has  been  '  concealed  or  withheld.'  Taking  all  the  language  used,  the 
meaning  was  that  the  answers  were  true,  and  that  \X\ey  were  full,  in  the 
sense  that  the  assured  had  not  intentionally  concealed  or  withheld  any 
material  fact  or  circumstance.  The  assured  could  not  have  understood 
from  all  the  language  used  that  if  he  answered  honestly  all  the  questions 
put  to  him,  he  was  to  lose  the  benefit  of  his  policy  in  case  he  omitted 
some  fact  requisite  to  make  any  one  of  the  numerous  answers  full,  be- 
cause his  attention  was  not  particularly  called  to  it,  or  because  it  had  es- 
caped his  attention  or  memory,  or  because  he  did  not  deem  it  material  to 
a  full  answer.  Warranties  in  policies  of  insurance  are  strictly  construed. 
They  will  not  be  extended  to  include  anything  not  necessarily  implied  in 
their  terms." 

This  is  not  a  ruling  which  will  stand  with  time.  Good  faith  on  the 
part  of  the  insured  necessitated  a  more  complete  answer  than  was  given. 
The  facts  concealed  were  material,  and  had  they  been  disclosed,  it  is  safe 
to  assume  that  the  company  would  never  have  taken  the  risk.  Only  by 
■concealing  these  facts  was  the  applicant  enabled  to  obtain  the  insurance. 
The  negligence  which  will  omit  to  mention  an  hemoptysis  occurring  within 
a  year  is  too  culpable  to  be  excused.  The  precedent  here  established  is 
very  bad,  and  at  variance  with  other  decisions  on  similar  points. 

Sound  Health. — What  constitutes  sound  or  good  health  from  a  life 
insurance  point  of  view  ?  This  phrase  certainly  does  not  mean  absolute 
perfection  of  physical  health,  for  on  that  construction  hardly  any  one 
would  be  insurable.  The  actuarial  calculations,  on  which  are  based  the 
premiums  of  the  company,  are  supposed  to  have  for  their  foundation 
persons  of  average  good  health,  but  they  do  not  require  more  than  that. 
At  the  same  time  the  boundary  line  between  sound  and  unsound  health 
is  very  ill-defined  and  unsubstantial,  they  merge  into  one  another  so  in- 
sensibly. 

Some  of  the  old  decisions  on  this  point  are  more  amusing  than  valu- 
able now.  Sir  James  Ross  took  out  a  policy  of  insurance  for  one  year 
from  October,  1759,  and  he  then  warranted  that  he  was  in  good  health. 
He  died  before  the  end  of  the  year,  and  payment  was  resisted  on  the 
ground  of  a  breach  of  this  warranty.  It  was  proven  that  he  had  received 
a  wound  in  his  loins,  in  the  year  1747,  which  gave  rise  to  incontinence 
•of  urine  and  fa?ces.  It  was  shown  that  this  had  no  connection  with  the 
disease  of  which  he  died.  There  was  some  medical  testimony  to  the  effect 
that  the  incontinence  was  not  a  disorder  which  tended  to  shorten  life. 
Lord  Mansfield  said:  "The  question  of  fraud  cannot  exist  in  this  case. 
When  a  man  makes  insurance  upon  a  life  generally,  without  any  repre- 
sentation of  the  life  insured,  the  insurer  takes  all  the  risk,  unless  there 
was  some  fraud  in  the  person  insuring,  either  by  his  suppressing  some 
circumstance  which  he  knew,  or  by  alleging  what  was  false.  But  if  the 
person  insuring  knew  no  more  than  the  insurer,  the  latter  takes  the  risk. 
When  an  insurance  is  upon  a  representation,  every  material  circumstance 
should  be  mentioned,  such  as  age,  way  of  life.  etc.  But  where  there  is 
a  warranty,  then  nothing  need  be  told,  but  it  must  in  general  be  proved, 


520  A   SYSTEM  OF  LEGAL  MEDLCLNE. 

if  litigated,  that  the  life  was  in  fact  a  good  one,  and  so  it  may  be,  though, 
he  have  a  particular  infirmity.  The  only  question  is,  whether  he  was  in 
a  reasonably  good  state  of  health,  and  such  a  life  as  ought  to  be  insured 
on  common  terms."  Needless  to  say,  the  jury  promptly  found  for  the 
plaintiff. 

In  another  case,  about  the  same  time  or  a  little  later,  the  same  judge 
remarked,  in  reference  to  a  warranty  of  good  health,  that  "such  a  war- 
ranty can  never  mean  that  a  man  has  not  the  seeds  of  a  disorder.  AW 
are  all  born  with  the  seeds  of  mortality."  To  this  there  can  certainly  be 
no  objection ;  but  when  the  learned  judge  goes  on  to  say  that  this  war- 
ranty is  not  broken  in  the  case  of  a-  man  who  was  subject  to  the  gout,, 
one  is  startled.  It  is  very  likely,  however,  that  his  personal  medical  igno- 
rance compared  favorably  with  that  of  the  times.  Both  of  these  cases 
would  be  thrown  out  of  court  at  the  present  time. 

After  all,  the  question  is,  provided  the  man  is  not  in  absolutely  per- 
fect physical  health,  which  condition  from  our  own  experience  is  the 
height  of  rarity,  Is  there  a  fair  possibility  that  the  ailment  from  which 
he  is  suffering  will  tend  to  shorten  life  in  the  degree  in  which  he  has  it? 
This  way  of  putting  the  question  seems  simple  enough  until  it  comes  to 
a  particular  application.  In  the  case  of  Watson,  vs.  Mainwaring,  4  Taun- 
ton's Rep.  763,  the  term  "  good  health  "  was  construed  very  liberally. 
The  insured  concealed  from  the  company  the  fact  that  he  had  had  con- 
siderable dyspepsia.  It  was  certified  that  this  disease  was  the  ultimate 
cause  of  death,  although  it  was  much  disputed  whether  it  was  organic 
at  the  time  of  the  application.  The  fact  that  he  died  from  the  dyspepsia 
would  seem  reasonably  conclusive  that  it  was  organic.  In  spite  of  this 
it  was  held  that  "  all  disorders  have  more  or  less  tendency  to  shorten  lifer 
even  the  most  trifling ;  as,  for  instance,  corns  may  end  in  a  mortification  ; 
but  that  is  not  the  meaning  of  the  clause.  If  dyspepsia  were  a  disor- 
der that  tended  to  shorten  life,  within  this  exception  the  lives  of  half  the 
members  of  the  profession  of  law  would  be  uninsurable."  By  these 
generalities  the  judge  completely  ignored  the  fact  that  the  insured  had 
died  from  the  same  disease  which  he  was  proven  to  have  had  at  the  time 
he  made  application. 

In  more  recent  times  the  term  has  been  construed  very  variably.  On 
the  one  hand  it  has  been  held  not  to  mean  perfect  physical  health.  Thus 
in  the  case  of  Morrison  vs.  Life  Insurance  Co.,  59  Wis.  162,  it  wras  said : 
"  It  would  be  most  unreasonable  to  interpret  the  term  l  in  sound  health,* 
as  used  in  contracts  for  life  insurance,  to  mean  that  the  insured  is  abso- 
lutely free  from  all  bodily  infirmities  or  from  all  tendencies  to  disease. 
If  that  were  its  meaning,  we  apprehend  that  but  few  persons  of  middle 
age  could  truthfully  say  they  were  in  sound  health."  Of  very  similar 
purport  was  the  charge  to  the  jury  in  the  case  of  Gaucher  vs.  Life  Insur- 
ance Assn.,  20  Fed.  Rep.  596  :  "  The  term  l  good  health,'  as  here  used,  does 
not  import  a  perfect  physical  condition.  It  would  not  be  reasonable  to 
interpret  it  as  meaning  absolute  exemption  from  all  bodily  infirmities,  or 
from  all  tendencies  to  disease." 

Some  very  good  dicta  are  laid  down  in  the  case  of  Peacock  vs.  Life 
Insurance  Co.,  20  N.  Y.  293,  296.  "The  epithet  'good'  is  comparative. 
It  does  not  require  absolute  perfection.  When,  therefore,  one  is  described 
as  being  in  good  health,  that  does  not  necessarily  nor  ordinarily  mean 
that  he  is  absolutely  free  from  all  and  every  ill  which  '  flesh  is  heir  to." 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  521 

If  the  phrase  should  be  so  interpreted  as  to  require  entire  exemption 
from  physical  ills,  the  number  to  whom  it  would  be  strictly  applicable 
would  be  very  inconsiderable.  In  applying  terms  somewhat  indefinite, 
reference  should  be  had  to  the  business  to  which  they  relate.  This  rule 
is  very  necessary  when  construing  a  language  which,  like  ours,  is  defect- 
ive in  precision.  The  most  important  question  on  applications  for  life  in, 
surance  is,  whether  the  proponent  is  exempt  from  any  dangerous  disease- 
one  which  frequently  terminates  fatally.  It  is  not  usually  deemed  an  objec- 
tion that  one  has  some  slight  physical  disturbance,  of  which  in  all  human 
probability  he  will  soon  be  relieved,  although  it  might  possibly  lead  to  a 
fatal  disease.  A  slight  difficulty,  such  as  the  sting  of  a  bee,  the  puncture 
of  a  thorn,  a  boil,  or  a  common  cold,  has  sometimes  induced  complaints 
which  have  shortened  human  life ;  but  this  result  is  so  infrequent  and 
improbable  that  the  mere  possibility  is  disregarded  in  the  business  of 
life  insurance."  If  any  fault  could  be  found  with  these  excellent  obser- 
vations, it  might  be  in  the  use  of  the  word  "frequently,"  which  we  have 
italicized.  This  objection,  however,  is  practically  obviated  by  the  rest 
of  the  quotation. 

An  opinion  which  was  more  open  to  criticism  was  rendered  in  the 
case  of  Brown  vs.  Life  Insurance  Co.,  65  Mich.  306,  314.  "  The  '  sound 
health '  evidently  meant  in  the  application  is  a  state  of  health  free  from 
any  disease  or  ailment  that  affects  the  general  soundness  and  healthful- 
ness  of  the  system  seriously,  not  a  mere  temporary  indisposition  which 
does  not  tend  to  weaken  or  undermine  the  constitution  of  the  assured. 
The  instruction  that  the  disease  must  be  '  of  serious  nature '  is  objected 
to,  and  it  may  seem  at  first  blush  to  be  too  strong  a  term  to  use ;  but  it 
is  difficult  to  see  how  a  person  can  be  in  unsound  health  or  unsound 
condition  of  body  or  mind  without  the  disease  that  causes  such  condi- 
tion is  a  serious  one.  If  the  affliction  is  of  a  permanent  character,  it 
must  certainly  be  a  serious  one ;  and  if  it  is  merely  temporary,  and  to 
pass  away  without  serious  results,  it  cannot  well  be  said  to  render  a  per- 
son unsound  in  his  general  health.  The  word  'serious'  is  not  generally 
used  to  signify  a  dangerous  condition,  but  rather  to  define  a  grave,  im- 
portant, or  weighty  trouble."  Against  this  we  can  say  that  there  are 
numerous  afflictions  which  are  permanent  but  not  serious,  such  as  nasal 
catarrh,  for  example.  Furthermore,  lobar  pneumonia  is  usually  tempo- 
rary, the  mortality  being  only  about  fifteen  percent.,  and  recovery  being 
generally  complete.  But  no  one  would  say  that  this  was  not  a  serious 
disease,  or  that,  while  it  lasted,  the  individual  was  in  sound  health. 

Now  let  us  suppose  that  the  insured,  at  the  time  of  making  application, 
had  some  disease  of  which  he  was  entirely  ignorant,  and  which  was  not 
inquired  about  iu  the  application ;  and  let  us  also  suppose  that  he  war- 
ranted that  he  was  in  good  health.  Such  a  case  was  presented  in  Hutch- 
ison vs.  Life  Assurance  Society,  3  Bigelow's  Life  and  Ace.  Ins.  Rep.  444. 
The  case  was  submitted  to  the  Court  of  Session  in  Scotland  with  a  note 
from  the  lord  ordinary,  in  which  he  said :  "  The  defenders  allege  that 
there  has  been  a  breach  of  the  warranty  thus  undertaken  by  the  insured. 
And  without  going  into  the  details,  it  will  be  found  that  their  plea  upon 
the  warranty  results  in  this :  if  it  shall  be  proved  that,  at  the  date  of 
opening  the  policy,  Mrs.  Armstrong  was  not  healthy,  or  free  from  dis- 
ease, but  was  affected  by  a  particular  disease  (not  being  one  of  those  par- 
ticularly mentioned,  and  in  regard  to  which  a  special  query  was  put  and 


522  A   SYSTEM  OF  LEGAL  MEDICINE. 

answer  given),  this  amounts  in  law  to  a  breach  of  warranty,  although,  to 
all  appearance,  and  so  far  as  her  knowledge  went,  she  was  at  the  time  in 
perfect  and  robust  health,  and  had  no  disease  whatever;  and  although 
there  may  have  been  no  negligence  or  want  of  attention  to  render  her 
actual  ignorance  inexcusable,  the  disease  alleged  to  have  existed  never 
having  exhibited  itself,  and  being,  while  present  in  the  frame,  entirely 
undiscernible  to  all  ordinary  or  even  the  most  skillful  observation.  .  .  . 

"  Now,  holding  that  in  construing  the  warranty  the  intention  of  the 
parties  must  be  found  out  by  a  reference  to  the  subject-matter,  it  is  diffi- 
cult to  see  how  the  declaration  of  the  party  insured,  that  'I  am  now' 
(that  is,  at  the  date  of  the  policy)  'in  good  health  and  do  ordinarily 
enjoy  good  health,'  can  be  held  to  import  a  warranty  or  undertaking  by 
the  policy  that  he  is  free  not  only  from  any  disease  which  has  positively 
affected  his  health,  but  from  any  latent  disease  tending  to  shorten  life, 
although  it  has  never  sensibly  affected  his  health;  and  that  the  decla- 
ration must  be  true  in  the  latter  sense  in  order  to  support  the  policy. 
Such  a  declaration,  it  is  thought,  in  its  natural  and  obvious  meaning, 
imports  an  answer  to  an  inquiry  capable  of  being  answered  by  the  party 
at  whom  it  is  made ;  and,  therefore,  has  reference  to  the  apparent  and 
known  condition,  present  or  past,  of  the  individual  as  respects  his  act- 
ual enjojmient  of  good  or  bad  health,  or  to  his  positive  experience  in  re- 
gard to  health,  and  not  to  the  possible  existence  of  some  disease,  which, 
however  injurious  in  its  character,  has  had  no  perceptible  influence  upon 
the  health,  or  no  influence  which  can  impeach  the  truth  of  the  declaration 
— applying  it  to  the  feelings  and  experience  of  the  party — that  he  is  in 
good  health  and  ordinarily  enjoys  good  health.  To  extend  the  warranty 
undertaken  by  such  a  declaration  so  as  to  make  it  embrace  the  latter 
case  would  be  an  excessive  stretch  of  its  meaning,  if  indeed  it  will,  by 
any  violence,  admit  of  that  meaning  being  put  upon  it." 

Further  on  in  the  same  case  Lord  Fullerton  makes  these  excellent 
remarks:  "If  the  term  'good  health'  means  the  perfect,  conscious  enjoy- 
ment of  all  one's  faculties  and  functions,  and  the  conscious  freedom  from 
any  ailment  affecting  them,  or  any  symptom  of  ailment,  the  question  may 
be  asked  and  answered ;  but  if  the  term  is  construed  as  meaning  an  ab- 
solute freedom  from  all  defect  or  derangement,  imperceptible  as  well  as 
perceptible,  the  declaration  is  one  which  cannot  be  made,  and  which  it 
would,  therefore,  be  absurd  to  ask.  And  when  the  defenders  represent 
it  as  a  warranty,  nothing  is  gained  in  the  inquiry,  because  the  question 
occurs,  'What  is  it  which  was  warranted?  Good  health;'  and  that  just 
leads  to  the  same  inquiry,  in  what  sense  the  term  was  employed ;  for,  it 
will  be  observed,  there  is  here  no  express  warranty  by  which  a  party 
may,  and  often  does,  take  the  risk  of  events  or  circumstances  on  which  he 
possesses  no  present  information.  Here  the  warranty  is  at  best  only  im- 
plied from  the  term  of  a  declaration,  asked  by  one  party  and  given  by 
the  other,  and  which  is  made  part  of  the  contract ;  and  as  the  term  is 
used  in  mere  declaration,  its  sense  must  be  determined  by  that  which 
it  evidently  bears  in  the  passage  containing  it.  The  provision,  that  the 
declaration  shall  form  the  basis  of  the  contract,  may  be  held  to  render  the 
declaration  equivalent  to  a  warranty ;  but  still  the  point,  what  is  declared, 
and  consequently,  what  is  warranted,  depends  on  the  construction  of 
the  declaration,  and  in  choosing  between  the  two  senses  of  the  disputed 
term,  according  to  one  of  which  a  party  may  declare,  while,  according 


THE  MEDICAL  JUIUSPEUDEXCE   OF  LIFE  IXSUEAXCE.  523 

to  the  other,  it  would  be  absurd  to  ask  and  impossible  to  give  a  declara- 
tion, the  former  sense  must,  according  to  every  rule  of  construction,  be 
adopted."  The  court  finally  issued  an  interlocutor,  in  which  they  said 
that  the  declaration  "  I  am  now  in  good  health,  and  do  ordinarily  enjoy 
good  health  "  imports  "  a  warranty  only  to  the  effect  that  the  declarant 
was  and  had  been,  according  to  her  own  knowledge  and  reasonable 
belief,  free  from  any  disease  or  from  any  symptom  of  disease  material 
to  the  risk,  and  that  they  do  not  import  a  warranty  against  any  latent 
and  imperceptible  disease,  that  could  only  be  discovered  by  post-mortem 
examination,  or  from  symptoms  disclosing  themselves  at  an  after  period 
of  time." 

This  decision  was  certainly  very  liberal  to  the  insured,  but  it  was 
completely  transcended  in  the  case  of  Life  Association  vs.  Foster,  4  Bige- 
low's  Life  and  Ace.  Rep.  520,  and  the  doctrine  expressed  above  was 
carried  to  an  unreasonable  length.  In  this  case  it  appears  that  the  in- 
sured had  at  the  time  of  making  application,  and  for  some  months  prior, 
a  swelling  in  the  groin,  the  existence  of  which  she  knew.  This  was  a 
hernia,  which  became  strangulated  and  caused  death  within  six  months 
of  the  time  of  taking  out  the  policy.  She  was  asked  in  the  application 
if  she  had  rupture,  and  gave  a  negative  answer,  as  she  did  not  know  the 
nature  of  the  swelling  in  the  groin.  The  following  declaration  was  also 
made  by  her :  "  I  undertake  that,  in  the  event  of  my  having  rupture, 
either  now  or  at  any  other  future  time,  I  will  constantly  wear  a  properly 
adjusted  truss."  She  did  not  comply  with  this  declaration  for  the  same 
reason,  that  of  ignorance.  The  court  held  that  there  was  no  negligence 
on  the  part  of  the  insured  in  not  having  mentioned  the  existence  of  the 
swelling  in  the  groin,  since  persons  without  medical  knowledge  could 
not  be  expected  to  know  that  it  was  material,  and  that,  as  the  answers 
were  not  absolute  warranties,  the  policy  was  not  avoided.  It  seems  to 
us  that  the  doctrine  of  irresponsibility  from  ignorance  was  carried  to  an 
extreme  in  this  case,  as  the  question  about  hernia  was  specifically  asked 
and  attention  was  again  drawn  to  the  subject  by  the  declaration. 

The  opinion  given  in  these  two  Scotch  decisions  is  radically  different 
from  the  decisions  rendered  in  English  cases.  Thus  in  the  case  of  Duckett 
vs.  Williams,  3  Bigelow's  Life  and  Ace.  Ins.  Rep.  8,  it  was  decided  that 
absolute  truth  must  prevail.  "A  statement  is  not  the  less  untrue  because 
the  party  making  it  is  not  apprised  of  its  untruth."  But  it  must  be 
noted,  however,  that  the  declarations  in  this  case  were  made  by  third 
parties,  and  not  by  the  insured.  It  might  well  be  held  that  in  such  a 
case,  where  one  states  as  a  matter  of  fact  that  which  is  not  within  his 
own  knowledge,  with  a  view  to  induce  another  to  enter  into  a  contract, 
he  does  so  at  his  own  peril.  Otherwise  he  should  qualify  his  statements 
as  being  to  the  best  of  his  knowledge. 

The  possibility  of  evading  the  issue  is  well  shown  in-  the  case  of 
Fowkes  vs.  Loan  Assn.,  3  Best  and  S.  917.  Here  the  proposal  and  decla- 
ration contained  the  proviso  that  if  "  any  fraudulent  concealment  or  de- 
signedly nn true  statement  be  contained  therein,"  the  policy  should  be 
null  and  void.  Although  the  statements  of  the  insured  were  warranted, 
it  was  held  that  an  untrue  statement  about  good  health  did  not  avoid  the 
policy  unless  it  was  designedly  untrue. 

Freedom  from  Disease. — This  is  another  phase  of  the  question  just 
discussed.     The  insured  states  that  he  is  free  from  some  disease,  specif- 


524  A   SYSTEM  OF  LEGAL  MEDICINE. 

ically  mentioned,  or  from  any  serious  illness.  Of  course  the  question 
arises,  What  constitutes  a  serious  illness  ?  Very  good  limitations  were 
given  in  the  case  of  Goucher  vs.  Life  Insurance  Assn.,  20  Fed.  Rep.  59G, 
where  it  was  said  that  "  clearly  the  term  '  severe '  or  '  serious '  illness  does 
not  mean  slight  temporary  physical  disturbances  or  ailments,  speedily 
and  entirely  recovered  from,  not  materially  interfering  with  the  pursuit 
of  one's  avocation,  producing  no  permanent  effect  on  the  constitution, 
and  not  rendering  the  insurance  risk  more  than  usually  hazardous." 

The  cases  under  this  head  can  be  divided  into  three  groups.  In 
one  the  contract  is  construed  liberally  in  favor  of  the  insured,  he  being 
usually  held  more  or  less  irresponsible  on  account  of  ignorance.  In  the 
second  group  the  statements  are  held  to  be  warranties  and  the  contract 
is  interpreted  very  rigidly.  In  a  third  set  there  is  evidence  that  the  in- 
sured knew  of  the  existence  of  the  defects  or  diseases,  and,  so  knowing, 
misrepresented  them.     We  will  discuss  each  group  separately. 

1.  One  of  the  earliest  cases  decided  in  this  group  was  that  of  Life 
Insurance  Co.  vs.  Francisco,  17  Wall.  G72,  680.  "  The  principal  defense 
set  up  at  the  trial  was  that  in  the  application  for  insurance  false  answers 
had  been  given  to  the  questions  propounded  by  the  defendants.  These 
questions  were,  in  substance,  whether  the  person  whose  life  was  proposed 
for  insurance  had  had  certain  diseases,  or,  during  the  next  preceding 
seven  years,  any  disease,  and  the  answers  given  were  that  he  had  not.  It 
was  in  reference  to  this  that  the  court  instructed  the  jury  that  it  was  for 
them  to  determine  from  the  evidence  whether  the  person  whose  life  was 
insured  had  had,  during  the  time  mentioned  in  the  questions  propounded 
•on  making  the  application,  any  affliction  that  could  properly  be  called  a 
sickness  or  disease,  within  the  meaning  of  the  term  as  used,  and  said : 
1  For  example,  a  man  might  have  a  slight  cold  in  the  head,  or  a  slight 
headache,  that  in  no  way  seriously  affected  his  health  or  interfered  with 
his  usual  avocations,  and  might  be  forgotten  in  a  week  or  month,  which 
might  be  of  so  trifling  a  character  as  not  to  constitute  a  sickness  or  a 
disease  within  the  meaning  of  the  term  as  used,  and  which  the  party  would 
not  be  required  to  mention  in  answering  the  questions.  But  again,  he 
might  have  a  cold  or  a  headache  of  so  serious  a  character  as  to  be  a  sick- 
ness or  disease  within  the  meaning  of  those  terms  as  used,  which  it  would 
be  his  duty  to  mention,  and  a  failure  to  mention  which  would  make  his 
answer  false.' 

"  There  is  no  just  ground  of  complaint  in  this  instruction,  either  con- 
sidered abstractly  or  in  its  application  to  the  evidence  in  the  case.  It 
was,  in  effect,  saying  that  substantial  truth  in  the  answer  was  what  was 
required." 

The  argument  advanced  in  the  preceding  opinion  has  many  points  in 
its  favor.  But  a  little  extension  of  the  same  idea  borders  on  the  unrea- 
sonable. The  same  court,  in  the  later  case  of  Moulor  vs.  Life  Insurance 
Co.,  Ill  U.  S.  335,  343,  went  to  much  greater  length  in  this  question. 
The  declarations  made  by  the  insured  were  to  the  effect  that  statements 
"  untrue  in  any  respect "  would  avoid  the  policy.  There  was  considerable 
proof  that  some  of  the  diseases  mentioned  in  the  application  had  existed, 
although  possibly  unknown  to  the  insured.  By  some  adroit  word-jug- 
gling the  statements  denying  the  existence  of  these  diseases  were  con- 
verted into  representations  only,  and  it  was  then  held  as  follows  :  "  Look- 
ing into  the  application  upon  the  faith  of  which  the  policy  was  issued  and 


THE  MEDICAL  JUEISFEUDENCE   OF  LIFE  INSUEJXCE.  525 

accepted,  we  find  much,  justifying  the  conclusion  that  the  company  did 
not  require  the  insured  to  do  more,  when  applying  for  insurance,  than 
observe  the  utmost  good  faith,  and  deal  fairly  and  honestly  with  it,  in  re- 
spect of  all  material  facts  about  which  inquiry  is  made,  and  as  to  which 
he  has  or  should  be  presumed  to  have  knowledge  or  information.  The 
applicant  was  required  to  answer  yes  or  no  as  to  whether  he  had  been 
afflicted  with  certain  diseases.  In  respect  of  some  of  those  diseases,  par- 
ticularly consumption  and  diseases  of  the  lungs,  heart,  and  other  internal 
organs,  common  experience  informs  us  that  an  individual  may  have  them, 
in  active  form,  without  at  the  time  being  conscious  of  the  fact,  and  be- 
yond the  power  of  any  one,  however  learned  or  skillful,  to  discover.  Did 
the  company  expect,  when  requiring  categorical  answers  as  to  the  exist- 
ence of  diseases  of  that  character,  the  applicant  should  answer  with  abso- 
lute certainty  about  matters  of  which  certainty  could  not  possibly  be 
predicated  ?  Did  it  intend  to  put  upon  him  the  responsibility  of  know- 
ing that  which,  perhaps,  no  one,  however  thoroughly  trained  in  the  study 
of  human  diseases,  coidd  possibly  ascertain  ?  .  .  . 

"The  entire  argument  in  behalf  of  the  company  proceeds  upon  a 
too  literal  interpretation  of  those  clauses  in  the  policy  and  application 
which  declare  the  contract  null  and  void  if  the  answers  of  the  insured 
to  the  questions  propounded  to  him  were,  in  any  respect,  untrue.  What 
was  meant  by  '  true '  and  '  untrue '  answers  ?  In  one  sense  that  only  is 
true  which  is  conformable  to  the  actual  state  of  things.  In  that  sense, 
a  statement  is  untrue  which  does  not  express  things  exactly  as  they  are. 
But  in  another  and  a  broader  sense  the  word  '  true '  is  often  used  as  a 
synonym  of  honest,  sincere,  not  fraudulent." 

Hence  it  was  held  that  all  that  was  required  of  the  applicant  was  the 
utmost  good  faith  in  answering  the  questions.  This  seems  rather  stretch- 
ing the  meaning  of  "  true,"  especially  in  view  of  the  declaration  made 
by  the  insured  that  statements  "untrue  in  any  respect"  should  avoid  the 
policy. 

In  the  case  of  Horn  vs.  Life  Insurance  Co.,  64  Barb.  81,  this  now 
familiar  doctrine  of  irresponsibility  from  ignorance  was  carried  to  a  still 
further  point.  "  The  applicant  may  not  know  enough  of  the  human  sys- 
tem to  be  aware  of  the  existence  of  some  affection  of  a  vital  organ.  The 
victim  of  Bright's  disease,  or  of  an  affection  of  the  heart,  liver,  or  lungs, 
may  be,  and  often  is,  in  the  enjoyment  of  such  a  condition  of  health  and 
strength  as  to  lead  him  to  the  belief  that  his  vital  organs  are  all  sound. 
It  woidd  be  monstrous  to  hold,  in  such  a  case,  that  the  applicant  war- 
ranted himself  to  be  sound  as  to  those  organs  by  an  answer  to  the  effect 
that  he  was  never  sick,  or  had  no  disease  of  those  organs.  The  company 
retains  their  own  medical  advisers  for  the  purpose  of  making  a  careful 
and  scientific  examination  of  all  applicants  for  life  insurance  ;  and  they 
are  far  better  able  to  detect  incipient  disease  than  the  subject,  in  most 
cases.  I  think  these  statements  are  not  understood  or  intended  by  the 
parties  as  warranties.  I  think  the  judge  at  the  trial  properly  held  that 
the  inquiry  was  one  of  honest  and  fair  dealing  on  the  part  of  the  appli- 
cant, and  that  the  statements  concerning  the  condition  of  his  health  were 
not  warranties.  .  .  . 

"  The  assured  must  state  all  that  he  knows  bearing  upon  the  condi- 
tion of  his  health ;  and  any  untrue  statement  or  concealment  in  this  re- 
spect ought,  justly,  to  render  the  policy  void.     In  all  respects,  where  it 


52G  ^   SYSTEM  OF  LEGAL  MEDICINE. 

appears,  or  it  can  be  proven,  that  the  applicant  had  any  knowledge  of  the 
facts  called  for  by  the  interrogatories,  it  matters  very  little  whether  the 
answer  be  held  a  warranty  or  not,  inasmuch  as  an  untrue  statement  will 
be  a  misrepresentation  or  fraud  which  will  equally  render  the  policy  void." 
This  is  not  an  inequitable  doctrine  if  strictly  applied.  Under  it  the  whole 
burden  of  proving  a  man  sound  would  be  thrown  upon  the  medical  ex- 
aminer ;  but  it  is  well  known  that  in  the  early  stages  of  the  diseases  men- 
tioned above,  especially  consumption  and  Bright's  disease,  the  diagnosis 
can  hardly  be  made  without  material  assistance  from  the  patient  by  in- 
forming the  physician  of  every  little  symptom  that  he  has.  It  is  absurd 
to  expect  that  an  applicant  for  insurance  will  render  such  aid.  On  the 
contrary,  he  undergoes  a  species  of  self-deception  and  glosses  over  all 
that  he  can,  even  though  he  knows  that  he  is  not  as  strong  as  he  has 
been.  He  does  not  do  this  exactly  willfully  or  consciously,  but  still  he 
does  it.  The  result  is  that,  unless  these  principles  are  veiy  strictly  ap- 
plied, the  company  has  to  bear  all  the  burden  of  the  concealment  of  his 
condition.  This  often  does  not  seem  fair,  nor  what  is  reasonably  to  be 
expected  by  the  insurer.  For  if  it  can  be  proved  by  collateral  evidence 
that  the  insured. had  a  certain  disease  prior  to  the  time  of  examination,  it 
seems  reasonable  to  assume  that,  if  he  had  fully  and  accurately  told  the 
examiner  all  his  symptoms,  the  examiner  would  have  been  able  to  make 
the  correct  diagnosis  by  means  of  them  and  the  physical  signs  which  his 
examination  would  elucidate. 

We  have  seen  in  many  of  the  preceding  cases  that  a  strong  endeavor 
was  made  to  take  the  declarations  and  statements  of  the  applicant  out  of 
the  category  of  warranties  through  some  wording  of  the  clauses  of  the 
contract.  This  is  notably  the  case  in  some  of  the  American  decisions, 
and  in  the  Scotch  cases  brutal  force  was  exerted  to  make  the  statements 
representations.  This  principle  was  very  properly  applied,  however,  in 
the  case  of  Benevolent  Society  vs.  Winthrop,  85  111.  537.  The  declaration 
contained  the  words  "no  misrepresentation  or  suppression  of  known 
facts."  The  court  held  that  the  contract  should  be  construed  in  just 
this  manner,  and  that  the  concealment  must  be  a  willful  one  in  order  to 
avoid  the  policy. 

Similarly  in  the  case  of  Clapp  vs.  Benefit  Assn.,  146  Mass.  519,  the  ap- 
plicant certified  his  statements  "  to  the  best  of  my  knowledge  and  belief." 
It  was  held  that  this  element  of  the  applicant's  knowledge  must  be  con- 
sidered in  all  his  answers. 

2.  In  this  set  of  cases  the  statements  of  the  insured  have  been  held 
to  be  absolute  warranties.  There  are  no  mitigating  expressions  in  the 
contract  and  no  doctrine  of  irresponsible  ignorance  which  would  tend  to 
excuse  the  misstatements  of  the  insured.  These  decisions  seem  to  bear 
hardly  at  times  upon  the  insured,  and  the  tendency  of  the  courts  at  pres- 
ent is  undoubtedly  toward  the  other  interpretation.  One  of  the  stiff  est 
decisions  in  this  set  is  that  given  in  the  case  of  Powers  et  al.  vs.  Life 
Association,  50  Vt.  630.  It  was  proven  that  the  applicant  had  had  heart 
disease  for  seven  years  prior  to  the  application  for  a  policy,  although  he 
very  possibly  might  not  have  known  it.  It  was  held  that  the  answers 
were  warranties,  and  hence  that  "  the  applicant  assumed  the  whole  risk 
of  the  consequences  if  his  answers  turned  out  untrue.  The  existence  of 
disease  in  an  applicant  for  life  insurance  is  the  presence  of  the  very  peril 
that  the  company  insures  against,     It  is  like  insuring  a  building  already 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  527 

on  fire.  The  question  as  to  the  health  of  the  applicant  is  a  preliminary 
one,  to  ascertain  if  he  is  an  insurable  subject.  The  force  of  the  stipula- 
tions and  conditions  above  recited  is,  to  create  a  contract  obligation  on 
the  part  of  the  applicant  that  he  was  free  from  heart  disease.  He  agreed 
that  such  peril  and  risk  would  not  be  encountered  by  issuing-  the  policy, 
and  if  such  peril  did  exist  the  contract  should  not  be  operative.  Proof 
of  the  existence  of  heart  disease  established  a  breach  of  the  underlying 
contract  upon  which  the  policy  rested. 

"  It  is  wholly  immaterial  whether  the  applicant  knew  of  the  existence 
of  the  disease,  because  he  agreed  absolutely  that  it  did  not  exist.  Nor 
is  it  any  answer  to  say  that  the  question  is  a  scientific  one,  and  a  layman 
might  easily  be  deceived  into  a  false  answer.  Scientific  or  simple,  the 
applicant  took  the  risk  of  the  answer.  If  he  had  answered  that  he  had 
no  knowledge  that  the  disease  existed,  the  finding  of  the  jury  might  affect 
the  result." 

Of  very  similar  import  was  the  decision  rendered  in  the  case  of  Bay 
vs.  Life  Insurance  Co.,  4  Bigelow's  Life  and  Ace.  Rep.  15,  23.  "We  are 
of  the  opinion  that  if  the  statements  made  by  Day  in  the  application, 
being  part  of  the  contract  to  procure  the  policy,  were  untrue  in  point  of 
fact,  the  eontract  became  null  and  void.  This  results  from  the  form  of 
the  contract.  It  was  evidently  the  design  to  protect  the  company  from 
the  ignorance,  as  well  as  the  willful  misrepresentations,  of  those  applying 
for  insurance.  If,  for  instance,  Day  did  not  know  or  suppose  that  he 
had  consumption,  although  in  point  of  fact  that  fatal  disease  had  already 
seized  upon  his  lungs,  his  statements  would  be  contrary  to  fact  in  an  im- 
portant respect,  for  no  company  would  insure  a  life  subject  to  so  much 
risk.  It  would  be  untrue  as  matter  of  fact,  and  therefore  fatal  to  the 
contract." 

In  the  case  of  Price  vs.  Life  Insurance  Co.,  17  Minn.  473,  one  of  the 
important  ridings  given  by  the  Appellate  Court  was  as  follows  :  "  But  if 
he  had  any  affection  amounting  to  a  disease  of  the  kind  mentioned,  his 
negative  answer  would  be  a  material  misrepresentation,  no  matter  how 
'trifling'  the  character  of  the  affection,  nor  whether  it  was  remembered 
at  the  time  of  the  application,  nor  whether  it  would  have  any  influence 
on  the  length  of  his  life,  nor  whether  it  would  be  noticed  by  the  medical 
examiner." 

In  the  case  of  Baker  vs.  Life  Insurance  Co.,  64  X.  Y.  648,  the  court 
affirmed  the  rule  that  the  policy  having  been  issued  upon  the  condition 
that,  if  the  statements  should  lie  found  untrue,  the  policy  shoidd  be  void, 
the  untruthfulness  of  such  statements  avoided  the  policy,  and  it  was 
immaterial  whether  they  were  made  in  ignorance  or  fraudulently.  The 
statements  in  the  application  were  warranties,  but  there  was  some  evi- 
dence that  the  applicant  knowingly  misrepresented  the  facts,  or  that  the 
ignorance  amounted  to  culpability.  This  circumstance  possibly  deter- 
mined the  severity  of  the  opinion. 

Similar  considerations  may  have  influenced  the  court  in  the  case  of 
Miles  et  al.  vs.  Life  Insurance  Co.,  3  Gray  580.  Here  it  was  provided  that 
if  the  statements  of  the  insured,  "  upon  the  faith  of  which  this  agreement 
is  made,  shall  be  found  in  any  respect  untrue,  then  and  in  such  case  the 
policy  shall  be  null  and  void."  Testimony  was  presented  that  the  insured 
for  some  time  before  the  application  had  been  troubled  with  bronchitis 
and  consumption ;  that  his  father  had  died  of  consumption,  and  his  brother 


528  ^   SYSTEM  OF  LEGAL  MEDICINE. 

had  been  afflicted  with  some  pulmonary  trouble.  He  had  denied  all  of 
these  facts  when  making  application,  although  possibly  he  was  not  aware 
of  their  existence.  The  court  held  that  "the  statements  and  declarations 
contained  in  the  application  for  insurance,  and  referred  to  in  the  policy, 
were  warranties ;  and  if  any  of  them,  whether  material  or  immaterial  to 
the  risk,  were  untrue,  either  from  design,  mistake,  or  ignorance,  the  plaint- 
iffs cannot  recover." 

A  similar  question  was  raised  in  the  case  of  Vose  vs.  Life  Insurance 
Co.,  6  Cush.  42.  Here  the  applicant  died  of  consumption  soon  after  the 
policy  was  issued.  It  was  proven  that  he  had  the  disease  prior  to  the 
date  of  examination,  although  it  was  possible  that  he  did  not  know  it. 
The  case  was  carried  to  the  Appellate  Court,  and  it  was  there  held  that 
"  it  is  immaterial  that  the  deceased  did  not  suppose  himself  in  a  consump- 
tion ;  the  fact  was  so,  and  the  statement  was  manifestly  contrary  to  the 
fact,  which  was  a  most  material  and  conclusive  fact."  In  the  application 
he  stated  that  he  had  had  some  general  debility  lately,  but  the  court 
ruled  that  "  the  fact  of  the  general  debility  of  the  system,  as  stated  by 
the  insured,  was  not  important  in  the  manner  in  which  it  was  stated ;  as 
it  might  arise  from  a  variety  of  causes  not  materially  affecting  the  risk, 
and  would  not,  therefore,  by  any  means,  give  the  insurers  the  informa- 
tion wanted." 

3.  In  the  second  set  of  cases  it  was  noticed  that  the  severity  of  some 
■of  the  decisions  was  influenced  by  the  suspicion  that  the  insured  knew 
something  of  his  condition  before  he  applied  for  insurance.  The  third 
;set  of  cases  comprise  those  in  which  there  is  good  evidence  that  the  mis- 
representation or  concealment  concerning  health  or  previous  disease  was 
of  facts  known  to  the  applicant,  or  that  should  have  been  known  to  him 
in  all  reasonable  probability.  Under  these  circumstances  the  courts  are 
usually  very  severe  in  their  decisions,  and  hold  the  insured  closely  to  the 
line  of  his  contract.  In  many  of  them  high-sounding  principles  are  laid 
down  which  do  not  well  agree  with  those  offered  in  the  cases  where  irre- 
sponsible ignorance  is  advanced  as  a  palliative.  Thus,  compare  the 
opinion  given  in  Moulor  vs.  Life  Insurance  Co.  (p.  524)  with  that  given  in 
the  case  of  Life  Insurance  Co.  vs.  France  et  al,  91  U.  S.  510.  Here  it  was 
proved  that  the  insured  was  ruptured  in  1846,  in  1854,  and  in  1870,  al- 
though from  1855  until  after  the  examination  in  1865  he  was  compara- 
tively, if  not  absolutely,  free  from  rupture.  He  was  asked  directly  if  he 
had  ever  had  rupture,  and  denied  it.  There  was  no  dispute  that  the  in- 
jured knew  that  he  had  had  a  rupture  prior  to  the  time  of  making  the 
application.  Consequently  the  misrepresentation  was  one  of  facts  known 
to  him,  even  if  it  happened  by  accident.  The  court  reviewed  the  case  of 
Jeffries  vs.  Life  Insurance  Co.,  22  Wall.  47,  and  said :  "It  is  only  necessary 
to  reiterate  that  all  the  statements  contained  in  the  proposal  must  be 
true ;  that  the  materiality  of  such  statements  is  removed  from  the  con- 
sideration of  the  court  or  jury  by  the  agreement  of  the  parties  that  such 
statements  are  absolutely  true,  and  that,  if  untrue  in  any  respect,  the 
policy  shall  be  void." 

Cancer. — By  this  term  nowadays  is  meant  the  carcinomata,  and  on 
a  strict  construction  we  think  it  should  be  limited  to  that  group  of  neo- 
plasms. Thus  Payne  says  (GeuernJ  PatJioioe/i/,  p.  239) :  "The  term  cancer, 
which  was  formerly  used  in  a  clinical  or  physiological  sense  to  signify 
tumors  having  the  properties  called  malignant,  is  now  a  structural  or  ana- 


THE  MEDICAL  JUEISPEUDENCE   OF  LIFE  INS  USANCE.  529 

tomieal  term,  meaning  tumors  arising  from  epithelial  tissues,  and  com- 
posed of  epithelial  cells  irregularly  arranged."  Greene  (Pathology  and  Mor- 
bid Anatomy)  and  also  Satterthwaite  [Reference  Handbook  of  the  Medical 
Sciences,  vol.  i.)  use  the  term  in  a  similar  way.  Some  other  tumors  are 
fullv  as  malignant  as  the  carcinomata. 

Only  one  case  could  be  found  in  which  the  question  of  cancer  arose. 
That  is  the  case  of  Cheever  vs.  Life  Insurance  Co.,  5  Bigelow's  Life  and 
Ace.  Cases  458.  In  it  only  the  clinical  aspects  of  the  malignancy  of  the 
cancer  were  considered,  and  its  histology  was  entirely  overlooked.  One 
•or  two  years  prior  to  the  date  of  policy  the  applicant  had  a  malignant 
tumor  or  cancer  on  his  neck,  which  was  made  the  subject  of  a  medical 
consultation,  at  which  it  was  determined  to  perform  an  operation  He 
changed  his  mind,  however,  and  went  to  a  quack,  who  healed  up  the 
open  sore.  Three  years  after  the  policy  was  issued  the  cancer  recurred 
at  the  original  site,  and  was  ojierated  on,  but  the  insured  died.  The 
jury  gave  the  usual  verdict.  On  appeal  the  court  held  that  the  state- 
ments were  only  material  representations,  but  said :  "  The  point  for  the 
determination  of  the  jury  really  was  whether  or  not  the  recurrence  of  the 
•cancer  or  tumor  was  the  reappearance  of  the  old  trouble,  or  whether  it 
was  a  new  and  distinct  ailment  occurring  after  the  insurance  was  effected. 
If  the  former,  there  should  have  been  a  verdict  for  the  defendant ;  if  the 
latter,  for  the  plaintiff.  The  court  instructed  the  jury  in  effect,  that  if 
the  party  had  once  supposed  and  been  told  that  he  had  cancer,  and  in 
alarm  had  engaged  physicians  to  treat  it  as  such,  and  they  did  so,  but 
that  after  it  healed  they  advised  him  that  it  was  not  a  cancer  or  a  seri- 
ous ailment,  and  he  believed  them,  and  in  fact  it  was  not  what  he  and 
they  once  thought  and  feared,  he  was  excused  from  stating  the  facts,  the 
same  as  he  would  have  been  had  he,  from  eating  green  fruit  or  vegetables 
during  the  prevalence  of  cholera,  been  attacked  with  acute  cholera  mor- 
bus, and,  in  his  alarm,  called  in  several  physicians  to  treat  him,  and  who 
at  the  time  thought  his  disease  was  cholera,  but  that  all  afterward  ascer- 
tained the  trivial  nature  of  the  complaint.  But  we  think  that  the  evidence 
established  clearly  that  the  insured  had  been,  prior  to  Ins  application, 
afflicted  with  a  malignant  fibroid  tumor  or  cancer ;  that  treatment  had 
simply  arrested  it  for  a  time  without  removing  it  from  his  system  ;  and  that 
it  reappeared  and  caused  his  death.  If  we  are  right,  he  misrepresented  the 
fact,  though,  as  we  think,  innocently,  under  the  belief  that  his  ailment  had 
been  trivial,  producing  more  of  fright  than  of  danger.  But  the  effect  of  a 
misrepresentation  of  a  material  and  positive  fact,  upon  which  an  insurer 
relies,  does  not  depend  upon  the  good  faith  or  honest  belief  of  the  appli- 
cant making  the  representation.  Such  representations  must  be  true  ;  and 
if  not  so,  substantially,  the  liability  of  the  insurer  will  be  avoided  where  the 
truth  of  such  representation  is  made  tin- 1  »asis  of  the  contract  of  insurance." 

Under  the  construction  of  this  decision,  *any  malignant  tumor  would 
be  included  under  the  term  "  cancer."  While  this  is  incorrect  anatomi- 
cally, it  probably  represents  the  idea  of  the  framer  of  the  application,  it 
being  rather  an  old  one.  Hence  the  decision,  although  it  might  be  tech- 
nically incorrect,  is  probably  in  consonance  with  the  ideas  prevalent  at 
the  time  the  contract  was  consummated. 

Consumption. —  This  is  a  term  which  is  supposed  to  refer  to  several 
varieties  of  tuberculosis,  especially  pulmonary,  laryngeal,  and  intestinal. 
It  does  not  seem  proper  to  embrace  the  other  varieties  of  tuberculosis 


530  A   SYSTEM  OF  LEGAL  MEDICINE. 

within  this  designation.  There  are,  however,  several  synonyms  used  by 
the  laity  which  it  is  necessary  to  mention.  These  are  hemorrhage  of  the 
lungs,  abscess  of  the  lungs,  disease  of  the  lungs,  and  chronic  pneumonia. 
These  terms  are  largely  used  by  them  in  stating  the  cause  of  death  of 
other  members  of  the  family.  From  the  experience  of  a  life  insurance 
office  we  can  safely  say  that  they  practically  always  mean  consumption. 
Consumption  is  a  more  frequent  cause  of  death  than  any  other  disease. 
About  fifteen  percent,  of  all  deaths  are  to  be  traced  to  this.  When  adults 
only  are  considered,  this  proportion  reaches  nearly  one  third.  It  is  so 
common  and  widespread  that  all  insurance  companies  guard  as  carefully 
as  they  can  against  admitting  cases  of  it.  The  effect  of  this  selection  is- 
very  marked  and  important,  but  not  complete.  The  method  of  examina- 
tion as  usually  practiced  by  life  insurance  examiners  is  not  sufficiently 
thorough  to  eliminate  entirely  this  risk.  It  is  no  easy  matter  to  detect, 
at  times,  the  signs  of  incipient  phthisis  even  under  the  most  favorable  cir- 
cumstances and  when  the  attention  is  drawn  to  it  by  the  history  of  the 
patient.  How  much  more  difficult  is  it  when  the  patient  denies  or  con- 
ceals all  pulmonary  symptoms  ?  But  this  selection  of  risks  has  a  decided 
influence  on  diminishing  loss  to  the  insurer  from  this  disease,  as  can  be 
seen  by  the  following  table  (Mortuary  Statistics  of  the  Mutual  Life,  Insur- 
ance Company  of  Neiv  York,  part  ii.) : 

SHOWING  THE  ANNUAL  NUMBER  OP  DEATHS  FROM  CONSUMPTION  IN  NEW  YORK  CITY" 
AND  IN  THE  MUTUAL  LIFE,  CALCULATED  FOR  10,000  LIVING  AT  EACH  DECENNIAL 
PERIOD   OF   LIFE. 

Age  in  Decennial  Periods.  New  YorJc  City.  Mutual  Life. 

20  to  29  years 70  24 

30  to  39  years 71  20 

40  to  49  years 66  17 

50  to  59  years 84  14 

60  to  69  years 110  18 

70  and  upward 150  30 

This  table  shows  also  how  mistaken  is  the  common  impression  that 
consumption  is  more  prevalent  between  the  ages  of  fifteen  and  thirty. 
To  quote  further  from  this  statistical  report :  "  This  prevailing  but  erro- 
neous opinion  has  originated,  as  suggested  by  Dr.  Walshe,  from  merely 
counting  the  number  of  cases  occurring  at  each  year,  or  period  of  life,, 
without  taking  into  consideration  the  number  of  individuals  living  at  cor- 
responding ages  to  furnish  the  observed  number  of  cases.  For  instance, 
there  are  nearly  three  times  as  many  persons  living  at  the  ages  of  twenty 
to  thirty  years  as  at  fifty  to  sixty  years,  and  consequently,  three  times 
as  many  cases  of  consumption  at  the  earlier  period  as  at  the  later  would 
only  indicate  an  equal  prevalence  of  the  disease  at  both  periods." 

Undoubtedly  many  applicants  are  insured  while  they  are  in  the  first 
stages  of  phthisis.  They  find  out  that  they  have  some  trouble  which  is 
steadily  debilitating  them,  but  to  which  they  do  not  care  to  give  a  name. 
Their  own  doctor  is  ignorant  or  deceives  them.  But  they  know  that 
they  are  not  capable  of  doing  as  much  work  as  formerly,  and  that  their 
physical  health  is  deteriorating.  For  this  reason  they  seek  to  make  sure 
of  some  future  means  of  sustenance  for  their  families,  realizing,  probably 
in  a  vague  way,  that  they  are  no  longer  certain  of  an  apparently  indef- 
inite term  of  life.     In  this  mood  thev  come  to  obtain  insurance,  if  they 


THE  MEDICAL  JUEISPRUDENCE   OF  LIFE  INSURANCE.  531 

can.  But  like  the  man  whose  toothache  fled  when  he  reached  a  dentist's 
door,  their  ideas  on  the  subject  of  ill  health  undergo  a  radical  change 
when  it  comes  to  telling  their  sjanptoms  to  the  medical  examiner.  As  a 
rule  they  do  not  intend  to  deceive,  but  the  little  trifles,  which  make  up 
the  early  history  in  many  cases  of  consumption,  do  not  seem  to  be  of 
sufficient  importance  to  tell  the  examiner.  They  have  not  been  told  that 
they  have  phthisis,  and  of  course  they  do  not  know  it  themselves,  so  what 
is  the  use  of  bothering  the  examiner  with  these  petty  details  about  a 
little  dry  cough,  some  loss  of  weight,  and  an  occasional  pain  in  the  chest  ? 
Besides  that,  he  is  going  to  examine  their  lungs,  and  it  is  his  business  to 
find  out  if  there  is  anything  wrong  there.  And  the  old  story  is  repeated 
in  about  six  months  or  a  year.  The  proofs  of  his  death  are  handed  in, 
the  company  looks  up  the  case,  and  unless  they  find  evidence  of  gross 
fraud,  the  death-claim  is  paid  without  protest,  for  the  futility  of  an  ap- 
peal to  the  jury,  in  such  cases,  is  too  well  known  to  the  loss  department. 

In  the  case  of  Vose  vs.  Insurance  Co.,  6  Cush.  42,  quoted  on  p.  528,  the 
•evidence  was  fairly  conclusive  that  the  applicant  knew  that  he  was  quite 
sick,  even  if  he  did  not  know  that  he  had  consumption,  of  which  he  died 
soon  after  the  issuing  of  a  polic}'.  The  jury  gave  the  usual  verdict  for 
the  plaintiff,  but  on  appeal  it  was  held  as  follows :  "  It  is  immaterial  that 
the  insured  did  not  suppose  himself  in  a  consumption ;  the  fact  was  so, 
.and  the  statement  was  manifestly  contrary  to  the  fact,  which  was  a  most 
material  and  conclusive  fact.  The  fact  of  the  general  debility  of  the 
system,  stated  by  the  insured,  was  not  important  in  the  manner  in  which 
it  was  stated,  as  it  might  arise  from  a  variety  of  causes  not  materially 
affecting  the  risk,  and  would  not,  therefore,  by  any  means  give  the  in- 
surers the  information  wanted.  The  insured  was  asked  directly  whether 
he  was  at  the  time  affected  with  any  disease  or  disorder,  and  what ;  to 
which  he  answered  that  he  could  not  say  he  was  afflicted  with  any  disease 
or  disorder;  but  he  could  have  stated  the  symptoms  of  consumption, 
which  he  had,  and  which  he  knew  he  had,  and  which  he  had  had  for  five 
months  previous ;  and  which  were  most  certainly  material  and  impor- 
tant to  be  known  by  the  insurers.  It  is  believed  that  omissions  or  con- 
cealments less  important  than  this,  and  without  any  intentional  fraud, 
have  been  held  to  avoid  policies  upon  life." 

It  is  doubtful,  however,  if  this  opinion  would  be  held  to  apply  unless 
the  evidence  was  reasonably  conclusive  that  the  applicant  knew  he  was 
suffering  from  some  illness  at  the  time  of  examination.  Otherwise  there 
would  be  a  doubt  as  to  the  commencement  of  the  illness. 

In  the  case  of  Glutting  vs.  Insurance  Co.,  50  N.  J.  L.  287,  and  also  in 
Life  Insurance  Co.  vs.  Dempsey,  72  Md.  288,  there  was  apparently  conceal- 
ment of  the  symptoms  and  existence  of  phthisis,  and  on  appeal  the  ver- 
dict of  the  jury  was  reversed. 

An  interesting  point  was  decided  in  the  case  of  Scoles  vs.  Life  Insur- 
ance Co.,  42  Cal.  523.  The  question  in  the  application  was:  "Have  you 
hid  any  serious  illness,  local  disease,  or  personal  injury;  and  if  so,  of 
what  nature,  and  how  long  since?"  Answer,  "Not  any."  It  was  proven 
that  he  had  consumption,  which  was  defined  as  tubercles  on  the  lungs, 
and  also  tubercles  on  the  brain.  On  appeal  it  was  held  that  these  would 
come  clearly  within  the  definition  of  "  a  local  disease."  To  this  there 
can  be  no  exception,  for,  although  general  miliary  tuberculosis  would 
probably  be  considered  a  constitutional  disease  in  the  same  sense  that 


532  ^   SYSTEM  OF  LEGAL  MEDLCINE. 

typhoid  fever  is,  this  is  quite  rare,  and  certainly  other  manifestations  of 
tuberculosis  are  local. 

Hemoptysis. — This  is  so  striking  a  symptom,  that  its  preexistence  is 
almost  always  asked  by  the  companies.  Furthermore,  it  is  one  that  can 
hardly  be  overlooked  by  the  subject. 

The  question  is  variously  worded,  the  more  common  ways  being* 
"spitting  of  blood,"  "raising  of  blood,"  "coughing  of  blood,"  for  it  is 
reasonable  to  suppose  that  but  few  of  the  laity  would  understand  what 
hemoptysis  meant.  As  the  question  is  usually  put,  it  covers  all  sources 
of  the  hemorrhage  from  the  lips  and  nose  down  to  the  pulmonary  alveoli 
and  the  stomach  itself,  except  when  the  term  "coughing"  is  used.  This 
way  of  wording  the  question  is  very  comprehensive,  but  is  more  satis- 
factory to  the  companies;  for  many  patients,  if  there  is  no  further 
trouble  from  the  hemorrhage  within  a  short  time,  are  apt  to  persuade 
themselves  that  the  origin  of  it  was  something  trivial,  such  as  a  sore 
gum  or  an  inflamed  pharynx. 

As  a  symptom,  it  indicates  in  the  large  majority  of  cases  some  tuber- 
culous affection  of  the  throat  or  lungs.  It  may  be  due  to  a  variety  of 
other  causes,  but  they  sink  into  insignificance  as  compared  with  this. 
The  table  {Mortuary  Statistics  of  the  Mutual  Life  Insurance  Company  of 
Wew  York,  part  ii.)  from  which  the  following  quotations  are  taken  has 
considerable  value  in  this  connection,  for  it  is  founded  upon  the  state- 
ments of  the  laity  themselves  and  their  beliefs.  The  records  of  the  cases 
were  then  submitted  to  careful  medical  scrutiny.  All  the  doubtful  ones, 
especially  those  in  which  there  was  any  family  history  of  phthisis,  were 
carefully  eliminated.  The  conclusions  herewith  given  are  only  based 
upon  those  subjects  which,  after  all  these  precautions  to  exclude  the 
possibility  of  future  phthisis,  were  finally  accepted.  The  conclusions 
were  as  follows : 

"  The  general  ratio  of  the  consumption  mortality  was  19.74  percent.,, 
while  in  these  cases  it  is  34.92  percent.,  or  nearly  double.  ...  Of  the 
total  63  cases  of  hemoptysis,  the  date  of  its  occurrence  is  stated  in  39 ; 
in  13  cases  the  date  of  the  hemorrhage  was  within  seven  years,  in  22 
cases  within  ten  years.  Of  those  occurring  within  seven  years,  9,  or  69 
percent.,  died  of  consumption ;  of  those  occurring  within  ten  years,  13,  or 
58.18  percent. ;  while  in  those  cases  in  which  the  date  of  the  hemorrhage 
was  more  than  ten  years  before  insurance,  only  18.75  percent,  died  of 
consumption.  ...  In  less  than  half  the  cases  the  supposed  source  or 
cause  of  the  hemorrhage  is  given,  and  in  the  majority  of  these  it  was  re- 
ported as  slight,  as  coming  from  the  throat  and  nose,  or  as  the  result  of 
an  injury  or  excessive  exertion.  These  explanations  are  mostly  given  in 
the  consumptive  cases,  and  our  experience  shows  that  statements  indi- 
cating the  cause  of  the  hemorrhage  are  usually  untrustworthy,  as  the 
patient  always,  and  the  physician  sometimes,  are  apt  to  delude  themselves 
with  the  most  hopeful  views." 

These  statements  show  how  important  an  influence  hemoptysis  exerts 
upon  the  risk  even  after  seven  years.  Hence  the  knowledge  of  its  exist- 
ence is  of  prime  importance  to  the  correct  estimation  of  the  prospect  for 
longevity.  Therefore,  no  matter  how  insignificant  it  may  have  been, 
it  should  be  carefully  stated  in  all  cases.  This  opinion  has  good  legal 
authority,  for  in  the  case  of  Life  Insurance  Co.  vs.  Milter,  39  Ind.  475,  it 
wras  held  that:  "Whether  the  hemorrhage  proceeded  from  one  cause  or 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  533 

another,  it  was  material  and  necessary  that  the  statement  in  answer  to 
the  question  relating  to  it  should  have  been  true." 

This  was  more  elaborately  considered  in  the  case  of  Geach  vs.  Ingalls, 
14  M.  and  W.  95,  and  the  following  extracts  from  the  opinions  of  the 
three  judges  who  sat  on  the  case  are  given  as  showing  slight  variations. 

Pollock,  C.  B. :  "By  the  expression  'spitting  of  blood'  is,  no  doubt, 
meant  the  disorder  so  called,  whether  proceeding  from  the  lungs,  the 
stomach,  or  any  other  part  of  the  body ;  still,  however,  one  single  act 
of  spitting  of  blood  would  be  sufficient  to  put  the  insurers  on  inquiry  as 
to  the  cause  of  it,  and  ought  therefore  to  be  stated." 

Alderson,  B. :  "  By  spitting  of  blood  must,  no  doubt,  be  understood  a 
spitting  of  blood  as  a  symptom  of  disease  tending  to  shorten  life ;  the 
mere  fact  is  nothing :  a  man  cannot  have  a  tooth  pulled  out  without 
spitting  blood.  But,  on  the  other  hand,  if*  a  person  has  an  habitual 
spitting  of  blood,  although  he  caunot  fix  the  particular  part  of  his  frame 
from  whence  it  proceeds,  still,  as  this  shows  a  weakness  of  some  organ 
which  contains  blood,  he  ought  to  communicate  the  fact  to  the  insurance 
company,  for  no  one  can  doubt  that  it  would  most  materially  assist  them 
in  deciding  whether  they  should  execute  the  policy ;  and  good  faith  ought 
t( »  be  kept  with  them.  So,  if  he  had  had  spitting  of  blood  only  once,  but 
that  once  was  the  result  of  the  disease  called  spitting  of  blood,  he  ought  to 
state  it,  and  his  not  doing  so  would  probably  avoid  the  policy." 

Rolf e,  B. :  "I  have  no  doubt  that,  if  a  man  had  spit  blood  from  his 
lungs,  no  matter  in  how  small  a  quantity,  or  even  had  spit  blood  from 
an  ulcerated  sore  throat,  he  would  lie  bound  to  state  it.  The  fact  should 
lie  made  known  to  the  office,  in  order  that  their  medical  adviser  might 
make  inquiry  into  its  cause." 

To  one  point  in  these  opinions  we  must  take  exception.  There  is  no 
such  disease  as  "spitting  of  blood,"  unless  by  this  is  meant  that  the 
blood  comes  from  a  diseased  organ.  It  should  be  distinctly  understood 
that  hemoptysis  is  in  all  cases  only  a  symptom,  whether  of  a  wound  or 
of  a  diseased  viscus.  There  may  even  be  hemoptysis  without  any  wound 
or  disease,  such  as  that  occurring  in  vicarious  menstruation,  but  these 
latter  cases  are  notoriously  short-lived,  and  the  hemoptyses  certainly 
cannot  be  called  a  disease  in  these  cases.  In  view  of  these  facts  the  ex- 
istence of  a  single  hemoptysis  should  be  carefully  stated,  although  by  a 
quibble  the  contrary  was  held  in  the  case  of  Dreier  vs.  Life  Insurance 
Co.,  24  Fed.  Rep.  G70.  The  question  in  the  application  was:  "Has  the 
party  had  an}r  of  the  following  complaints  f  .  .  .  Spitting  or  raising  of 
blood?"  Answer,  "No."  It  was  held  that:  "There  is  no  warranty  in 
this  case  that  the  insured  never  had  spitting  or  raising  of  blood,  but  only 
that  he  had  not  had  the  complaint  of  spitting  or  raising  blood,  equiva- 
lent to  a  warranty  that  he  had  not  blood-spitting  in  such  form  as  to 
be  called  a  disease,  disorder,  or  constitutional  vice.  ...  If  the  question 
had  been  put  to  the  applicant  for  insurance  whether  or  not  he  had  had 
any  spitting  of  blood,  or  had  had  any  symptom  of  disease,  such  as  spit- 
ting or  raising  of  blood,  it  would  doubtless  have  required  the  disclosure 
of  a  siugle  instance  of  blood-spitting." 

It  cannot  be  too  strongly  insisted  upon  that  one  single  hemoptysis 
constitutes  evidence  of  disease;  for,  to  repeat,  it  is  only  the  symptom  of 
a  disease,  unless  it  comes  from  a  wound.  The  disease  may  be  trifling 
or  grave,  but  that  is  for  the  company  to  judge. 


534  -4   SYSTEM  OF  LEGAL  MEDLCLNE. 

Even  more  liberal  is  the  opinion  given  in  the  case  of  Singleton  vs. 
Life  Insurance  Co.,  27  Am.  Rep.  321,  326,  as  follows:  "We  think 
evidence  properly  admissible  to  show  in  what  sense  the  term  '  spitting 
of  blood'  was  used  in  the  application.  Without  any  evidence  of  the 
meaning  of  that  term,  the  court  might  properly  have  instructed  the  jury 
that  spitting  of  blood  in  consequence  of  a  drawn  tooth,  or  a  cut  on  the 
gums,  was  not  meant  by  that  term,  and  yet  if  Anderson  had  spit  blood 
from  such  trivial  causes,  literally  the  answer  to  his  question  woidd  have 
been  false.  .  .  .  There  is  something  ambiguous  in  the  term  '  spitting  of 
blood.'  Literally  the  meaning  is  spitting  of  blood,  whether  from  the 
teeth,  gums,  or  lungs,  but  it  would  be  absurd  to  hold  that  sense  in  the 
application." 

Against  these  we  can  set,  in  pleasing  contrast,  the  decision  in  the 
recent  case  of  Bancroft  vs.  Benefit  Association,  12  N.  Y.  Supp.  718.  Here 
it  was  proven  that  the  insured,  about  one  year  before  the  issue  of  the 
policy,  spat  a  little  blood  after  a  fencing-bout ;  and  that  this  was  after- 
ward considered  to  be  due  to  a  slight  injury  to  his  larynx  from  the  foil. 
He  denied  this  fact  of  the  hemoptysis  in  his  application.  His  statements 
were  held  to  be  warranties ;  it  was  found  that  "  the  said  Bancroft  was 
afflicted  with  the  complaint  of  spitting  of  blood."  This  was  sustained  on 
appeal  to  the  General  Term. 

Fits. — This  term  unfortunately  is  one  that  is  used  in  a  good  many  of 
the  older  applications.  It  is  so  indefinite  and  vague  that  it  has  no  stand- 
ing medically.  The  present  tendency  is  to  construe  it  as  referring  to 
epileptic  convulsions  alone.  Thus  the  definition  in  the  Century  Diction- 
ary is :  "  An  attack  of  convulsive  disease ;  a  muscular  convulsion,  often 
with  loss  of  self-control  and  unconsciousness ;  spasm ;  specifically,  an 
epileptic  attack." 

In  the  old  applications  some  importance  was  attached  to  it.  As 
the  distinction  between  the  different  varieties  of  spasms  was  not  then 
well  understood,  the  term  probably  then  included  other  convulsions  than 
epileptic.  The  use  of  the  word  in  former  times  is  well  shown  in  the  case 
of  Chattock  vs.  Shawe  et  al.,  3  Bigelow's  Life  and  Ace.  Ins.  Rep.  10. 
One  Griswold  was  insured  in  1831  and  then  stated  that  he  was  "in  a 
sound  and  perfect  state  of  health,  and  has  not  been  afflicted  with,  nor  is 
subject  to,  gout,  vertigo,  fits,  hemorrhage,  dropsy,  etc."  It  was  proven 
that  he  had  had  two  fits,  of  an  epileptic  character,  in  1827,  but  testimony 
was  offered  to  show  that  they  were  the  result  of  an  injury  to  the  head. 
The  judge,  in  his  charge  to  the  jury,  said :  "  The  interpretation  I  put  on 
a  clause  of  this  kind  is,  not  that  the  party  never  accidentally  had  a  fit, 
but  that  he  was  not,  at  the  time  of  the  insurance  being  made,  a  person 
habitually  or  constitutionally  afflicted  with  fits ;  or  a  person  liable  to  fits 
from  some  peculiarity  of  temperament,  either  natural  or  contracted  from 
some  cause  or  other  during  life." 

Dyspepsia. — From  a  medical  point  of  view,  dyspepsia,  strictly  speak- 
ing, is  of  little  consequence  unless  severe.  The  ordinary  form,  which 
every  one  has  after  eating  too  much  or  too  rich  food,  has  but  little 
effect  upon  the  expectation  of  life.  If  it  becomes  a  chronic  condition, 
its  influence  is  more  marked,  not  necessarily  serious,  however.  But  in 
many  of  these  cases  the  term  "dyspepsia"  is  used  to  cover  more  decided 
organic  changes,  such  as  chronic  gastritis  or  even  gastric  cancer.  It  is, 
therefore,  of  some  little  importance  to  describe  this  condition  with  care 


THE   MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  535 

and  accuracy,  for  it,  associated  with  other  conditions,  might  be  sufficient 
to  cause  rejection.  Owing  probably  to  the  misuse  of  the  terms,  dyspep- 
tics are  less  desirable  risks,  and  do  not  as  a  class  come  up  to  their  expec- 
tation. We  think  that  the  opinion  expressed  in  the  case  of  Morrison  vs. 
Insurance.  Co.,  59  Wis.  1G2,  is  excellent :  "  A  touch  of  dyspepsia  coming 
on,  which  manifests  itself  only  after  long  intervals,  which  yields  readily 
to  treatment,  and  which  is  not  shown  to  have  been  organic  and  excessive, 
is  not  inconsistent  with  a  representation  that  a  person  is  in  sound  health, 
as  that  term  is  employed  in  contracts  for  life  insurance  !  "  If  the  state- 
ments were  warranties,  it  might  be  held  otherwise  ;  but  even  in  this  case 
it  would  seem  correct  to  make  the  exception.  A  man  in  this  day  and 
generation  can  hardly  remember  every  little  attack  of  indigestion  or 
dyspepsia,  or  reasonably  be  supposed  to.  In  this  connection  the  terms 
"dyspepsia"  and  "indigestion"  should  be  considered  synonyms,  for  the 
distinctions  and  differences  between  them  are  practically  nil.  Thus  Wil- 
son Fox  (Reynold's  System  of  Medicine,  vol.  iii.)  uses  them  interchangeably 
with  perfect  freedom.  The  examiner  must  bear  in  mind  that  they  are, 
after  all,  nothing  but  symptoms,  and  must  closely  question  the  applicant 
to  see  if  there  is  a  possibility  of  any  organic  lesion  being  present. 

Disease  of  Heart. — Under  this  head  would  be  naturally  included  all 
the  lesions  of  the  coverings  of  the  heart,  inside  and  out,  as  well  as  of  the 
muscle  substance,  and  even  the  functional  diseases  of  the  heart  would 
properly  be  grouped  here.  It  is  hardly  necessary  to  state  that  the  term 
heart-burn  is  a  symptom  of  a  gastric  disorder  exclusively,  and  has  no 
relation  to  the  heart  except  in  the  situation  of  the  pain. 

The  possibility  of  well-marked  heart  disease  being  present  without 
the  knowledge  of  the  individual  is  thoroughly  established.  This  is,  of 
course,  even  more  true  of  the  lesser  grades  of  cardiac  involvement.  Our 
own  experience  is  that  many  cases  are  not  recognized  by  the  individuals 
from  any  symptoms  which  the  heart  gives  rise  to.  Valvular  disease  can 
generally  be  diagnosticated  on  careful  physical  examination,  although 
occasionally  the  murmur  may  be  slight  or  even  absent  for  some  time. 
Other  forms  of  cardiac  trouble,  such  as  adherent  pericardium,  myocar- 
ditis, etc.,  hardly  admit  of  diagnosis  without  careful  elaboration  of  the 
symptoms  beforehand.  This  is  also  true  of  many  of  the  functional  forms 
which  appear  only  at  intervals,  such  as  palpitation,  angina  pectoris,  and 
paroxysmal  tachycardia,  Unless  the  individual  is  seen  in  an  attack  of 
one  of  these  his  condition  can  only  be  discovered  by  careful  study  of  the 
symptoms  as  related  by  himself. 

If  the  individual  knew  that  he  had  heart  disease  at  the  time  of  the 
examination  and  willfully  concealed  the  fact,  it  would  be  fraudulent,  If 
he  felt  distinct  symptoms  from  it  but  did  not  know  whence  they  origi- 
nated, the  suppression  of  these  symptoms  would  probably  be  considered 
a  material  misrepresentation,  conformably  to  the  rule  laid  down  in  Yose 
vs.  Insurance  Co.,  6  Cush.  42.  But  suppose  that  it  had  given  rise  to  no 
symptoms  noticeable  to  the  applicant,  and  he  had  not  been  informed  of 
its  existence.  We  could  find  but  one  case  bearing  directly  on  this  point ; 
that  is  the  case  of  Powers  et  al.  vs.  Life  Insurance  Association,  50  Vt.  630. 
It  appears  in  this  case  that  the  applicant  had  been  examined  several 
years  before  for  a  pension,  and  at  that  time  the  heart  disease  was  discov- 
ered but  not  mentioned  to  him.  The  life  insurance  examiner  confessedly 
made  a  hurried  examination,  and  did  not  detect  the  lesion.     The  appli- 


536  A   SYSTEM  OF  LEGAL  MEDICINE. 

cant  died  soon  after,  and  on  the  trial  these  facts  were  brought  out.  In 
the  Appellate  Conrt  it  was  held  to  be  "  wholly  immaterial  whether  the  ap- 
plicant knew  of  the  existence  of  the  disease,  because  he  agreed  absolutely 
that  it  did  not  exist.  Nor  is  it  any  answer  to  say  that  the  question  is 
a  scientific  one,  and  a  layman  might  be  deceived  into  a  false  answer. 
Scientific  or  simple,  the  applicant  took  the  risk  of  the  answer."  This  was 
construed  thus  literally  because  the  statements  of  the  applicant  were 
considered  to  be  absolute  warranties.  In  most  cases  of  this  kind  the 
language  of  the  contract  would  be  scanned  very  closely  to  see  if  the  war- 
ranties could  not  be  converted  into  representations,  or  if  there  were  not 
some  modifying  words  to  break  the  force  of  an  absolute  warranty,  in 
accordance  with  the  established  legal  custom. 

Rheumatism. — This  is  a  term  in  which  are  included  a  number  of 
conditions.  Medically,  it  is  often  used  with  an  excess  of  freedom ;  and 
little  aches  and  pains  in  joints  and  muscles  are  often  spoken  of  as  "  rheu- 
matic" when  they  hardly  amount  to  any  disease.  Included  under  this 
designation  "  rheumatism "  are  the  following  diseases :  acute  articular 
rheumatism,  subacute  articular  rheumatism,  chronic  articular  rheuma- 
tism, gonorrhoea!  rheumatism,  and  probably  the  rheumatism  associated 
with  certain  infectious  diseases,  such  as  scarlet  fever  and  puerperal  fever, 
even  though  these  latter  may  be  due  to  septic  poisoning.  It  is  very  doubt- 
ful if  the  so-called  muscular  rheumatism  should  be  grouped  under  this 
head.  On  this  point  authorities  are  much  divided.  Flint  {Practice  of 
Medicine)  calls  muscular  rheumatism  "myalgia,"  and  groups  it  with 
diseases  of  the  nerves.  Further  he  says  (p.  SOT) :  "  The  term  rheumatism, 
as  applied  to  these  affections,  is  manifestly  inappropriate,  and  it  is  de- 
sirable that  the  name  in  this  application  should  become  obsolete."  On 
the  other  hand,  Strumpell  (Textbook  of  Medicine)  speaks  of  it  in  connec- 
tion with  the  other  rheumatisms,  but  he  says  (p.  863) :  "  The  two  diseases 
[acute  articular  rheumatism  and  muscular  rheumatism],  therefore,  are 
alike  only  in  certain  symptoms  and  in  the  fact  that  they  are  often, 
though  not  always,  ascribable  to  wet  or  cold  and  the  like." 

Part  of  the  importance  of  rheumatism  from  a  life  insurance  point  of 
view  consists  in  its  tendency  to  recurrence  and  its  liability  to  invade  the 
heart.  This  latter  is  more  especially  applicable  to  the  acute  and  sub- 
acute articular  rheumatism.  Concerning  the  influence  of  the  subacute 
forms  on  the  heart,  most  writers  are  agreed.  Thus  Garrod  (Reynold's 
System  of  Medicine,  vol.  i.)  says:  "  As  far  as  my  own  experience  goes,  it 
amounts  to  this,  namely,  that  although  the  severer  forms  of  the  articular 
disease  are  very  apt  to  be  complicated  with  cardiac  inflammation,  yet 
even  in  the  very  slight  forms,  measured  by  the  febrile  and  joint  symp- 
toms, serious  mischief  may  arise  in  the  heart ;  and  several  such  cases 
have  come  under  my  own  observation." 

These  statements  seem  a  necessary  prelude  to  a  discussion  of  the  case 
of  Price  vs.  Life  Insurance  Co.,  17  Minn.  489.  When  the  case  came  up 
for  review  by  the  Supreme  Court,  Judge  Berry  spoke  with  reference  to 
this  point  as  follows :  "  The  thirteenth  question  and  answer  in  the  appli- 
cation were,  'Has  the  party  ever  had  any  of  the  following  diseases?' 
(Naming  several,  and  among  others  rheumatism.)  Answer,  '  Never.'  .  .  . 
There  was  evidence  in  this  case  tending  to  show  that  the  life  insured  had 
had  subacute  rheumatism.  There  was  also  evidence  in  this  case  tend- 
ing to  show  that  subacute  rheumatism  is  not  the  disease  of  rheumatism 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  537 

in  the  ordinary  understanding  of  the  term.  There  was  also  evidence- 
tending  to  show  that,  technically  and  in  medical  parlance,  subacute 
rheumatism  is  the  disease  of  rheumatism.  The  rheumatism  referred  to 
in  the  question  is  the  disease  of  rheumatism.  Any  rheumatic  affection 
not  amounting  to  the  disease  of  rheumatism  is  not  comprehended  in  its 
terms,  any  more  than  the  spitting  of  blood  occasioned  by  a  wound  of  the 
tongue,  or  the  extracting  of  a  tooth,  is  the  disease  of  spitting  of  blood 
mentioned  in  the  same  question.  The  life  insured  had  the  right  to 
answer  the  question  upon  the  basis  that  its  terms  were  used  in  their 
ordinary  signification.  If  there  was  any  ambiguity  in  the  question,  so 
that  its  language  was  capable  of  being  construed  in  an  ordinary  as 
well  as  in  a  technical  sense,  the  defendant  can  take  no  advantage  from 
such  ambiguity."  The  principles  enunciated  in  the  beginning  of  this 
section  would  involve  the  inclusion  of  all  forms  of  articular  rheumatism 
under  the  designation  rheumatism,  no  matter  how  light  the  attacks  were. 
But  if  the  inflammation  did  not  involve  the  joints,  it  might  possibly  be 
construed  as  not  rheumatic.  Even  on  this  point  it  would  be  reason- 
able to  speak  of  it  as  rheumatic,  as  it  is  certainly  considered  so  ~by  the 
laity.  While  these  would  seem  to  be  the  fundamental  principles,  the 
difficulty  arises  that  many  cases  described  as  subacute  rheumatism  are 
nothing  but  neuralgias,  or  other  painful  affections  not  rheumatic.  This 
question  would  be  one  of  fact  for  a  jury  to  determine  on  the  proper  pres- 
entation of  testimony.  But  in  the  ordinary  as  well  as  the  technical  sense 
of  the  words,  subacute  rheumatism  must  be  considered  one  of  the  forms 
of  the  disease  rheumatism. 

Bright's  Disease. — The  views  held  by  physicians  about  the  lesions 
which  should  be  grouped  under  this  term  are  so  diverse  that  it  seems  a 
mistake  to  use  it  at  all  in  life  insurance.  Any  misrepresentation  con- 
cerning it  can  be  so  well  excused  that  its  value  as  a  warranty  is  but  little. 
It  cannot  be  regarded  as  synonymous  with  nephritis,  nor  is  even  the  lat- 
ter term  free  from  objection;  for  the  condition  of  the  kidneys  which 
Flint  (Practice  of  Medicine)  calls  parenchymatous  degeneration  Delafield 
and  Prudder  (Handbook  of  Pathological  Anatomy  and  Histology)  call 
acute  parenchymatous  nephritis.  It  is  now  proven  that  albuminuria  is 
present  in  many  conditions  which  are  not  indicative  of  inflammation  of 
the  kidneys  and  not  due  to  any  exudation  further  down  the  urinary 
tract.  This  fact  of  functional  albuminuria  is  well  recognized  at  present 
in  insurance  work.  In  1892  we  traced  the  after-history  of  forty-four 
cases  of  albuminuria  which  had  been  observed  in  the  years  1875-78. 
(New  York  Medical  Examiner,  August,  1892.)  Of  these  forty-four  cases 
thirty  were  alive  and  in  apparent  good  health  in  1892.  The  phy- 
sician of  one  stated  that  at  intervals  he  had  slight  albuminuria — which 
fact  we  also  confirmed — without  apparent  detriment  to  his  health. 
The  existence  of  casts  even  has  been  held  not  to  be  incompatible  with 
freedom  from  organic  disease  of  the  kidneys.  Furthermore,  it  is  true 
that  it  is  not  easy  at  times  to  differentiate  them  from  the  so-called  mu- 
cous cylindroids,  which,  in  many  cases,  are  certainly  not  indicative  of 
any  nephritis,  whatever  their  origin  may  be.  On  the  other  hand,  some 
cases  of  inflammation  of  the  kidneys  give  but  few  symptoms  in  their 
early  stages.  In  some  of  these  cases  an  examination  of  the  urine  may 
reveal  no  abnormal  constituents,  either  chemically  or  microscopically. 
Such  a  case  might  readily.be  passed  by  an  examiner  and  die  in  a  few 


538  ^   SYSTEM  OF  LEGAL  MEDICINE. 

months  from  an  acute  exacerbation  of  a  chronic  condition.  In  fact,  this 
has  happened  more  than  once,  to  our  certain  knowledge,  after  careful 
chemical  and  microscopical  examinations  by  skilled  physicians.  From 
all  these  considerations  it  would  seem  much  better  to  drop  the  terms 
Bright's  disease  and  nephritis,  and  use  in  their  stead,  disease  of  the  kid- 
neys. This,  we  hold,  would  cover  also  all  forms  of  albuminuria  except 
those  due  to  the  presence  of  pus  or  blood  from  some  part  of  the  urinary 
tract  below  the  kidney.  For  whether  the  albuminuria  is  transient  or 
permanent,  it  is  due  to  some  affection  of  the  kidneys,  either  functional 
or  organic,  which  could  properly  be  called  a  disease.  We  hold  that  a 
man,  knowing  that  he  had  albuminuria  and  denying  that  he  had  disease 
of  the  kidneys,  would  be  misrepresenting,  within  the  limitations  stated 
above. 

In  the  case  of  Insurance  Co.  vs.  Yung,  113  Ind.  159,  the  term  Bright's 
disease  was  discussed.  The  conflict  of  medical  opinions  was  so  great, 
however,  that  the  court  very  properly  declined  to  give  any  ruling  on  its 
use  or  meaning. 

Tonsilitis. — In  the  case  of  McCollum  vs.  Life  Insurance  Co.,  55  Hun 
108,  it  was  held  as  follows :  "  It  is  argued,  however,  by  counsel  for  the 
appellant  that  tonsilitis  is  not  a  sickness  within  the  meaning  of  McCol- 
lum's  answer  in  the  application  for  these  policies.  It  is  shown,  however, 
by  the  testimony  of  Dr.  Eddy,  that  tonsilitis  is  an  inflammation  of  the 
tonsils,  called  by  the  common  term  quinsy,  and  commonly  results  from 
a  cold,  and  that  a  person  who  has  had  it  is  much  more  liable  to  have  his 
throat  affected  by  colds  than  he  would  otherwise  be ;  that  it  is  liable  to 
make  a  man  quite  ill,  and  is  oftentimes  an  indication  of  a  scrofulous  tend- 
ency. No  effort  was  made  at  the  trial  to  prove  that  the  deceased  was 
not  in  fact  as  ill  as  serious  tonsilitis  might  cause  him  to  be.  But  the 
deceased  himself,  who  was  a  medical  man,  seems  to  have  had  no  idea  that 
tonsilitis  was  not  a  disease,  for  in  the  question  put  to  him  in  his  applica- 
tion to  the  Buffalo  Life  and  Reserve  Association  he  was  asked  when  he 
was  last  attended  by  a  physician,  not  for  any  more  ailment,  but  for  '  what 
disease?'     His  answer  was,  'Eight  years  ago;  tonsilitis.'" 

Although  the  opinion  was  undoubtedly  correct  on  the  evidence  offered, 
the  medical  testimony  is  open  to  considerable  criticism  on  the  following 
points : 

1.  There  are  several  varieties  of  tonsilitis,  among  them  simple,  follic- 
ular, diphtheritic,  and  phlegmonous. 

2.  The  term  quinsy  is  applied  only  to  the  last,  and  in  this  the  major- 
ity of  abscesses  are  peritonsilar,  according  to  Brannan.  {Medical  Record, 
1893,  vol.  ii.,  p.  549.) 

3.  The  other  forms  of  tonsilitis  are  often  very  mild  and  harmless, 
and  might  frequently  well  be  described  as  "  a  mere  ailment." 

Disease  of  the  Liver. — Under  this  term  are  properly  included  a  num- 
ber of  conditions  so  well  known  that  it  is  unnecessary  to  mention  them 
here.  The  liver,  however,  is  unjustly  accused  of  many  crimes,  and  it  be- 
comes advisable  to  consider  the  limitations  of  the  term.  Jaundice  should 
not  be  included,  for  it  is  properly  only  a  symptom  of  some  disease  which 
may  or  may  not  be  of  the  liver.  It  seems  to  us  that  the  passage  of  a  gall- 
stone should  be  regarded  as  a  disease  of  the  liver,  although  it  arises  out- 
side of  the  liver,  strictly  speaking.  We  think  that  the  term  liver  in 
this  connection  includes  its  appendages,  the  gall-bladder  and  the  ducts. 


THE   MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  539 

"  Biliousness "  is  applied  by  the  laity  to  so  many  conditions,  most  of 
which  have  no  connection  with  the  liver,  that  its  inclusion  here  does  not 
seem  warranted.  In  fact,  it  is  doubtful  where  it  would  be  placed,  for  it 
is  never  "  a  serious  illness." 

We  heartily  approve  of  the  limitations  of  the  term  "  disease  of  the 
liver,"  laid  down  in  the  case  of  Cushman  vs.  Life  Insurance  Co.,  70  N.  Y. 
76.  "  In  construing  contracts  words  must  have  the  sense  in  which  the 
parties  used  them ;  and  to  understand  them  as  the  parties  understood 
them,  the  nature  of  the  contract,  the  objects  to  be  attained,  and  all 
the  circumstances  must  be  considered.  By  the  questions  inserted  in 
the  application,  the  defendant  was  seeking  for  information  bearing 
upon  the  risk  which  it  was  to  take,  the  probable  duration  of  the  life  to 
be  insured.  It  was  not  seeking  information  as  to  merely  temporaiy  dis- 
orders or  functional  disturbances  having  no  bearing  upon  general  health 
or  continuance  of  life.  Colds  are  generally  accompanied  with  more  or 
less  congestion  of  the  lungs,  and  yet  in  such  a  case  there  is  no  disease 
of  the  lungs  which  an  applicant  for  insurance  would  be  bound  to  state. 
So  most,  if  not  all,  persons  will  have  at  times  congestion  of  the  liver, 
causing  slight  functional  derangement  and  temporary  illness ;  and  yet  in 
the  contemplation  of  parties  entering  into  contracts  of  life  insurance, 
and  having  regard  to  general  health  and  continuance  of  life,  it  may 
safely  be  said  that  in  such  cases  there  is  no  disease  of  the  liver.  In  con- 
struing a  policy  of  life  insurance  it  must  be  generally  true  that,  before 
any  temporary  ailment  can  be  called  a  disease,  it  must  be  such  as  to 
indicate  a  vice  in  the  constitution,  or  be  so  serious  as  to  have  some  bear- 
ing upon  general  health  and  the  continuance  of  life,  or  such  as  according 
to  common  understanding  would  be  called  a  disease." 

A  similar  ruling  was  given  in  the  case  of  Life  Insurance  Co.  vs.  Trust 
Co.,  112  U.  S.  250.  It  was  held  that :  "  Unless  he  had  an  affection  of 
the  liver  that  amounted  to  a  disease — that  is,  of  a  character  so  well  de- 
fined and  marked  as  to  materially  derange  for  a  time  the  functions  of 
that  organ — the  answer  that  he  had  never  had  the  disease  called  affection 
of  the  liver  was  a  'fair  and  true'  one;  for  such  an  answer  involved 
neither  fraud,  misrepresentation,  evasion,  nor  concealment,  and  withheld 
no  information  as  to  his  physical  condition  with  which  the  company 
ought  to  have  been  made  acquainted." 

In  the  case  of  McGrath  vs.  Life  Insurance  Co.,  6  N.  Y.  State  Rep.  376, 
it  was  held  that  jaundice  and  torpid  liver  were  not  organic  ailments  of 
the  liver ;  that  their  existence  was  not  fatal  even  in  view  of  the  warranty 
that  the  insured  never  had  disease  of  the  liver. 

Diseases  of  the  Eye. — Many  of  the  more  serious  ocular  disturb- 
ances, such  as  glaucoma,  cataract,  iritis,  etc.,  would  properly  come  under 
this  designation.  But  it  seems  reasonable  to  consider  that  errors  of 
refraction  do  not  amount  to  a  disease.  This  is  the  view  taken  in  the 
case  of  Cotton  vs.  Life  Insurance  Co.,  41  Fed.  Rep.  506,  where  it  was  held 
that  myopia  was  not  included  under  the  term  bodily  infirmity.  This 
would  probably  not  hold  if  the  question  referred  to  impairment  of  sight 
directly,  but  even  in  this  case  there  would  be  some  doubt,  provided  that 
the  error  was  well  corrected  by  glasses.  The  term  impairment  of  sight 
might  well  be  held  to  refer  to  some  disease  of  the  eye  which  prevented 
normal  acuteness  of  vision.  In  examining  applicants  we  have  noticed 
that,  as  a  rule,  they  say  their  sight  is  good  even  if  they  are  wearing 


540  ^   SYSTEM  OF  LEGAL  MEDICINE. 

glasses  at  the  time.  This  is  so  regularly  the  case  that  we  have  concluded 
that  lajmien  do  not  consider  their  vision  impaired  simply  by  some  error 
of  refraction  which  is  corrected.  In  view  of  this  fact,  a  judicial  inter- 
pretation of  the  term  impairment  of  vision  might  be  held  not  to  include 
errors  of  refraction,  unless  severe  or  uncontrollable.  In  Fitch  vs.  Life 
Insurance  Co.,  2  N.  Y.  Sup.  T.  and  C.  2-47,  it  was  proven  that  the  in- 
sured had  had,  six  years  before  the  issuing  of  the  policy,  conjunctivitis, 
due  to  some  injury  to  the  eye.  This  was  considered  to  prove  a  breach 
of  warranty,  as  he  had  a  negative  answer  to  the  question,  "Have  you 
ever  had  any  illness,  local  disease,  or  any  injury  in  any  organ?"  But 
on  appeal  (59  N.  Y.  557)  it  was  decided  that  the  statements  were  not 
warranties,  and  it  was  held:  "We  think  that,  according  to  the  construc- 
tion we  have  put  upon  the  contract  in  question,  the  judge  would  not 
have  been  justified  in  holding  that  the  omission  to  mention  a  temporary 
injury  to  the  eye  by  sand  being  thrown  into  it,  which  had  produced  in- 
flammation six  years  before  the  policy  was  applied  for,  and  which  was 
then  cru-ed,  was  conclusive  evidence  of  fraud,  or  a  breach  of  warranty 
sufficient  to  avoid  the  policy.  If  of  any  importance,  it  was  at  most  evi- 
dence of  fraud,  to  be  submitted  to  the  jury." 

Headaches. — It  is  out  of  the  question  to  enumerate  the  different 
causes  of  headaches.  In  themselves  they  are,  of  course,  only  a  symptom, 
and  may  be  due  to  either  functional  or  organic  disturbances.  They  are 
not  a  cause  of  death  directly  unless  they  lead  to  suicide.  As  a  symptom 
they  have  a  bearing  upon  the  risk,  and  a  question  with  reference  to  them 
is  usually  asked  in  the  application.  It  is  generally  worded  so  as  to  cover 
only  severe  or  frequent  headaches,  or  the  question  is  directly  asked, 
"Are  you  subject  to  headaches?" 

How  these  questions  would  be  construed  it  is  not  possible  to  state,  as 
we  have  not  been  able  to  find  a  decision  bearing  upon  this  point. 

Even  if  they  are  severe  and  frequent,  headaches  are  not  necessarily 
indicative  of  any  intracranial  disease.  In  many  of  the  worst  cases,  they 
are  due  to  some  general  dycrasia,  such  as  gout,  or  to  some  local  disease 
of  another  organ,  such  as  Bright's  disease  or  some  peripheral  irritation, 
such  as  an  uncorrected  error  of  refraction.  In  view  of  these  facts,  we 
must  indorse  the  decision  rendered  in  the  case  of  HigUe  vs.  Life  Insur- 
ance Co.,  53  N.  Y.  603.  In  the  application  in  this  case  occurred  the 
question,  "Are  the  functions  of  the  brain,  the  muscular  and  the  nervous 
system,  in  a  healthy  state  ? "  Answer,  "  Yes."  It  was  proven  that  the 
applicant  had  been  subject  to  severe  headaches  for  several  years.  But 
the  court  very  properly  held  that  the  question  above  stated  "  did  not  in- 
clude a  temporary  or  occasional  physical  disturbance  the  result  of  ac- 
cidental causes ;  that  there  was  no  evidence  that  the  recurrence  of  the 
periodical  headaches  had  an  origin  or  cause  indicating  any  mental  un- 
soundness or  derangement  of  the  head  or  brain  or  permanent  disease, 
or  that  the  fact  of  their  existence  was  at  all  material  to  the  risk." 

Cold. — This  is  an  utterly  unscientific  term,  used  to  designate  a  number 
of  affections  supposed  to  be  due  to  the  action  of  cold.  When  used  as  the 
name  of  a  disease,  it  would  mean  an  acute  catarrhal  inflammation  of  the 
nose,  larynx,  trachea,  or  bronchi.  It  is  rarely  serious  except  at  the  ex- 
tremes of  life,  and  in  the  vast  majority  of  cases  is  not  worth  mentioning. 

This  view  of  its  importance  is  borne  out  in  the  opinion  rendered  in 
the  case  of  Life  Insurance  vs.  McTague,  49  N.  J.  L.  587,  where  it  was  held 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  541 

that  a  cold,  even  if  prescribed  for  by  a  physician,  did  not  necessarily 
show  that  it  had  produced  either  disease  or  sickness ;  that  it  was  not  in- 
consistent with  the  statement  that  he  had  not  been  sick  or  afflicted  with 
any  disease.  Presumably  its  existence  at  the  time  of  an  examination  is 
incompatible  with  a  warranty  of  sound  health  at  that  time,  although  in 
view  of  the  principles  laid  down  in  the  case  of  Cushman  vs.  Life  Insur- 
ance Co.,  70  N.  Y.  76  (see  p.  539),  this  view  might  be  questioned. 

Habits. — For  the  purposes  of  life  insurance,  this  term  refers  only  to 
the  various  forms  of  drug-addiction.  Getting  up  late,  eating  too  much 
and  too  fast,  wet  feet,  and  such  other  bad  habits,  are  not  considered  of 
importance  to  know  about.  Nor  does  the  insurer  regard  it  of  any  con- 
sequence to  know  the  amount  of  tobacco,  tea,  and  coffee  consumed  by 
an  individual,  since  the  capacity  to  assimilate  these  varies  so  greatly.  If 
they  are  taken  to  an  excessive  degree,  they  promptly  show  harmful  effects 
by  causing  functional  disturbances  of  various  kinds ;  and  then  the  ap- 
plicant would  be  rejected  on  account  of  these  functional  disturbances, 
and  not  on  account  of  the  abuse  of  tobacco,  tea,  or  coffee.  Consequently 
we  mean  the  use  of  alcohol,  opium,  chloral,  and  other  narcotics.  Of 
these  by  far  the  most  important  is  alcohol. 

The  question  of  the  chinking  habit  can  be  divided  into  two  phases, 
the  first  with  reference  to  past  and  present  custom,  and  the  second  with 
regard  to  the  restriction  of  future  excesses.  In  order  to  elicit  informa- 
tion concerning  the  first,  the  application  contains  some  questions  about 
the  habits,  such  as,  "  Do  you  now,  or  have  you  ever,  used  intoxicating 
liquors  ? "  or,  "  Have  you  always  been  sober  and  temperate  ? "  or,  "  Are 
the  party's  habits  of  life  temperate  or  otherwise  ? " 

The  second  is  accomplished  by  inserting  agreements  and  provisos 
which  restrict  future  excesses,  but  with  considerable  variations  in  the 
details.  Their  general  idea  is  that,  if  the  insured  die  in  consequence  of 
the  use  of  alcoholics,  the  policy  shall  be,  wholly  or  in  part,  avoided.  If 
an  applicant  proves  that  he  has  always  been  temperate,  most  companies 
assume  that  he  will  continue  so,  and  therefore  do  not  require  aiw  agree- 
ment with  regard  to  future  excesses. 

It  has  uniformly  been  held  that,  if  the  question  refer  only  to  past 
and  present  habits,  it  will  in  no  way  be  construed  as  referring  to  future 
excesses.  Hence  it  might  be  possible  to  subdivide  this  subject  into  these 
two  categories  ;  but  this  is  not  practicable,  and  is  of  no  consequence,  since 
the  gist  of  the  whole  matter  lies  in  the  definition  of  the  words  "  temper- 
ate and  sober."  We  will  first  consider  what  the  legal  decisions  on  this 
point  have  been,  and  then  see  how  they  comport  with  the  medical  ideas 
on  the  same  subject. 

1.  If  the  questions  or  provisos  are  so  worded  as  to  indicate  total  ab- 
stinence without  the  possibility  of  any  mistake,  then  they  must  be  liter- 
ally construed,  and  nothing  but  the  total  abstinence  from  all  alcoholic 
liquors  will  suffice.  Thus,  in  the  case  of  Hogin  vs.  Supreme  Council,  16 
Cal.  109,  the  assured  agreed  to  abstain  wholly  from  alcoholic  liquors,  the 
association  being  composed  only  of  prohibitionists.  He  broke  his  pledge, 
and  by  so  doing  avoided  the  policy,  without  reference  to  anything  else. 
Of  a  somewhat  similar  purport  is  the  decision  in  the  case  of  Shade/  vs. 
Life  Assurance  Co.,  66  N.  Y.  441,  although  here  no  question  of  total  ab- 
stinence enters.  In  this  case  the  proviso  was  that:  "No  claim  shall  be 
made  under  this  policy  where  the  death  or  injury  may  have  happened 


542  ^   SYSTEM  OF  LEGAL  MEDICINE. 

while  the  insured  was,  or  in  consequence  of  his  having  been,  under  the 
influence  of  intoxicating  drink."  It  was  held  that  proof  was  not  required 
that  the  use  of  intoxicating  drinks  was  the  moving  cause  of  death,  but 
only  that  he  was  under  the  influence  of  stimulants  at  the  time  of  death. 

2.  When  the  words  used  in  the  question  are  "  temperate  and  sober," 
it  has  been  held  that  this  expression  in  no  sense  means  total  abstinence 
from  all  intoxicating  liquors.  Thus,  in  the  case  of  Brockway  vs.  Life 
Insurance  Co.,  9  Fed." Rep.  249,  the  questions  were,  "Is  the  party  sober 
and  temperate?  Has  he  always  been  so?"  The  answer  to  each  was, 
"  Yes."  In  the  charge  it  was  laid  down  that  "  the  words  '  sober  and  tem- 
perate '  are  to  be  taken  in  their  ordinary  sense.  The  language  does  not 
imply  abstinence  from  intoxicating  liquors.  The  moderate,  temperate 
use  of  intoxicating  liquors  is  consistent  with  sobriety.  But  if  a  man 
uses  liquors  to  such  an  extent  as  to  produce  frequent  intoxication,_  he  is 
not  sober  and  temperate  within  the  meaning  of  this  contract  of  insur- 
ance." The  latter  part  of  this  decision  may  be  considered  too  liberal,  as 
we  shall  see  later,  but  it  is  to  the  first  part  that  we  now  wish  to  draw 
attention.  The  same  idea  is  well  brought  out  in  the  case  of  Meacham  vs. 
Insurance  Association,  120  N.  Y.  238.  There  the  questions  were,  "Is  the 
applicant  temperate  and  correct  in  his  habits  ?  Does  applicant  agree  to 
remain  so  ? "  The  answer  to  each  was,  "  Yes."  The  Court  of  Appeals 
held  that:  "The  word  'temperate'  suggests  moderation,  not  abstinence, 
and  the  warranty  is  to  the  effect  that  his  habit  is  to  refrain  from  excessive 
indulgence  in  the  use  of  intoxicants,  and  not  that  he  abstains  from  all 
use." 

3.  We  have  seen  in  the  preceding  section  that  temperance  does  not 
necessarily  mean  total  abstinence,  but  from  the  very  necessities  of  the 
subject  no  hard-and-fast  definition  of  temperance  can  be  given.  In  the 
case  of  Van  Valkenbergh  vs.  Life  Insurance  Co.,  70  N.  Y.  605,  it  was  held 
that  the  question,  "use  any  intoxicating  liquors  or  substances?"  did 
not  direct  the  mind  to  a  single  or  incidental  use,  but  to  a  customary  or 
habitual  use.  This  idea  is  also  very  well  expressed  in  the  case  of  Holter- 
liojf  vs.  life  Insurance  Co.,  4  Bigelow's  Life  and  Ace.  Rep.  395.  Here 
the  questions  were,  "  Is  the  party  sober  and  temperate  ?  Has  he  always 
been  so  ? "  The  answer  to  each  was  in  the  affirmative,  and  these  answers 
were  held  to  be  material  representations.  Judge  Tilden,  in  his  charge 
to  the  jury,  which  was  afterward  approved  by  the  higher  court,  said : 
"  The  statement  itself  amounts  to  an  assertion  that  the  insured  at  the 
time  of  the  application  was  sober  and  temperate,  and  had  always  been 
so.  As  a  matter  of  construction,  it  is  manifest  and  clear  to  the  court 
that  these  words,  taken,  as  they  are  placed,  together,  refer  to  the  charac- 
ter, habit,  or  state  of  the  party,  and  that  they  are  fairly  convertible  into 
the  phrase  or  statement  that  the  party  was,  and  always  had  been,  a  sober 
and  temperate  person.  The  question  of  fact  will  then  be, '  Was  he  such  ? ' 
In  considering  this  question  you  will  inquire  whether  or  not  he  continued 
the  use  of  intoxicating  liquors  sufficiently  long,  or  repeated  libations 
sufficiently  often,  to  amount  to  a  habit ;  and  if  he  did,  then  whether  such 
habit,  considered  in  reference  to  its  extent  or  degree  of  indulgence,  wTas 
such  that  he  was  not  temperate  and  sober." 

In  the  case  of  Life  Insurance  Co.  vs.  Davey,  123  U.  S.  739,  it  is  worth 
while  to  note  the  distinction  drawn  between  intemperate  and  habitually 
intemperate.     Here  it  was  provided  that  if  the  insured  should  become 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  543 

"  so  far  intemperate  as  to  impair  his  health  or  induce  delirium  tremens, 
or  if  his  death  shall  result  from  injuries  received  while  under  the  influ- 
ence of  alcoholic  liquors,"  the  policy  might  be  avoided.  On  appeal  it  was 
held  that :  "  If  the  substantial  cause  of  the  death  of  the  insured  was  an 
excessive  use  of  alcoholic  stimulants,  not  taken  in  good  faith  for  medical 
purposes  or  under  medical  advice,  his  health  was  impaired  by  intemper- 
ance, within  the  meaning  of  the  words  '  so  far  intemperate  as  to  impair 
his  health,'  although  he  may  not  have  had  delirium  tremens,  and  although 
previously  to  his  last  illness  he  had  not  indulged  in  strong  drink  for  such 
a  loug  period  or  so  frequently  as  to  become  habitually  intemperate." 

In  England,  in  the  case  of  SoutlicomJ>e  vs.  Merrimcm,  1  C.  and  Marsh 
286,  the  assured  stated  that  he  was  of  temperate,  sober  habits.  It  was 
held  sufficient  to  avoid  liability  under  the  policy  to  prove  that  he  was  in- 
temperate, but  not  necessarily  to  such  a  degree  as  to  impair  his  health. 

Unfortunately,  this  opinion  has  not  always  been  adopted  in  America. 
Thus,  in  the  case  of  McGinley  vs.  Life  Insurance  Co.,  8  Daly  390,  the  ques- 
tion was,  "Are  the  party's  habits  of  life  temperate  or  otherwise  :;"  To 
which  the  answer  was,  "Temperate."  It  was  held  that  this  "rather  de- 
pended upon  the  individual,  for  what  would  be  temperate  in  the  use  of 
alcoholic  drinks  in  one  man  would  be  intemperate  in  anothei  ;  that  the 
taking  of  a  moderate  amount  of  liquor  in  a  weak  man  might  be  an  in- 
temperate act,  when  it  would  not  be  by  a  man  of  vigor  and  strength ; 
that  it  is  not  in  the  use  of  alcoholic  drinks  that  intemperance  exists,  but 
in  taking  them  to  such  an  extent  as  to  impair  the  constitution  and  gen- 
eral health."  This  does  not  take  into  account  the  very  unfavorable  effect 
which  alcoholics  have  on  the  prognosis  of  all  acute  diseases  or  their  in- 
fluence in  producing  accidents.  These  are  factors  of  great  importance, 
as  we  shall  see  later,  but  they  seem  to  be  entirely  ignored  in  this  as  in 
many  of  the  other  decisions. 

The  great  value  of  an  Appellate  Court  is  shown  in  the  case  of  MilU  r 
vs.  Life  Insurance  Co.,  34  Iowa  222,  and  also  to  what  extremes  a  jury 
will  go  in  cases  of  this  kind.  It  was  provided  that  the  policy  should  be 
forfeited  if  the  insured  should  die  "by  reason  of  intemperance  from  the 
use  of  intoxicating  liquors."  It  was  proven  that  he  was  a  confirmed 
drunkard.  At  last,  after  a  spree  of  several  days,  he  developed  delirium 
tremens.  While  in  this  condition  he  escaped  from  his  keepers  and  ran 
about  the  city  in  his  night-clothes.  It  was  proven  that  the  congestion  of 
the  kings  and  brain,  of  which  he  died,  were  due  to  exposure  and  that  to 
intemperance,  and  hence  the  policy  should  be  avoided.  These  facts  were 
hardly  questioned,  but  yet  the  jury  promptly  returned  a  verdict  for  the 
plaintiff.  The  case  was  carried  to  the  Appellate  Court,  the  judgment  was 
there  reversed,  and  the  case  was  sent  back  for  another  trial.  It  was  a 
second  time  taken  to  the  highest  court,  whose  opinion  (39  Iowa  304)  was 
as  follows  :  "  How,  in  view  of  the  evidence  and  the  law  given  by  the  court, 
an  impartial  and  unprejudiced  jury,  indifferent  as  between  the  parties, 
and  anxious  to  ascertain  the  truth  and  effectuate  the  right,  could  return 
a  general  verdict  for  the  plaintiff,  and  find  specially  that  the  congestion 
of  the  lungs  and  brain  which  caused  Miller's  death  was  not  caused  by  the 
intemperate  use  of  intoxicating  liquors,  passes  our  comprehension.  .  .  . 
We  interfere  with  the  verdict  of  a  jury  always  reluctantly,  and  never 
unless  it  is  clearly  unsupported  by  the  evidence,  or  has  been  otherwise 
improperly  reached. 


544  A  SYSTEM  OF  LEGAL  MEDICINE. 

"  We  deprecate  the  necessity  which  impels  us  a  second  time  to  set  aside 
a  verdict  upon  substantially  the  same  testimony.  But  it  were  much  more 
to  be  deprecated  if  the  pertinacity  of  a  jury  could  override  law  and  right 
and  give  triumph  to  injustice  and  wrong." 

An  interesting  and,  so  far  as  we  know,  unique  question  is  presented 
in  the  case  of  Jarvis  vs.  Life  Insurance  Co.,  5  Ins.  L.  J.  507 :  Does  intem- 
perance, leading  to  insanity,  and  that  to  suicide,  avoid  the  policy  if  there 
are  provisos  against  both  insanity  and  intemperance  as  causes  of  death  ! 
In  this  case  there  were  provisos  against  suicide  and  also  against  intem- 
perance. The  jury  were  charged  as  follows :  "  If  you  should  find  that 
his  intemperance  produced  the  mental  condition  relied  upon  to  avoid 
the  effect  of  the  self-destruction  clause  in  the  policy,  then  the  plaint- 
iff cannot  recover.  If  the  insanity  was  produced  by  habits  prohibited 
by  the  policy,  then  it  cannot  be  set  up  in  avoidance  of  a  breach  of  another 
condition.  Intemperance  avoids  the  policy,  and  if  intemperance  produced 
the  insanity,  this  insanity  cannot  be  set  up  as  an  excuse  for  the  violation 
of  the  proviso  against  self-destruction."  Unfortunately,  the  jury  dis- 
agreed, so  the  case  has  not  yet  been  carried  to  one  of  the  higher  courts. 

4.  We  have  grouped  in  this  section  some  opinions  against  which  we 
can  only  offer  our  most  earnest  protest.  Thej^  abuse  language,  medicine, 
and  sense  so  grossly  that  it  seems  impossible  for  them  to  prevail  ulti- 
mately. We  do  not  doubt  that  they  will  be  recanted,  but  then  influence 
is  very  bad  while  it  lasts. 

The  first  degree  of  liberality  is  probably  represented  in  the  charge  of 
the  judge  in  the  case  of  Fox  vs.  Life  Insurance  Co.,  4  Bigelow's  Life  and 
Ace.  Rep.  458  :  "Now,  what  is  the  meaning  of  these  words  in  the  fifth 
question,  'Have  you  always  been  sober  and  temperate?'  It  does  not 
mean  total  abstinence.  We  are  to  give  these  words  the  common,  ordi- 
nary interpretation.  It  does  not  mean  total  abstinence  from  drink,  and 
there  is  no  man  who  takes  a  glass  or  two  when  he  feels  like  it  who  would 
not  describe  himself,  in  answer  to  that  question,  a  sober  and  temperate 
man.  As  to  the  question  of  what  constitutes  sobriety,  or  to  mean  a  tem- 
perate man,  I  suppose  there  are  classes  of  people  in  the  community  who 
hold  different  opinions.  .  .  .  On  the  other  hand,  there  are  a  class  of  peo- 
ple who  would  drink  a  great  many  times  a  day  and  become  very  much 
under  the  influence  of  liquor,  who,  perhaps,  because  they  never  become 
what  is  termed  '  dead  drunk/  would  say,  if  they  were  asked  this  question, 
'I  take  an  occasional  glass,'  or,  'Yes,  I  occasionally  take  too  much.' 
Well,  I  need  not  say  to  you  that  an  occasional  debauch  even  would  not 
make  a  man  of  intemperate  habits.  I  take  it  that  this  question  means 
habitual  intemperance.  Especially  it  means  so  when  you  consider  the 
word  '  always.'  If  the  question  to  be  put  to  a  man  obtaining  a  life  insur- 
ance policy  is,  '  Have  you  always  been  sober  and  temperate  ? '  and  if  that 
means,  '  ever  drunk  in  your  life,'  I  am  afraid  there  would  be  a  great  many 
people  who  would  never  get  then  lives  insured.  There  are  very  few  who 
have  not  some  time  or  other,  young  or  old,  been  drunk  literally  and  fully, 
and  are  conscious  of  it,  so  that  they  could  not  give  an  affirmative  answer 
if  such  were  the  meaning  of  it;  but  it  means  habitual  drunkenness.  .  .  . 
The  risk  may  be  increased  by  habitual  drinking  every  day  of  an  amount 
of  liquor  that  perhaps  would  not  at  all  affect  his  head  or  his  legs."  There 
was  the  usual  verdict  for  the  plaintiff,  but  it  was  set  aside  and  a  new  trial 
-ordered,  the  outcome  of  which  was  not  reported.     To  this  charge  we 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  545 

must  take  great  exception,  not  only  medically  but  logically.    Let  us  strip 
his  propositions  of  verbiage,  and  then  arrange  them  in  orderly  secpience. 

1.  "  I  have  always  been  sober  and  temperate." 

2.  This  statement  does  not  imply  total  abstinence. 

3.  An  occasional  debauch  does  not  make  a  man  intemperate. 

4.  This  statement  therefore  disaffirms  only  habitual  drunkenness. 

If  we  look  back  now  from  proposition  4  to  proposition  1,  we  can 
readily  see  how  untenable  his  argument  is. 

A  very  similar  ruling,  but  by  a  higher  court,  was  given  in  the  case  of 
Life  Insurance  Co.  vs.  Beif,  36  Ohio  St.  596:  "An  occasional  excess  in 
the  use  of  intoxicating  liquors  does  not,  it  is  true,  constitute  a  habit,  or 
make  a  man  intemperate  within  the  meaning  of  this  policy ;  but  if  the 
habit  has  been  formed  and  is  indulged  in  of  drinking  to  excess  and  be- 
coming intoxicated,  whether  daily  and  continuously,  or  periodically  with 
.sober  intervals  of  greater  or  less  length,  the  person  addicted  to  such  a 
habit  cannot  be  said  to  be  of  temperate  habits  within  the  meaning  of 
this  policy.  .  .  .  Where  the  general  habits  of  a  man  are  either  abstemi- 
ous or  temperate,  an  occasional  indulgence  to  excess  does  not  make  him 
a  man  of  intemperate  habits.  But  if  the  habit  is  formed  of  drinking  to 
excess,  and  the  appetite  for  liquor  is  indulged  to  intoxication,  either  con- 
stantly or  periodically,  no  one  will  claim  that  his  habits  are  temperate, 
though  he  may  be  duly  sober  for  longer  or  shorter  periods  in  the  inter- 
vals between  the  times  of  his  debauches." 

It  has  even  been  held  that  an  attack  of  delirium  tremens  is  compatible 
with  temperate  habits.  This  opinion  is  so  novel  and  the  authority  is  so 
high  that  we  think  it  worth  while  to  give  the  case  (105  U.  S.  350)  in  some 
detail.  One  Badenhop  wras  insured  by  his  creditor,  Foley,  in  January, 
1872.  In  January,  1875,  Badenhop  died.  His  statements  were  made 
warranties  by  express  stipulation.  To  the  questions,  "  Is  the  part}'  of 
.temperate  habits?  Has  he  always  been  so ?"  he  answered,  "Yes."  At 
the  trial  his  family  physician  testified  that  in  1871  and  1872  Badenhop 
was  drinking  hard ;  that  during  that  year  he  had  attended  him  for  de- 
lirium tremens,  and  once  or  twice  for  indisposition,  produced,  as  he 
thought,  from  the  excessive  use  of  intoxicating  drinks.  The  Circuit 
Court  charged  that  if  the  jury  found  his  habits  in  the  usual,  ordinary, 
and  every -day  routine  of  his  life  were  temperate,  then  such  representa- 
tions were  not  untrue  within  the  meaning  of  the  policy,  although  they 
might  find  that  he  had  an  attack  of  delirium  tremens,  resulting  from 
an  exceptional  over-indulgence  in  drink  prior  to  the  issue  of  the  policy. 
On  appeal  to  the  United  States  Supreme  Court,  Justice  Field  stated  the 
opinion  as  follows :  "  The  charge  given  by  the  court,  as  stated  above, 
correctly  presented  the  law  of  the  case.  The  question  was  as  to  the 
habits  of  the  insured.  His  occasional  use  of  intoxicating  liquors  did  not 
render  him  a  man  of  intemperate  habits,  nor  would  an  exceptional  case 
of  excess  justify  the  application  of  this  character  to  him.  An  attack  of 
delirium  tremens  may  sometimes  follow  a  single  excessive  indulgence. 
Ray,  in  his  treatise  on  medical  jurisprudence,  says  that,  though  it  most 
commonly  occurs  in  habitual  drinkers  after  a  few  days  of  total  absti- 
nence from  spirituous  liquors,  it  may  be  the  immediate  effect  of  an  excess 
or  a  series  of  excesses  in  those  who  are  not  habitually  intemperate  as  well 
as  in  those  who  are.  In  the  American  Encyclopaedia,  under  the  head  of 
*  Delirium  Tremens/  it  is  stated  that  it  sometimes  makes  its  appearance 


546  A   SYSTEM  OF  LEGAL  MEDICINE. 

in  consequence  of  a  single  debauch ;  though  commonly  it  is  the  result 
of  protracted  or  long-continued  intemperance.  .  .  .  The  court,  therefore, 
did  not  err  in  instructing  the  jury  that  if  the  habits  of  the  insured  in 
the  usual,  ordinary,  e very-day  routine  of  his  life  were  temperate  the  rep- 
resentations made  are  not  untrue  within  the  meaning  of  the  policy, 
although  he  may  have  had  an  attack  of  delirium  tremens  from  an  excep- 
tional over-indulgence." 

In  this  case  the  question  was,  "  Has  the  party  always  been  of  tem- 
perate habits  ? "  and  it  was  held  that  the  continuance  of  these  temperate 
habits  was  not  broken  by  an  attack  of  delirium  tremens.  We  do  not 
claim  that  an  occasional  spree  of  a  night  is  incompatible  with  temperate 
habits  as  they  are  commonly  regarded  nowadays ;  but  an  attack  of  de- 
lirium tremens  is  not  due  to  a  drunk  of  one  night,  but  in  the  shortest 
case  it  takes  many  nights  and  days  to  bring  on  an  attack.  We  have 
looked  up  the  etiology  in  a  number  of  treatises,  and  append  herewith  the 
results : 

"Delirium  tremens  is  usually  understood  to  be  a  disease  consequent 
upon  the  sottish  or  excessive  use  of  alcoholic  or  fermented  drinks." 
(Thomas  Laycock,  Edinburgh  Medical  Journal,  October,  1858.) 

"  It  seems  to  be  forgotten  that  the  disease  is  not  occasioned  by  a  fit  of 
drunkenness,  but  that  it  is  the  result  of  the  long-continued,  excessive  use 
of  stimulants."     (Alex.  Peddie,  Journal  of  Medical  Science,  1854,  p.  492.) 

"  To  me  it  is  apparent  that  habitual  excess  in  the  use  of  stimuli  is  alike 
the  exciting  and  the  predisposing  cause  of  delirium  tremens."  (Same, 
p.  496.) 

"  This  does  not  break  out  suddenly  or  after  a  prodromic  stage  of  only 
a  few  days,  as  is  often  described.  If  we  examine  the  antecedents  of  a. 
person  suffering  from  alcoholic  delirium,  we  shall  find  that  the  outbreak 
of  the  delirium  was  brewing  long  before."  (Tuke,  Dictionary  of  Psycho- 
logical Medicine,  Art.  '  Delirium  Tremens.') 

"  Delirium  tremens :  a  train  of  morbid  phenomena,  produced  by  the 
slow  and  cumulative  action  of  alcohol,  in  the  various  forms  in  which  it 
is  used  as  a  drink."  (Aitken,  Science  and  Practice  of  Medicine,  vol.  ii., 
p.  842.) 

"  Delirium  tremens.  It  must  be  looked  upon  as  an  episode  or  epiphe- 
nomenon  of  chronic  alcoholism.  It  is  rare  that  even  prolonged  tempo- 
rary excesses  in  persons  ordinarily  temperate  are  followed  by  delirium 
tremens."     (Wilson,  Pepper's  System,  of  Medicine,  vol.  v.,  p.  627.) 

The  last  quotation  is  the  only  one  that  in  any  respect  resembles  that 
given  by  the  learned  justice.  It  seems  to  us  that,  even  with  this,  it  is- 
hardly  possible  for  a  reasonable  man  to  look  upon  an  attack  of  delirium 
tremens  as  consistent  with  the  statement  of  always  being  temperate.  In 
this  contention  we  have  excellent  judicial  support,  which  ranks  quite  as 
high  as  the  authority  we  are  disputing.  In  the  case  of  Thomson  vs.  Weems, 
L.  R.  9  App.  Cas.  671,  this  very  decision  was  analyzed.  Here  also  the 
statements  of  the  insured  were  made  express  warranties.  The  questions 
in  the  application  were,  "  Are  you  temperate  in  your  habits  ? "  "  Have 
you  always  been  strictly  so  ? "  The  answers  were,  "  Temperate,"  "  Yes." 
The  case  was  finally  carried  to  the  House  of  Lords,  and  it  was  there  held 
as  follows :  t 

"  The  question  must,  in  my  opinion,  be  interpreted  according  to  the 
ordinary  and  natural  meaning  of  the  words  used,  if  that  meaning  be? 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  547 

plain  and  unequivocal,  and  there  be  nothing  in  the  context  to  qualify  it. 
On  the  other  hand,  if  the  words  used  are  ambiguous  they  must  be  con- 
strued contra  proferentes,  and  in  favor  of  the  assured.  For  my  own  part, 
I  can  discern  no  ambiguity  in  the  language  of  question  seven.  I  agree 
with  Lord  Rutherford  Clark  that  '  the  import  of  the  answer  is  precisely 
the  same  as  if  the  deceased  had  affirmed,  first,  that  he  was  temperate  in  his 
habits,  and  secondly,  that  he  had  always  been  strictly  so.'  In  its  plain 
and  ordinary  sense,  that  statement  is  an  averment  of  the  fact,  and  not  a 
mere  assertion  of  the  opinion  or  belief  entertained  by  the  assured  with 
regard  to  the  fact.  It  then  appeal's  to  me  that,  whatever  may  be  the  im- 
port of  the  word  '  temperate '  (which  is  a  separate  matter),  the  assured 
must  be  held  to  have  warranted,  not  that  the  assertion  was  true  accord- 
ing to  his  sincere  conviction,  but  true  in  point  of  fact ;  and  consequently, 
that  in  order  to  establish  a  breach  of  warranty  it  is  not  necessary  for  the 
appellant  to  prove  that  the  assertion  was  morally  false.  .  .  . 

"  An  ingenious  argument  was  addressed  to  your  Lordships  by  the  re- 
spondent's counsel,  for  the  purpose  of  showing  that  the  seventh  question, 
from  its  very  nature,  involved  only  matter  of  opinion  and  not  of  fact, 
and  consequently  that  any  reply  to  it  must  be  treated  as  an  expression 
of  opinion,  and  not  as  an  assertion  of  fact.  It  appeared  to  me  that  their 
argument,  which  turned  upon  a  very  fine-drawn  distinction  between 
what  were  termed  matters  of  pure  fact  and  matters  of  opinion,  had  really 
no  practical  bearing  upon  the  case  before  us.  There  are  facts  innumer- 
able which  can  only  be  ascertained  by  the  test  of  opinion,  but  they  are 
not  the  less  facts  in  a  legal,  whatever  they  may  be  in  a  metaphysical, 
sense.  It  appears  to  me  to  be  in  vain  to  contend  that  the  character  of  a 
man's  habits,  temperate  or  intemperate,  is  a  matter  of  opinion  and  not 
■of  fact.  .  .  . 

"  I  now  come  to  the  second  question  in  this  appeal,  which,  as  I  have 
already  stated,  is  a  question  not  of  law  but  of  fact.  Was  the  late  William 
Weems,  on  the  9th  of  November,  1881,  and  had  he  previously  been,  a 
man  of  '  temperate  habits '  as  he  then  asserted  ?  If  that  question  must  be 
answered  according  to  the  truth,  and  not  according  to  the  personal  belief 
■of  the  deceased,  two  of  the  judges  of  the  Second  Division  were  of  the 
opinion  that  he  was  not.  It  does  not  clearly  appear  what  view  of  the 
evidence  would  have  been  taken,  upon  that  assumption,  by  Lords  Young 
and  Craighill ;  but  I  think  the  Lord  Ordinary  was  prepared  to  hold,  and 
■did  hold,  that  the  deceased  was,  in  point  of  fact,  a  man  of  temperate 
habits  within  the  meaning  of  the  seventh  question.  I  entirely  agree  with 
many  of  the  observations  which  were  made  by  the  Lord  Ordinary  in  re- 
gard to  what  ought,  for  the  purposes  of  this  case,  to  be  considered  as 
•constituting  temperate  habits,  although,  upon  the  evidence  before  us,  I 
am  unable  to  come  to  the  same  conclusion  as  his  Lordship.  I  am  dis- 
posed to  think  that  the  learned  judge  must  have  attached  undue  weight 
to  the  case  of  The  Knickerbocker  Life  Assurance  Co.  of  New  York  vs.  Foh ;/. 
105  U.  S.  350,  in  regard  to  the  rubric  of  which  his  Lordship  says :  '  The 
law  here  stated  is  that  which  the  Lord  Ordinary  adopts,  and  which  he 
has  endeavored  to  apply  in  his  present  judgment.'  Now,  as  I  read  the 
rubric  and  report,  there  was  no  law  laid  down  in  that  case.  An  American 
jury  had  found  that  a  man  was  of  temperate  habits  although  it  had  been 
proved  at  the  trial  that  he  had  an  attack  of  delirium  tremens;  and  the 
court  refused  to  disturb  the  verdict,  the  main  reason  assigned  for  that 


54S  A    SYSTEM  OF  LEGAL  MEDICINE. 

decision  being  a  statement  occurring  in  some  treatise  on  medical  juris- 
prudence to  the  effect  that,  in  the  case  of  an  intemperate  man,  delirum 
tremens  is  occasioned  by  absence  from  drink,  and  in  the  case  of  a  tem- 
perate man  by  indulgence  in  liquor.  Even  if  it  had  been  laid  down  as 
a  matter  of  law,  I  should  hesitate  very  much  to  adopt  such  a  standard 
as  that.  A  man  suffering  from  delirium  tremens  occasioned  by  recent 
drinking  may  possibly  be  more  temperate  than  another  man  who  is 
similarly  afflicted  in  consequence  of  his  having  abstained  from  his  usual 
potations ;  but  I  should  not  like  to  affirm  that  either  of  them  was,  in  the 
ordinary  sense  of  the  term,  a  man  of  temperate  habits.  .  .  . 

"  I  believe  it  to  be  useless  to  attempt  a  precise  definition  of  what  con- 
stitutes 'temperate  habits'  or  'temperance'  in  the  sense  in  which  these 
expressions  are  ordinarily  employed.  Men  differ  so  much  in  their  capac- 
ity for  imbibing  strong  drinks  that  quantity  affords  no  test;  what  one 
man  might  take  without  exceeding  the  bounds  of  moderation  another 
could  not  take  without  committing  excesses.  In  judging  of  a  man's 
sobriety,  his  position  in  life  and  the  habits  of  the  class  to  which  he  be- 
longs must,  in  my  opinion,  always  be  taken  into  account,  because  it  is 
the  custom  of  men  engaged  in  certain  lines  of  business  to  take  what  is 
called  refreshment,  without  any  imputation  of  excess,  at  times  when  a 
similar  indulgence  on  the  part  of  men  not  so  engaged  would  be,  to  say 
the  least,  suspicious.  But  I  do  not  think  that  the  habits  of  a  particular 
locality  ought  to  be  taken  into  account,  or  that  a  man  who  would  be 
generally  regarded  as  of  intemperate  habits  ought  to  escape  from  that 
imputation  because  he  is  no  worse  than  his  neighbors.  In  the  present 
case  the  evidence  clearly  establishes  that  the  assured  was  a  most  able 
and  estimable  man ;  but  that  circumstance  is  not  of  much  weighty 
because  able  and  estimable  men  are  not  necessarily  exempt  from  social 
failings.  .  .  . 

"  It  seems  to  me  to  be  the  fair  result  of  the  evidence,  that  the  assured 
was  in  the  habit  of  taking  more  drink  than  was  good  for  him ;  that  he 
was  frequently  affected  with  drink  on  occasions  when  all  except  himself 
were  sober;  that  his  indulgence  to  excess  had  become  so  apparent  that 
several  of  his  friends  had  remonstrated  with  him  on  the  subject,  and  that 
instead  of  repudiating  the  charge  he  admitted  it  and  promised  amend- 
ment. These  facts  appear  to  me  to  be  fully  proved,  and  they  are,  in  my 
opinion,  altogether  inconsistent  with  the  truth  of  the  assertion  that  he 
was,  on  the  9th  of  November,  1881,  of  temperate  habits  and  had  always 
been  so." 

We  have  quoted  this  decision  at  considerable  length,  both  because  of 
its  intrinsic  excellence  and  also  because  it  so  ably  maintains  the  view 
for  which  we  are  contending,  namely,  that  an  attack  of  delirium  tremens 
is  utterly  irreconcilable  with  temperate  habits. 

5.  In  discussing  intemperance  from  the  medical  point  of  view,  it  is 
hardly  possible  to  give  a  definite  statement  as  to  what  constitutes  an 
"  intemperate  "  man  or  "  intemperate  habits."  In  the  Century  Dictionary 
"  intemperate  "  is  defined  as,  "  in  a  restricted  sense,  immoderate  in  the  use 
of  intoxicating  drinks;  given  to  excessive  drinking."  In  a  note  "intem- 
perate habits"  are  referred  to  as  the  "habitual  and  excessive  indulgence 
in  the  use  of  alcoholic  drinks."  This,  of  course,  carries  us  no  nearer  our 
goal,  for  we  must  define  " immoderate "  and  "excessive."  At  the  same  time 
it  shows  that  there  is  a  distinction  between  "intemperate"  and  "habits 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  549 

of  intemperance,"  and  the  distinction  is  popular  and  common.  It  has 
been  our  invariable  custom  for  some  years  past  to  ask  applicants  for  in- 
surance if  they  have  "  always  been  temperate."  The  answers  are  fre- 
quently like  this:  "I  have  never  been  drunk  in  my  life;"  or,  "Well,  I 
have  been  drunk  once  or  twice,  but  very  seldom."  These  answers,  we 
think,  show  very  clearly  that  the  laity  understand  the  question  to  refer 
to  ordinary  intoxication,  and  not  to  habits  of  intemperance.  But  this 
latter  is  the  judicial  construction  in  the  case  of  Fox  vs.  Life  Insurance 
Co.  (p.  544),  and  of  Life  Insurance  Co.  vs.  Re  if  (p.  545). 

The  liinits  within  which  temperance  can  range  vary  greatly.  It  cer- 
tainly does  not  mean  total  abstinence.  On  the  other  hand,  it  does  not 
mean  the  use  of  alcoholics  to  such  a  degree  as  to  give  rise  to  delirium 
tremens,  or  to  cause  some  pathological  lesion  which  is  traceable  directly 
to  the  alcoholic  poison,  such  as  hepatic  cirrhosis.  But  at  what  point  be- 
tween these  extremes  can  temperance  be  said  to  merge  into  intemper- 
ance ?  Where  shall  we  draw  the  line  ?  It  cannot  be  said  that  an  occa- 
sional "  drunk,"  once  or  twice  a  year  and  lasting  only  a  night,  constitutes 
intemperance.  How  many,  then,  will  it  take  to  convert  a  sociable  fellow 
into  an  intemperate  one  ?  Is  this  infrequent  spreeing  incompatible  with 
a  warranty  of  always  "  temperate  "  ?  On  the  other  hand,  can  a  man  be 
intemperate  without  getting  drunk?  This  latter  is  certainly  possible. 
A  man  can  distribute  over  the  day  and  evening  eight  or  ten  drinks  of 
whiskey,  amounting  to  five  or  six  ounces,  and  representing  two  or  three 
ounces  of  alcohol,  so  that  at  no  time  can  he  be  said  to  be  intoxicated. 
But  that  truly  constitutes  intemperance,  and  one  of  its  worst  forms. 

The  physiological  capacity,  so  called,  for  alcohol  is  set  by  Anstie  at 
one  and  a  half  to  two  ounces  of  alcohol  per  diem.  Parke  (Practical 
Hygiene,  vol.  i.)  indorses  this  view  after  a  fashion.  He  says  that  the 
limit  of  the  useful  effect  of  alcohol  is  produced  by  a  daily  quantity  of 
one  to  one  and  a  half  ounces ;  that  more  than  this  is  certainly  injurious, 
and  it  is  better  to  use  light  wines  than  liquors,  or  even  beer.  He  con- 
cludes by  saying  that  "the  facts  now  stated  make  it  difficult  to  avoid 
the  conclusion  that  the  dietetic  value  of  alcohol  has  been  much  over- 
rated. It  does  not  appear  possible  to  condemn  alcohol  altogether  as  an 
article  of  diet  in  health  or  to  prove  that  it  is  invariably  hurtful,  as  some 
have  attempted  to  do.  It  produces  effects  which  are  often  useful  in 
disease,  but  in  health  it  certainly  is  not  a  necessity,  and  many  persons 
are  much  better  without  it."  Even  these  small  amounts  of  alcohol 
unquestionably  have  an  influence  on  the  prospects  of  longevity.  But 
after  all,  an  average  risk,  that  has  sound  health  and  good  antecedents, 
is  all  that  an  insurance  company  can  ask  for.  Hence  moderate  drink- 
ing does  not  impair  their  calculations  by  introducing  an  element  of 
greater  risk,  for  it  is  already  reckoned  in  the  average.  But,  as  we  shall 
see  later,  any  excess  has  so  deleterious  an  influence  that  cases  subject  to 
it  must  be  carefully  excluded.  Does  any  one  imagine  that  any  of  the 
cases  mentioned  under  section  4  wTould  be  accepted  by  any  reputable 
life  insurance  company  if  the  applicants  had  told  the  truth  with  even 
approximate  accuracy  '. 

The  statistical  work  on  this  subject  does  not  reach  large  proportions. 
The  earliest  calculations  that  we  could  find  were  by  F.  G.  P.  Neison 
(Contributions  to  Vital  Statistics.  1857)  when  he  made  a  study  of  intem- 
perance by  means  of  circulars  inclosing  a  carefully  prepared  schedule 


550  -4   SYSTEM   OF  LEGAL   MEDICINE. 

of  questions.  In  this  way  lie  obtained  the  records  of  357  cases.  In 
the  circular  he  stated  that  the  cases  must  be  those  of  persons  who  were 
"  decidedly  addicted  to  drinking-  habits  during-  a  considerable  period  of 
life."  No  more  exact  definition  of  intemperance  was  adopted,  since,  as 
he  very  justly  remarks,  "  the  consequence  of  following  this  course  is, 
that  the  objections  which  might  be  urged  against  the  adoption  of  any 
individual  or  peculiar  test  are  avoided,  for,  by  leaving  it  to  each  con- 
tributor of  data  to  determine  for  himself  what  constitutes  decidedly 
intemperate  habits,  the  whole  data,  taken  collectively,  from  all  the 
various  contributors,  will  show  very  clearly  the  result  of  those  habits 
which  the  public,  by  common  consent,  admit  to  be  intemperate ;  so  that, 
however  any  individual  reasoner  on  the  results  may  argue,  and  what- 
ever peculiar  construction  he  may  choose  to  put  upon  them,  it  will  be 
impossible  to  avoid  the  conclusion  that  the  data  really  relate  to  what 
the  public  generally  regard  as  persons  of  intemperate  habits."  In  one 
table  he  compares  the  general  mortality  percent,  of  England  and  Wales 
with  that  of  intemperate  persons,  as  follows : 

j_ae  Mortality  percent,  of       Mortality  percent,  of 

J  '  intemperate  persons.         England  and  Wales. 

16  to  20  years 1.342  .730 

21  to  30  years 4.953  .974 

31  to  40  years 4.620  1.110 

48  to  50  years 5.992  1.452 

51  to  60  years 6.418  2.254 

61  to  70  years 7.992  4.259 

71  to  80  years 18.182  9.097 

81  to  90  years 20.000  19.904 

In  only  65  out  of  these  357  cases  was  the  cause  of  death  assigned 
directly  to  intemperance.  In  another  table  he  states  that  the  number  of 
deaths  assigned  to  delirium  tremens  and  intemperance  in  England  and 
Wales  in  1847  amounted  to  only  731  out  of  a  total  of  228,780.  This 
shows  how  insignificant  a  proportion  of  deaths  can  be  directly  ascribed 
to  intoxicants.  The  basis  of  these  tables  is  open  to  some  criticism  in 
that  the  number  of  cases  is  very  small  from  which  to  draw  any  reliable 
conclusions,  and  the  kind  of  intemperance  called  for  is  excessive.  Be- 
sides, the  ordinary  drinking  habits  in  those  days  were  considerably  larger 
titan  at  present.  Hence,  if  the  cases  were  of  persons  "  decidedly  addicted 
to  drinking  habits,"  they  would  rank  still  lower  in  the  scale  at  the  present 
time. 

From  this  report  it  will  be  seen  that  intemperance  infrequently  causes 
death  directly,  but  its  influence  is  felt  over  a  wide  range  of  diseases.  In 
fact,  its  manifestations  are  most  marked  in  its  unfavorable  effect  on  the 
prognosis  of  disease  in  general.  But  it  is  just  this  deleterious  influence 
which  is  apparently  overlooked  in  such  decisions  as  that  in  the  case  of 
McGinley  vs.  Life  Insurance  Co.  (see  p.  543). 

Bearing  upon  this  indirect  influence  of  alcoholics  is  the  report  of  a 
committee  to  the  Harveian  Society  (British  Medical  Journal,  1883,  vol.  i., 
p.  100.)  About  ten  thousand  lives  were  used  in  the  construction  of  a 
table,  from  which  the  following  conclusions  were  drawn  : 

"We  find,  therefore,  upon  the  whole,  reason  to  think  that,  in  the  me- 
tropolis, the  mortality  among  any  considerable  group  of  intemperate  per- 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  551 

sons  will  differ  from  that  generally  prevailing:  among  adults  in  the  fol- 
lowing important  particulars,  viz. :  a  fourfold  increase  in  the  deaths  from 
diseases  of  the  liver  and  chylopoetic  viscera;  a  twofold  increase  in  the 
deaths  from  diseases  of  the  kidneys,  a  decrease  of  half  as  much  again  in 
those  from  heart  disease,  a  marked  increase  in  those  from  pneumonia  and 
pleurisy,  a  considerable  increase  and  an  earlier  occurrence  of  those  from 
disease  of  the  central  nervous  system ;  a  marked  decrease  in  those  from 
bronchitis,  asthma,  emphysema,  and  congestion  of  the  lungs,  a  decrease 
nearly  as  great  from  phthisis,  and  a  later  occurrence,  or  at  least  termina- 
tion, of  the  disease ;  a  very  large  decrease  in  those  from  old  age,  with  an 
increase  in  those  referred  to  atrophy,  debility,  etc.,  and  the  addition  of  a 
•considerable  group,  referred  in  general  terms  to  alcoholism  or  chronic 
alcoholism,  or  resulting  from  accidents." 

In  1888  a  collective  investigation  committee  of  the  British  Medical 
Association  made  a  report  (British  Medical  Journal,  1888,  vol.  i.,  p.  1316) 
on  4234  cases,  with  reference  to  the  influence  of  habits  on  the  duration 
-of  life  and  the  canse  of  death.  The  cases  were  divided  into  five  classes, 
viz.,  total  abstainers,  habitually  temperate,  careless  drinkers,  free  drink- 
ers, decidedly  intemperate.  Among  the  conclusions  the  following  have 
relation  to  the  subject  under  discussion  : 

"  1.  That  habitual  indulgence  in  alcoholic  liquors  beyond  the  most 
moderate  amounts  has  a  distinct  tendenc}'  to  shorten  life,  the  average 
shortening  being  roughly  proportioned  to  the  degree  of  indulgence.   .  .  . 

"  3.  That  in  the  production  of  cirrhosis  and  gout  alcoholic  excess  plays 
the  very  marked  part  which  it  has  long  been  recognized  as  doing.  .  .  . 

"4.  That,  cirrhosis  and  gout  apart,  the  effect  of  alcoholic  liquors  is 
rather  to  predispose  the  body  toward  the  attacks  of  disease  generally 
than  to  induce  any  special  pathological  lesion.  .  .  . 

"  6.  That  there  is  no  ground  for  belief  that  alcoholic  excess  leads  in 
any  special  manner  to  the  development  of  malignant  disease,  and  some 
reason  to  think  that  it  may  delay  its  production. 

"  7.  That  in  the  youug  alcoholic  liquors  seem  rather  to  check  than  to 
induce  the  formation  of  tubercle ;  while  in  old  age  there  is  some  reason 
to  believe  that  the  effects  are  reversed." 

Some  life  insurance  companies  require  abstinence  of  their  policy- 
holders, or  divide  them  into  two  classes,  abstainers  and  non-abstainers. 
Not  many  of  these  companies  have  published  their  results,  but  what  has 
been  told  bears  out  the  argument  so  far  advanced  by  us.  Thus,  the 
■comparative  mortality  of  the  two  sections  in  the  United  Kingdom  Tem- 
perance and  General  Provident  Institution  for  the  nine  years,  1806-74, 
is  as  follows : 

General  section 

Abstinence  section 


Expected  Mortality. 

Act  nut  Mortality. 

1!<i  Ho 

2002 

1977 

98.80 

1111 

801 

72. 10 

It  is  presumed,  of  course,  that  the  usual  precautions  were  taken  to 
•exclude  persons  of  intemperate  habits  from  the  general  section. 

Opium  and  Allied  Narcotics. — The  influence  of  the  habitual  use  of 
these  drugs  is  usually  considered  harmful,  and  some  question  relating 
to  them  is  always  put  in  the  application.  It  does  not  seem  proper  that 
this  should  include  the  infrequent  administration  of  them  for  medicinal 
purposes  only,  and  regularly  with  the  advice  of  a  physician.    This  would 


552  ^   SYSTEM  OF  LEGAL  MEDICINE. 

be  straining  a  point,  and  we  think  it  would  be  justly  so  considered  in 
any  court  of  law.  Of  course,  the  question  arises  as  to  what  would  con- 
stitute a  breach  of  warranty  in  this  respect.  Here  we  are  confronted 
with  the  same  difficulties  which  were  present  in  the  case  of  alcoholics.. 
Fortunately,  there  are  fewer  decisions  and  consequently  less  confusion. 

Does  the  presence  or  absence  of  a  physician's  order  help  us  in  laying- 
down  a  rule  ?  It  is  with  some  diffidence  that  we  advance  the  proposition 
that,  in  the  absence  of  a  physician's  mandate,  the  use  of  opium  or  other 
narcotics  would  amount  to  an  improper  use  of  these  substances,  and  hence 
would  be  included  within  the  spirit  and  inteut  of  a  question  referring  to 
the  use  of  these  drugs.  As  a  general  rule,  it  may  be  said  that  such  cases 
are  rejected  by  life  insurance  companies  if  the  facts  are  told  to  them  in 
making  application.  It  is  true  that  there  are  the  occasional  exceptions 
of  the  man  who,  at  very  infrequent  intervals,  takes  some  favorite  mix- 
ture for  an  attack  of  insomnia  without  consulting  his  physician,  or  of  the 
man  who  relieves  his  very  infrequent  enteralgia  in  the  same  way.  But 
both  the  narcotic  and  the  need  for  taking  it  militate  strongly  against  his 
acceptance  by  any  good  life  insurance  company.  Such  being  the  case, 
it  seems  only  fail1  to  apply  the  same  rule  even  if  the  policy  has  already 
been  issued.  It  may  be  argued  that  the  applicant  does  not  attach  the 
same  importance  to  the  subject  that  the  company  does.  If  the  question 
is  plainly  put,  there  can  certainly  be  no  plea  of  ignorance,  as  there  might 
be  if  it  were  some  latent  disease.  It  is  not  for  the  applicant  to  judge  of 
the  importance  of  a  question ;  it  is  his  business  to  answer  it  as  fully  as 
he  can,  and  with  the  utmost  good  faith.  If  he  states  the  facts,  and  the 
company  then  decides  to  accept  him,  he  is  relieved  of  all  responsibility 
in  the  matter.  We  fear,  however,  after  considering  the  liberality  of  judi- 
cial construction  in  such  matters,  that  our  opinion  would  not  be  the  one 
adopted.  But  where  the  courts  would  draw  the  line  we  cannot  tell,  as 
there  are  no  decisions  on  the  subject.  On  the  other  hand,  the  prescrip- 
tion of  a  physician  to  take  any  one  of  these  drugs  should  secure  exemp- 
tion to  the  individual  from  telling  the  fact,  unless  the  treatment  had 
been  long  continued  or  recent. 

There  is  another  phase  of  this  subject  which  must  be  considered.  In 
many  of  the  old  policies  and  some  of  the  new  there  is  no  direct  question 
asked  with  reference  to  these  narcotics.  Consequently  the  attention  of 
the  applicant  is  not  drawn  to  the  subject.  In  all  of  them,  however,  there 
is  some  general  declaration  to  the  effect  that  the  applicant  is  concealing 
no  material  fact  from  the  insurer,  or  is  doing  nothing  in  any  way  to 
shorten  his  life.  Hence  arises  the  question,  Is  the  existence  of  a  habit 
of  this  kind  a  material  fact?  Does  it  tend  to  shorten  life?  To  answer 
this  question  properly  it  would  be  necessary  to  have  data  as  to  the 
effect  of  each  of  these  narcotics  on  longevity.  Exhaustive  information 
on  these  points,  however,  is  unfortunately  not  to  be  had.  Opium  alone 
has  been  the  object  of  some  observation  in  this  respect.  It  is  the  com- 
mon belief  that  the  chronic  use  of  this  drug  tends  decidedly  to  shorten 
life,  but  when  we  came  to  look  up  the  literature  on  this  point  we  were 
surprised  at  the  dearth  of  positive  information.  The  organic  lesions 
that  it  produces  are  almost  nil.  It  does  cause  a  chronic  gastro-intestinal 
catarrh,  considerable  ana?mia,  and  general  malnutrition,  and  occasion- 
ally some  albuminuria.  The  latter,  however,  according  to  Bancroft 
(Reference  Handbook  of  the  Medical  Sciences,  vol.  v.,  p.  328),  is  always 


THE  MEDICAL  JUEISPEUDENCE   OF  LIFE  INSURANCE.  553. 

functional,  for  it  entirely  disappears  after  the  use  of  the  drug  is  discon- 
tinued. All  the  other  effects  of  the  drug  are  exerted  upon  the  nervous 
system,  but  in  only  a  small  proportion  of  cases  does  its  use  lead  to 
sufficient  mental  alienation  to  amount  to  insanity.  Tuke  (Dictionary  of 
Psychological  Medicine,  vol.  ii.,  p.  820)  says:  "The  prognosis  of  mor- 
phiomania  as  a  disease  is  most  unfavorable ;  it  terminates  sooner  or 
later  fatally  by  general  marasmus.  A  certain  number  of  patients  be- 
come insane,  while  others  commit  suicide." 

Osier  (Practice  of  Medicine,  p.  100C)  says:  "Finally  a  condition  of  as- 
thenia is  induced,  in  which  the  victim  takes  little  or  no  food,  and  dies 
from  the  extreme  bodily  debility." 

Levinstein  (Morbid  Craving  for  Morphia,  p.  108)  makes  practically  the 
same  statement.  But,  after  all,  these  are  only  "  glittering  generalities," 
and  it  must  be  remembered  that  these  men  only  come  in  contact  with 
the  worst  cases.  On  the  other  hand,  we  have  a  great  deal  of  testimony 
that  the  habit  can  be  indulged  in  to  a  considerable  extent  and  for  a  long 
time  with  no  apparent  detriment  to  the  general  health.  In  the  famous 
case  of  the  Earl  of  Mar  it  was  proven  that  he  had  been  in  the  habit  of 
takiug  laudanum  for  thirty  years,  sometimes  as  much  as  two  or  three 
ounces  daily.  At  this  trial  there  were  man}7  examples  of  persons  ad- 
duced who  had  taken  opium  without  evil  effects  for  many  years.  While 
the  testimony  of  the  experts  was  that  the  habit  tended  to  shorten  life, 
they  could  give  no  examples  of  that  result. 

In  India,  if  we  can  accept  the  testimony  of  the  British  medical  officers 
there  stationed,  the  moderate  use  of  opium  is  in  no  marked  particular 
harmful.  This  is  very  elaborately  considered  in  the  British  Medical  Jour- 
nal (Dec,  1893,  Jan.  and  Feb.,  1894)  in  the  analysis  of  over  one  hun- 
dred reports  from  medical  officers  and  civilians  resident  in  India.  The 
abstract  states  that  the  moderate  use  of  opium,  meaning  thereby  from 
two  to  eight  grains  daily,  was  directly  beneficial  as  a  prophylactic 
against  malaria,  diarrhoea,  dysentery,  and  cholera,  and  that  in  no  case 
were  its  evils  as  great  as  those  of  alcohol.  Most  of  the  reports  were  to 
the  effect  that  opium  smoking  was  injurious,  although  they  did  not  in- 
dicate in  what  way.  As  regards  the  dangers  of  the  opium  habit  in 
India,  Sir  Joseph  Fayrer  (British  Medical  Journal,  1893,  vol.  ii.,  p.  1195) 
says :  "  It  is  said,  I  believe,  by  its  opponents,  that  the  tendency  to  opium 
eating  is  ever  to  increase,  to  induce,  it  may  be,  slow  but  sure  degrada- 
tion and  destruction.  I  do  not  believe  this.  In  the  course  of  many 
years'  experience  in  India  I  have  known  so  man 3^  who  have  been  habitual 
consumers  of  a  small  quantity  of  opium,  without  in  any  way  suffering 
from  it,  or  without  any  tendency  to  increase  the  habit,  that  I  am  unable 
to  agree  with  those  who  state  otherwise.  ...  It  seems  to  me  that  this 
crusade  against  opium,  though  well  meant,  is  not  reasonable.  It  is  as 
unfair  to  argue  from  the  habitues  of  opium-smoking  houses  as  it  is  from 
the  frequenters  of  gin  palaces  and  other  haunts,  where  the  most  degraded 
forms  of  alcoholic  abuse  may  be  met  with  in  our  own  country.  Both, 
in  extreme  cases,  are  an  evil ;  but  the  moderate  use,  either  of  alcohol  or 
of  opium,  must  be  left  to  the  discretion  of  those  who  feel  called  upon  to 
take  them." 

On  the  other  hand,  the  very  different  status  of  the  opium  habit  in  this 
country  must  be  remembered.  In  India  it  is  openly  indulged  in,  and 
opium  seems  to  take  the  place  of  both  alcohol  and  tobacco.    Here  its  use 


554  ^   SYSTEM  OF  LEGAL  MEDICINE. 

is  a  secret  vice,  practiced  chiefly  by  those  whose  will-power  is  in  abeyance, 
either  on  account  of  some  painful  disease  or  by  heredity.  The  most  in- 
sidious method  of  use  is  commonly  adopted  here,  that  of  hypodermic  injec- 
tion. Like  all  other  secret  vices,  there  is  a  constant  tendency  to  take  larger 
amounts,  and  this  inclination  is  here  usually  gratified,  contrary  to  the 
experience  in  India.  Hence  we  can  only  say  that  it  is  not  fair  to  apply 
the  same  rules  to  the  habit  here  and  in  India.  But  owing  to  the  entire 
absence  of  statistical  information,  we  are  unable  to  say  what  effect  it  has 
upon  the  duration  of  life.  It  would  seem  to  us,  however,  to  be  a  mate- 
rial fact,  the  existence  of  which  should  be  communicated  to  the  insurer, 
for  him  to  act  upon  as  he  wishes. 

Similar  remarks  must  apply  to  the  chloral  habit  and  other  forms  of 
drug  addiction.  So  far  as  we  know,  they  do  not  give  rise  to  any  organic 
changes,  but  all  the  testimony  we  have  is  to  the  effect  that  they  are  de- 
cidedly harmful,  and  have  a  marked  tendency  to  shorten  life.  The  exist- 
ence of  any  of  these  habits,  present  or  past,  is  a  material  fact,  which  must 
be  communicated  to  the  insurer. 

Family  Record. — Heredity  plays  a  very  important  part  in  some  dis- 
eases, and  is  regarded  of  so  much  consequence  that  insurers  regularly  ask 
for  the  family  history  with  considerable  detail.  Many  applicants  for  in- 
surance are  rejected  simply  on  their  bad  family  record.  The  age  of  the 
relatives  does  not  count  for  so  much  as  their  state  of  health,  if  living,  or 
the  cause  of  their  death.  While  man}-  diseases  may  be  due  to  some  ex- 
tent to  heredity,  only  those  in  which  this  influence  is  more  pronounced 
are  specifically  mentioned  in  the  applications.  These  usually  include  in- 
sanity and  other  nervous  diseases,  gout,  rheumatism,  consumption,  scrof- 
ula, and  cancer.  And  in  this  connection  the  statement  that  the  cause 
of  the  mother's  death  was  childbirth  always  casts  a  cloud  on  the  risk.  It 
is  held  that  name  usually  is  simply  a  disguise  for  phthisis.  Even  where 
the  duration  of  the  illness  is  stated  to  be  short,  it  is  probable  that  the 
exhaustion  of  parturition  has  brought  to  a  sudden  close  the  chronic  dis- 
ease. This  has  long  been  a  belief  among  insurance  examiners,  and  it  is 
supported  by  the  actual  results.  H.  W.  Mauley  {Journal  of  the  Institute 
of  Actuaries,  vol.  xxx.,  p.  97)  made  a  careful  investigation  of  this  point. 
Out  of  83  persons  whose  mothers  only  had  died  of  consumption,  there 
was  an  actual  mortality  of  22  against  an  expected  mortality  of  17.570  by 
the  Hm.  Table  ;  that  is  to  say,  the  mortality  was  25.2  percent,  in  excess  of 
the  expected.  Out  of  22G  persons  the  death  of  whose  mothers  was  ascribed 
to  childbirth,  the  actual  mortality  was  68  against  an  expected  mortality 
of  53.086 ;  that  is  to  say,  the  actual  mortality  was  28.1  percent,  in  excess 
of  the  expected.  The  influence  of  a  consumptive  mother  made  the  mor- 
tality 25  percent,  greater  than  was  reasonable  to  expect,  while  the  death 
of  the  mother  from  childbirth  made  it  28  percent,  greater.  On  comparing 
the  causes  of  death  in  the  two  sets  of  eases  it  was  noticed  that  tubercu- 
losis bore  nearly  the  same  proportion  in  each,  being  18  percent,  in  the 
former  and  16  percent,  in  the  latter. 

In  the  case  of  Baker  vs.  Life  Insurance  Co.,  4  Bigelow's  Life  and  Ace. 
Rep.  355,  the  insured  gave  a  negative  answer  to  the  question,  "  Have  the 
parents,  uncles,  aunts,  brothers,  or  sisters  of  the  party  been  afflicted  with 
insanity,  or  with  any  pulmonary,  scrofulous,  or  with  any  other  constitu- 
tional disease  ? " 

It  was  proven  beyond  doubt  that  at  least  one  brother  had  died  of  con- 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  555 

sumption  and  probably  others.  It  was  held :  "It  is  true,  the  twentieth 
question  is  very  far-reaching'.  And  the  answer  to  it,  being  an  unqualified 
negative,  was  a  very  incautious  and  dangerous  assertion,  but  it  is  not  for 
the  court  to  alter  the  plain  contract  of  the  parties." 

In  the  case  of  Insurance  Co.  vs.  Gray  et  ah,  91  111.  159,  the  insured 
gave  a  negative  answer  to  the  question,  "  Have  either  of  your  parents, 
brothers  or  sisters,  ever  had  any  pulmonary,  scrofulous,  or  any  mental 
or  constitutional  or  hereditary  disease  ? " 

On  appeal  it  was  held :  "  The  evidence  that  both  parents  died  of  pul- 
monary consumption,  of  which  they  each  suffered  for  several  years  before 
their  respective  deaths,  is  all  one  way.  It  is  proved  by  relatives,  neigh- 
bors, and  physicians,  and  it  is  not  reasonable  to  assume  that  the  assured 
was  even  ignorant  of  this  fact,  for  he  seems  to  have  been  living  with  or 
near  his  parents  during  the  time  they  were  thus  afflicted.  There  is  no 
effort  to  prove  that  either  of  them  died  of  a  fever,  or  were  even  sick  of  a 
fever.  The  disease  of  which  they  died  is  generally  believed  to  be  heredi- 
tary, and  it  is  impossible  to  escape  the  conviction  that  the  truth  here  was 
withheld  because  its  communication  woidd  either  have  defeated  the  ap- 
plication for  the  policy  or  materially  increased  the  premiums  for  the 
risk." 

In  the  case  of  Insurance  Co.  vs.  Gridley,  100  U.  S.  611,  to  the  question, 
"  Have  the  person's  [whose  life  is  to  be  insured]  parents,  uncles,  aunts, 
brothers,  or  sisters  been  afflicted  with  consumption,  scrofula,  insanity, 
epilepsy,  disease  of  the  heart,  or  any  other  hereditary  disease  ? "  the  as- 
sured answered,  "  No  hereditary  taint  of  any  kind  in  family  on  either 
side  of  house,  to  my  knowledge." 

It  was  proven,  on  behalf  of  the  company,  that  an  uncle  of  the  insured 
was  insane  for  more  than  a  year,  and  that  he  died  in  an  asylum,  twenty 
years  before  the  application  for  insurance.  And  it  was  argued  that  on 
this  ground  a  verdict  should  be  rendered  for  the  company.  It  was  not, 
however,  and  on  appeal  it  was  held :  "  To  make  out  the  defense  sought 
to  be  established  by  the  insurers,  three  things  were,  therefore,  necessary 
to  be  shown :  that  the  alleged  insanity  of  the  uncle  had  existed ;  that  it 
was  hereditary ;  and  that  both  of  these  things  were  known  to  the  appli- 
cant when  he  answered  the  question.  The  first  point  was  clearly  proved. 
In  relation  to  the  second  and  third  there  was  no  proof  whatever.  What 
was  proved,  without  what  was  not  proved,  was  of  no  account,  The  de- 
fense, therefore,  wholly  failed."  This  seems  very  reasonable,  as  the  de- 
fense, on  its  face,  is  only  a  quibble. 

Here  there  was  a  proper  indication  for  the  use  of  the  term  "  heredi- 
tary." In  some  cases,  however,  it  seems  to  be  confounded  with  the  term 
"  inherited."  The  definition  of  "  hereditary,"  according  to  Webster,  is, 
"  Transmitted,  or  capable  of  being  transmitted,  from  a  parent  to  a  child ; 
as,  hereditary  disease."  Except  for  its  narrow  limitations  to  lineals  only, 
this  definition  is  exactly  what  the  insurer  means.  The  insurer  does  not  care 
to  know  about  diseases  which  are  already  transmitted  to  the  applicant,  for  in 
that  case  his  physical  condition  is  already  such  as  to  warrant  his  rejection. 
But  the  insurer  does  wish  to  know  about  diseases  in  the  family  which 
are  capable  of  being  transmitted,  and  which  may  break  out  in  the  usual 
wa}'  at  any  time.  To  say  in  effect  that  the  disease  must  be  inherited  is 
absurd,  for,  to  make  a  bull,  it  cannot  be  proved  that  it  is  an  inherited 
disease  until  it  has  been  inherited,  i.e.,  developed.     This  view,  however, 


556  A   SYSTEM  OF  LEGAL  MEDICINE. 

was  the  one  apparently  taken  in  the  case  of  Sinclair  vs.  Life  Insurance  Co., 
9  Ins.  L.  J.  523.  Here  the  insured  gave  a  negative  answer  to  the  ques- 
tion, "  Have  the  parents  or  brothers  or  sisters  of  the  party  been  affected 
with  insanity,  or  with  pulmonary,  scrofulous,  or  any  other  constitutional 
disease  hereditary  in  its  character?"  It  was  proven  that  the  father  and 
sister  had  died  of  consumption.  The  family  physician  said  he  did  not 
know  whether  it  was  hereditary  or  not,  but  that  he  did  not  think  that  it 
was.  It  was  held  that  it  must  be  proven  that  it  was  "  hereditary  in  its 
character/'  in  order  to  come  within  the  question  above  mentioned.  The 
judge  said  that  "  the  undoubted  object  of  that  question  was  to  procure 
information  as  to  whether  insanity,  scrofulous  and  pulmonary  diseases 
had  developed  in  an  hereditaiy  form  among  the  relatives  of  the  appli- 
cant." That  is  true;  but  the  question  did  not  state  that  the  disease  must 
be  an  inherited  one.  Consumption  is  an  hereditary  disease,  and  in  about 
one  half  of  the  cases  we  can  get  evidence  of  its  diathesis  having  been  in- 
herited from  the  progenitors  or  the  collaterals  of  the  individual.  The 
accidental  development  of  the  other  fifty  percent,  does  not  preclude  con- 
sumption from  being  an  hereditary  disease.  The  question  does  not  refer 
to  a  particular  instance,  but  does  ask  if  the  individual  ever  had  any  hered- 
itary constitutional  disease.  How  many  generations  does  it  take  to  make 
an  hereditary  disease  ?  The  medical  testimony  admits  of  strong  criticism 
on  this  point. 

A  somewhat  different  criticism  must  be  made  in  the  case  of  Peasley 
vs.  Life  Insurance  Co.,  15  Hun  227.  Here  the  insured  gave  a  negative 
answer  to  the  question,  "  Have  the  party's  parents,  uncles,  aunts,  brothers, 
or  sisters  been  afflicted  with  consumption,  scrofula,  insanity,  epilepsy, 
diseases  of  the  heart,  or  other  hereditary  disease  ? " 

It  was  proven  that  the  mother  of  the  insured  had  had  three  attacks 
of  insanity,  in  each  case  apparently  due  to  accidental  causes,  such  as  a 
fever  or  displacement  of  the  uterus.  Although  the  statements  were 
warranties,  it  was  held  that  the  last  three  words  of  the  question  qualified 
all  the  others,  and  were  intended  to  show  that  the  diseases  mentioned 
must  be  the  product  of  heredity. 

This  definition  was  right ;  but  does  not  the  development  of  such  a 
disease  indicate  a  weakness  of  the  system  which  is  capable  of  transmis- 
sion to  the  offspring,  and  hence  hereditary  ?  Hereditary  does  not  mean 
necessarily  inherited.  An  outbreak  of  insanity  must  rarely  occur  in 
women  solely  as  the  result  of  a  displacement  of  the  uterus  unless  there 
is  associated  with  it  a  latent  capacity  for  mental  alienation.  If  it  did, 
there  are  few  of  our  women  who  would  not  be  in  an  asylum  at  some 
time  of  their  lives.  Then  this  inability  to  resist  nervous  strain,  being 
the  foundation  of  the  insanity  and  being  hereditary,  would  not  the  insan- 
ity itself  be  considered  hereditary  ? 

Occupation. — It  is  well  known  that  the  rates  of  mortality  vary  greatly 
according  to  the  occupation.  Some  occupations  are  so  hazardous  that 
no  company  will  take  persons  engaged  in  them.  In  the  case  of  others 
less  dangerous,  the  company  may  issue  a  policy,  but  obliges  the  insured 
to  take  the  risk  of  death  from  any  accident  which  is  incident  to  the 
occupation.  In  still  others  the  company  assumes  the  whole  risk,  but 
charges  an  extra  premium.  The  following  table  shows  the  relative 
mortality  in  the  more  common  occupations.  It  represents  the  number 
of  deaths  occurring  in  each  occupation  between  the  ages  of  twenty-five 


THE  MEDICAL  JUBISPBUDENCE  OF  LIFE  INSURANCE.  557 

and  sixty-five,  as  compared  with  a  normal  standard  of  one  thousand  deaths 
in  the  general  population  during  these  years.  {Medical  Handbook  of  Life 
Assurance,  by  Pollock  and  Chisholm,  p.  206  et  seq.) 

PROFESSIONAL   MEN. 

Clergyman 556 

Schoolmaster 719 

Barrister 842 

Artist 921 

Physician 1122 

Musician 1314 

MERCHANTS. 

Coal  merchant 758 

Bookseller,  stationer 825 

General  shopkeeper 865 

Ironmonger 895 

Fishmonger,  poulterer 974 

Tobacconist 1000 

Cheesemonger 1009 

Chemist,  druggist 1015 

Greengrocer,  fruiterer 1025 

MANUAL   "WORKERS. 

Gardener,  nurseryman 599 

Farmer 631 

Agricultural  laborer 701 

Fisherman 797 

Carpenter,  joiner 820 

Baker,  confectioner 958 

Builder,  mason,  bricklayer 969 

Tailor 1051 

Printer 1071 

Stone,  slate-quarrier 1122 

Cutler,  scissors-maker 1309 

File-maker 1667 

Earthenware  manufacturer 1742 

OCCUPATIONS   PARTICULARLY   SUBJECT   TO   INTEMPERANCE. 

Butcher 1170 

Brewer 1361 

Cab,  omnibus  service 1482 

Inn-keeper,  publican 1521 

Costermonger,  street-hawker 1879 

While  the  courts  are  quite  strict  in  their  construction  of  the  statement 
of  the  insured  as  to  his  occupation,  they  will  accept  no  quibbling  defense 
on  the  part  of  the  company,  as  the  following  cases  show.  In  the  case  of 
Life  and  Accident  Co.  vs.  Burroughs,  G9  Pa.  St.  43,  the  insured  stated  in 
his  application  that  he  was  an  earthenware  manufacturer.  His  death 
was  due  to  peritonitis,  caused  by  an  accident  while  working  in  a  hay 
field.  It  was  proven  that  he  was  on  a  visit  to  his  grandfather  and  was 
helping  him  in  the  haying.  The  court  held  that  this  constituted  no 
change  of  occupation. 

A  similar  ruling  was  given  in  the  case  of  Stones'  Administrators  vs. 
Casualty  Co.,  34  N.  J.  L.  371,  where  it  was  held  that :  "  A  teacher  who  has 
a  home  in  the  course  of  erection  may  visit  said  house  as  a  spectator,  with- 
out doing  anything  which  is  aside  from  the  ordinary  line  of  his  life." 


558  -4   SYSTEM  OF  LEGAL   MEDICINE. 

Again,  in  the  ease  of  Tucker  vs.  Life  Insurance  Co.,  50  Hun  50,  there 
was  a  clause  forbidding  employment  in  "  mining*,  blasting,  or  wrecking." 
The  insured  met  his  death  by  drowning,  while  saving  the  crew  of  a 
schooner  which  had  been  driven  ashore  near  his  farm.  The  court  held 
that :  "  He  was  a  farmer,  and  not,  bjr  occupation,  a  wrecker.  As  well 
might  a  farmer  who  should  be  smothered  in  attempting  to  rescue  his 
neighbors  from  their  burning  dwelling  be  called  a  fireman,  as  this  man 
a  wrecker."     This  was  indorsed  in  121  N.  Y.  718. 

Similarly,  in  the  case  of  Grattan  vs.  Life  Insurance  Co.,  80  N.  Y.  281,  it 
was  held  that  there  was  no  material  difference  between  a  soda-water 
maker  and  a  soda-water  peddler. 

On  the  other  hand,  where  there  is  any  suspicion  of  fraudulent  con- 
cealment the  decisions  are  very  severe  against  the  insured.  Thus,  in  the 
case  of  Hartmann  vs.  Life  Insurance  Co.,  21  Pa.  St.  466,  it  was  held :  •'  If 
the  insured,  who  represented  himself  to  be  a  farmer,  was  in  fact  a  slave- 
taker  by  occupation,  and  if  the  business  of  slave-taking  would  expose 
his  life  to  greater  danger  than  farming,  it  is  not  possible  to  escape  the 
conclusion  that  the  policy  was  thereby  rendered  void,  since,  if  it  was 
willfully  made,  it  was  a  fraud ;  and  though  made  ignorantly,  or  by  mis- 
take, it  was  a  warranty  by  the  express  terms  of  the  policy.  .  .  . 

"  The  court  very  properly  charged  that  the  occupation  of  the  insured, 
which  his  duty  required  him  to  disclose,  was  that  business  which  he  was 
engaged  in  at  the  time  he  made  his  application.  If  it  meant  the  trade 
he  learned  in  his  youth,  and  which  he  had  followed  years  before,  it  would 
indeed  be  immaterial  whether  he  told  the  truth  or  a  falsehood,  and  it 
would  have  been  mere  folly  in  the  insurers  to  ask  him  the  question." 

Again,  in  the  case  of  Aid  Society  vs.  White,  100  Pa.  St.  12,  the  insured 
stated  in  his  application  that  he  was  a  laborer,  but  it  was  proved  that  he 
had  done  no  work  at  all  for  several  years.  The  Appellate  Court  held  that 
it  was  an  error  to  charge :  "  We,  therefore,  instruct  you  that  the  answer 
'laborer'  in  evidence  shows  that  Murray  was  a  laborer  in  former  years, 
and  covers  the  question  in  the  application."  It  was  also  stated  that  a 
merely  temporary  suspension  of  the  alleged  occupation  would  not  con- 
stitute a  breach  of  warranty,  but  that  a  suspension  extending  through  a 
number  of  years  would. 

This  was  apparently  the  view  taken  in  the  case  of  Mowry  vs.  Life  In- 
surance Co.,  7  Daly  321.  The  insured  stated  in  his  application  that  his 
occupation  was  "  manufacturing."  It  was  held  that  the  fact  that  he  was 
keeping  a  billiard  saloon  at  the  time  of  the  application  did  not  constitute 
a  breach  of  warranty,  for  he  had  been  for  many  years  engaged  in  manu- 
facturing soda-water  and  expected  to  resume  that  business  in  a  few 
days.  This  is  a  very  liberal  extension,  and  is  susceptible  of  great  abuse. 
The  company  itself,  however,  was  partly  responsible,  since  it  accepted  this 
answer  as  being  a  sufficiently  definite  statement  of  his  business. 

A  more  rigid  rule  was  laid  down  in  the  case  of  Fitch  vs.  Life  Insur- 
ance Co.,  2  N.  Y.  Sup.  Rep.  T.  and  C.  247.  In  the  application  made  in 
1870,  the  applicant  was  asked  to  state  his  vocation,  what  it  was,  and 
Avhat  it  had  been,  and  his  answer  was,  "  Traveling  agent."  It  was  proven 
that  he  was  in  the  army  in  1864  and  1865,  and  had  been  a  painter  before 
and  after  that  time  until  1867. 

"His  answers,  too,  in  respect  to  his  vocation,  and  where  he  had  lived 
since  his  birth,  contained  covert  falsehoods,  which,  if  not  intended  to  de- 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  559 

ceive,  were  likely  to  do  so.  The  inquiry  as  to  his  vocation  was  what  it 
then  was  and  what  it  had  been.  His  answer,  '  Traveling  agent/  was  true 
as  to  what  it  then  was,  but  untrue  as  to  what  it  had  been;  for  the  in- 
quiry as  to  his  past  vocation  obviously  called  for  the  statement  that  he 
had  been  a  painter  and  a  soldier  as  well  as  a  traveling  agent.  The  answer 
was  false  from  the  clear  and  manifest  failure  to  tell  the  whole  truth." 
This  ruling  was  reversed  iu  59  N.  Y.  557,  chiefly  on  the  ground  that  the 
statements  of  the  insured  were  representations  only,  and  not  warranties. 

One  of  the  most  common  phases  of  this  subject  to  be  decided  arises 
from  the  applicant's  answer  to  the  question  whether  he  is  engaged  in  the 
occupation  of  selling  liquors.  The  form  of  question  used  for  eliciting 
this  information  varies  so  much  that  no  fixed  rules  can  be  deduced  from 
the  determinations  of  the  courts.  Generally  it  may  be  said  that  if  the 
questions  as  to  the  liquor- selling  are  clearly  put  by  the  company,  the 
courts  will  construe  as  material  and  fatal  any  falsity  in  the  answer. 
Thus,  in  the  case  of  Dwight  et  al.  vs.  Life  Insurance  Co.,  100  N.  Y.  341, 
the  insured  gave  a  negative  answer  to  the  question,  "  Is  he  now  or  has 
he  been  engaged  in  or  connected  with  the  manufacture  or  sale  of  any 
beer,  wine,  or  any  other  intoxicating  liquors  ? "  It  was  proven  that  the 
insured  had  kept  a-  hotel  for  three  years,  and  had  sold  wines  and  liquors 
to  his  guests,  although  there  was  no  bar  in  the  hotel.  It  was  held  that 
this  constituted  a  breach  of  warranty. 

On  the  other  hand,  the  courts  will  here,  as  elsewhere,  give  the  insured 
the  benefit  of  any  construction  of  the  contract  that  may  be  possible.  In 
the  case  of  McGurk  vs.  Life  Insurance  Co.,  56  Conn.  528,  a  correct  defini- 
tion was  used  with  telling  effect  against  the  company.  The  insured 
stated  in  his  application  that  he  was  a  "  grocer."  It  was  proven  that  he 
sold  liquors  freely  in  his  store,  but  it  was  held  that :  "  Webster  defines 
the  meaning  of  the  word  'grocer'  to  be  'A  trader  who  deals  in  tea,  sugar, 
spices,  coffee,  liquors,  fruit,  etc'  The  word,  therefore,  properly  describes 
McGurk's  occupation,  and  nothing  whatever  appears  in  the  case  tending 
to  show  any  want  of  sincerity  on  his  part  in  his  answer,  much  less  that 
1  > v  it  he  committed  a  fraud  on  the  defendants  which  made  void  the  con- 
tract of  insurance  in  its  inception.  He  doubtless  believed  at  the  time 
that  the  word  'grocer'  covered  his  entire  occupation."  This  ruling  seemed 
for  a  moment  incorrect,  but  the  Century  Dictionary  bears  out  Webster, 
and  we  remember  that  we  have  hardly  ever  seen  a  country  grocery  where 
liquor  was  not  sold. 

A  very  fine  point  was  decided  in  the  case  of  Kenyon  et  al.  vs.  Aid  Asso- 
ciation, 122  N.  Y.  247.  The  insured  was  asked:  "Profession  or  occupa- 
tion ?     State  previous  nature  of  business. 

"  A.  Importer  and  wholesale  dealer  in  wines  and  liquors. 

"  Q.  Is  the  person  engaged  in  any  way  in  the  retailing  of  alcoholic 
liquors  ? 

"A.  No ;  keeps  no  bar  and  sells  only  at  wholesale  ;  have  government 
license  and  town  license." 

These  answers  of  the  insured  were  regarded  as  strict  warranties.  It 
was  proven  that  he  sold  by  measure  and  bottle,  in  quantities  less  than 
five  gallons,  but  not  to  be  drunk  on  the  premises.  It  was  held  that  this 
was  not  incompatible  with  his  statement  that  he  was  a  wholesale  dealer, 
in  view  of  the  elaborate  explanation  he  had  made  in  the  next  answer ; 
that  he  intended  to  convey  the  idea,  and  did  convey  it,  that  he  did  not 


560  -4   SYSTEM  OF  LEGAL  HEDTCINE. 

sell  liquor  to  be  drunk  on  his  premises ;  and  that  the  company,  having- 
accepted  his  application  with  this  explanation,  must  stand  by  it. 

Residence. — A  company  will  either  decline  to  insure  applicants  in  a 
locality  which  they  know  to  be  unhealthy,  or  else  will,  when  insuring, 
charge  a  higher  premium,  sufficient  to  cover  the  increased  risk.  In 
order,  therefore,  to  prevent  persons  who  are  insured  in  healthy  regions 
from  moving  into  unhealthy  localities,  clauses  are  inserted  in  the  policy 
restricting  the  right  of  travel  and  residence.  In  former  times  these  re- 
strictions were  quite  complicated,  and  extended  over  the  whole  life  of  the 
policy.  Of  late  years  they  have  been  much  simplified,  and  usually  apply 
to  the  first  year  or  two  only.  These  clauses  are  generally  interpreted 
quite  rigidly  by  the  courts,  but  in  one  of  the  earliest  cases,  Baldwin  vs. 
Insurance  and  Trust  Co.,  3  Bosworth  530,  a  liberal  rule  was  laid  down. 
The  insured  was  forbidden  to  visit  "  those  parts  of  the  United  States 
which  lie  south  of  t\\Q  southern  boundaries  of  Virginia  and  Kentucky." 
He  received  a  permit  "  to  travel  anywhere  in  the  United  States,  but  must 
be  north  of  the  south  boundary  of  Virginia  by  July  10,  1854."  He  was 
taken  sick  in  Appalachicola,  Fla.,  on  June  11th,  was  too  sick  to  be  moved, 
and  died  there  on  July  20th.  It  was  held  that  the  contract  was  not  void, 
for  the  disability  to  perforin  the  condition  was  the  act  of  God,  and  oc- 
curred without  any  default  or  neglect  on  his  part. 

This  opinion  was  overruled  in  the  case  of  Evans  vs.  Life  Insurance 
Co.,  G4  N.  Y.  304,  on  a  permit  of  a  similar  character.  The  insured  made 
no  effort  to  return,  it  is  true,  but  the  court  held  that  "  another  answer  to 
this  claim  [that  it  was  the  act  of  God]  is,  that  he  took  the  chances  of 
being  able  to  return.  He  went  south  for  business  purposes,  knowing  that 
the  polic}^  would  be  avoided  if  he  did  not  return  by  the  1st  of  July." 

A  similar  decision  was  rendered  in  the  case  of  Nightingale  et  at.  vs. 
Insurance  Co.,  5  R.  I.  38.  Here  the  insured  between  July  1st  and  Octo- 
ber 15th  was  not  allowed  to  be  in  any  portion  of  the  United  States,  out- 
side of  certain  named  States,  more  than  five  days  without  a  permit.  He 
went  to  Maryland,  which  was  outside  the  permitted  limits,  and  stayed 
there  ten  days,  when  he  died  of  apoplexy.  This  disease  had  no  relation 
to  the  climate  or  the  countrv,  but  the  court  held  that  that  made  no  differ- 
ence,  and  the  policy  was  void  according  to  the  terms  of  the  restriction. 
This  case  seems  particularly  severe,  as  the  insured  was  the  Bishop  of 
Rhode  Island,  who  was  called  to  Maryland  on  account  of  the  illness  and 
temporary  absence  of  the  Bishop  of  Maryland,  to  attend  to  some  of  his 
canonical  duties,  and  also  because  the  fatal  disease  was  in  no  sense  due  to 
the  climate  or  the  voyage.  The  court  probably  construed  the  proviso  so 
rigidly  because  a  permit  to  extend  his  time  beyond  five  days  could  easily 
have  been  obtained  by  the  insured. 

A  reminiscence  of  the  days  when  we  had  a  frontier  is  brought  out  by 
the  case  of  Caster  vs.  Life  Insurance  Co.,  22  N.  Y.  427,  where  the  courts 
held  by  five  judges  against  three  that  the  term  "settled  limits  of  the 
United  States  "  did  not  mean  the  region  of  the  settlements,  but  referred 
to  the  established  boundaries  of  the  United  States,  including  in  this  both 
States  and  Territories.     This  case  was  decided  in  1860. 

Restrictions  as  to  the  routes  to  be  traveled  in  going-  from  one  place 
to  another  must  be  followed  very  closely.  "  Thus  in  the  case  of  Hath  away 
vs.  Life  and  Fire  Insurance  Co.,  11  Cush.  448,  the  insured  was  permitted 
"  to  make  one  voyage  out  and  home  to  California,  in  a  first-rate  vessel 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  561 

around  Cape  Horn  or  by  Vera  Cruz."  He  went  to  California,  was  taken 
sick,  and  returned  home  by  way  of  Panama.  There  was  no  usually  trav- 
eled route  then  by  way  of  Vera  Cruz,  and  the  one  chosen  was  the  safest 
and  shortest.  But  the  court  held :  "  It  is  of  no  consequence  that  the 
route  taken  home  by  the  assured  was,  or  may  have  been,  as  the  plaintiff 
offered  to  prove,  the  safest  and  shortest.  The  policy  excluded  him,  if  he 
would  avail  himself  of  the  provisions  and  of  the  assurance  contained  in 
it,  from  being-  governed  by  what  was  advisable  and  expedient.  It  fixed 
the  terms  upon  which  the  promise  shoidd  be  binding,  and  upon  which  it 
should  be  annulled.  By  these  terms  the  parties  are  bound.  There  hav- 
ing been  a  breach  of  the  condition,  the  contract  is  thereby  rendered  void." 

The  "glorious  days"  of  B01  Tweed  and  the  still  brighter  days  of  his 
downfall  are  recalled  in  the  case  of  Douglas  et  al.  vs.  Life  Insurance  Co. 
83  N.  Y.  492.  Tweed  took  out  a  policjr  in  18G8  which  contained  the  re- 
striction that  the  insured  should  not,  "without  the  written  consent  of 
this  company,  previously  obtained,  travel  upon  the  seas  except  in  voyages 
between  coastwise  parts  of  the  United  States."  As  is  well  remembered, 
Tweed  was  arrested  and  sent  to  jad,  but  escaped  from  custody  on 
September  1,  1875.  He  was  not  found  until  September,  187G,  when  he 
was  recaptured  at  Vigo,  in  Spain.  Needless  to  say,  he  had  not  obtained 
the  consent  of  the  insurance  company  for  this  little  trip.  They  very 
properly  and  successfully  resisted  payment  on  this  technical  point.  Had 
it  been  any  one  but  a  notorious  criminal,  who  broke  the  conditions  of 
his  policy  in  violation  of  the  law,  it  is  more  than  likely  that  no  ques- 
tion would  have  been  raised  about  the  settlement  of  the  claim  by  the 
•company. 

In  the  case  of  PohalsJxi  vs.  Life  Insurance  Co.,  36  N.  Y.  Sup.  Ct.  234, 
there  were  the  usual  restrictions  in  the  policies  issued  at  that  time,  for- 
bidding the  insured  to  pass  outside  of  the  United  States  and  Canada. 
The  insured  had  business  in  Havana,  and  obtained  the  following  permit 
without  extra  charge :  "  Permission  is  hereby  given  to  J.  M.  Pohalski 
to  proceed  to  Cuba,  and  return  before  April  1, 1871.  He  to  take  his  own 
risk  of  death  from  epidemics."  He  went  to  Cuba  and  died  there  in  Feb- 
ruary, 1871,  of  yellow  fever.  Payment  of  the  policy  was  resisted  on  the 
ground  that  yellow  fever  belonged  to  the  class  of  diseases  known  as  epi- 
demics. It  is  most  likely  that  this  was  the  idea  that  the  insurers  had 
when  the  permit  was  given.  But  the  referee  found  that,  as  the  word 
was  ordinarily  used,  it  referred  to  a  condition  of  a  disease,  in  which  the 
number  of  cases  of  that  disease  were  so  great  that  it  might  be  called  gen- 
erally prevalent.  He  found  that  yellow  fever  was  endemic  in  Havana 
at  the  time  of  insured's  illness  there,  but  not  epidemic ;  in  fact,  it  seemed 
probable  that  the  cases  which  occurred  there  during  that  time  might  be 
called  sporadic,  so  infrequent  were  they.  We  think  this  a  very  proper 
verdict  under  the  circumstances.  The  permit  was  so  loosely  drawn  that 
on  its  face  it  had  no  other  meaning  than  the  one  given  above.  The  at- 
tempt was  made  to  introduce  parol  evidence  that  between  the  parties 
it  had  the  interpretation  which  the  defendants  desired,  but  this  was  suc- 
cessfully resisted.  The  case  was  then  carried  to  the  Court  of  Appeals 
and  judgment  affirmed  (56  N.  Y.  640). 

Age. — The  question  of  age  is  one  of  fundamental  importance  in  life 
insurance,  for  upon  it  depends  the  amount  of  the  premiums  to  be  paid, 
except  in  some  assessment  companies.     Furthermore,  it  is  of  prime  con- 


562  -4   SYSTEM  OF  LEGAL  MEDICLNE. 

sequence  in  the  medical  selection  of  some  cases.  In  many  companies  it 
is  the  rule  not  to  take  applicants,  one  of  whose  parents  has  died  of  eon- 
sumption,  before  they  have  reached  a  fixed  age,  usually  thirty  or  thirty- 
five  years.  In  the  case  of  women  an  extra  premium  is  usually  charged 
during  the  child-bearing  period,  the  limit  of  which  many  companies  fix 
arbitrarily  at  a  certain  age,  about  forty-eight  or  fifty.  For  these  and 
many  other  reasons  it  is  necessary  to  know  the  age  exactly.  Many  com- 
panies, especially  in  Europe,  require  certificates  of  birth  before  they 
issue  a  policy.  As  a  man  may  not  know  his  age,  it  is  sometimes 
neeessary  to  obtain  collateral  evidence.  In  the  case  of  Splentsvs.  Lefevre? 
11  L.  T.  N.  S.  114,  it  was  held  that  a  family  Bible  was  not  good  evidence 
as  to  age,  unless  it  was  also  proven  that  the  dates  therein  were  made  by 
some  living  member  of  the  family,  or  were  known  to  be  made  by  some 
dead  member. 

As  it  is  a  matter  of  simple  fact,  the  courts  have  usually  been  very 
strict  in  their  decisions  upon  this  point.  Thus  in  the  case  of  Swett  vs. 
Relief  Society,  78  Me.  541,  the  applicant  stated  his  age  to  be  fifty-nine, 
when  in  reality  it  was  sixty-four,  and  was  so  proven.  It  was  held  that 
"  the  age  of  the  applicant  was  a  material  fact.  .  .  .  His  representation 
of  the  fact  was  a  warranty  of  its  truth.,  and  if  not  true,  the  contract  was 
invalid.  This  rule  is  so  uniformly  held  by  the  courts  that  no  authorities 
need  be  cited." 

A  similar  conclusion  was  reached  in  the  case  of  Life  Insurance  Co. 
vs.  France  et  dl,  91  U.  S.  510,  and  in  the  case  of  Ortlieb  vs.  Insurance  Co.,. 
4  Ins.  L.  J.  311. 

On  the  other  hand,  the  company  may,  by  carelessness,  inadvertence, 
or  the  faulty  conduct  of  agents,  lose  its  right  to  set  up  a  claim  of  breach 
of  warranty  as  to  age.  Thus,  in  the  case  of  Morrison  vs.  Life  Insurance 
Co.,  59  Wis.  162,  the.  insured  had  one  policy  in  this  company,  and  then 
took  out. another.  In  this  one  he  put  his  age  at  ten  years  younger  than 
in  the  correct  previous  policy.  Five  years  later  he  took  out  a  third  policy, 
in  which  he  now  again  stated  his  age  correctly.  The  company  continued 
to  receive  assessments  on  all  these  policies  for  two  more  years,  when  he 
died.  It  was  held  that  his  misstatement  in  the  second  policy  had  been 
waived  by  the  company. 

A  similar  result  was  reached  in  the  case  of  Miller  vs.  Life  Insurance 
Co.,  107  N.  Y.  292,  where  it  was  proven  that  the  insured  was  seventy- 
three  instead  of  sixty-four,  as  was  stated  in  the  application.  It  was  also 
proven  that  the  insured  was  a  German  who  knew  but  little  English  ;  that 
when  he  was  asked  his  age  by  the  agent  he  said  he  did  not  know ;  that 
the  agent  made  some  computation  as  to  his  probable  age  and  inserted 
this,  which  was  apparently  largely  a  guess,  into  the  application.  The 
court  held  that  under  the  circumstances  the  company  was  estopped  from 
setting  up  the  falsity  of  this  statement,  as  it  was  in  reality  the  statement 
of  its  own  agent. 

Other  Insurance. — The  question  is  asked  by  most  companies  whether 
the  applicant  has  been  insured  in  other  companies,  and  for  what  amounts. 
This  is  not  a  theoretical  consideration,  or  mere  inquisitiveness  on  the 
part  of  the  company.  It  is  proper  for  them  to  know  it,  for,  if  a  man  is 
taking  insurance  beyond  his  means,  the  knowledge  will  put  them  on  their 
guard  and  cause  more  searching  inquiries  as  to  the  reasons  for  the  heavy 
insurance.    And  in  many  cases  it  might  well  cause  them  to  refuse  the 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  563 

risk  altogether,  on  the  ground  of  the  financial  hazard.  Therefore,  the 
question  should  be  answered  quite  closely  and  accurately.  In  the  case 
of  McCuJIum  vs.  Life  Insurance  Co.,  55  Hun  104,  106,  it  was  even  held 
that  benefit  and  accident  associations  were  included  under  the  term  in- 
surance company  in  the  question  as  to  other  insurance. 

The  law  on  this  point  was  very  clearly  announced  in  the  case  of 
Jeffries  vs.  Life  Insurance  Co.,  22  Wall.  47  :  "  The  company  deems  it  wise 
and  prudent  that  the  applicant  shall  inform  it  truly  whether  he  has 
made  any  other  application  to  have  his  life  insured.  So  material  does  it 
deem  this  information  that  it  stipulates  that  its  liability  shall  depend 
upon  the  truth  of  the  answer.  The  same  is  true  of  its  inquiry  whether 
the  party  is  married  or  single.  The  company  fixes  this  estimate  of  its 
importance.  The  applicant  agrees  that  it  is  thus  important  by  accepting 
the  test.  It  would  be  a  violation  of  the  legal  rights  of  the  company  to 
take  from  it  its  acknowledged  power,  thus  to  make  its  opinion  the  stand- 
ard of  what  is  material,  and  to  leave  that  point  to  the  determination  of 
a  jury.  The  jury  may  say,  as  the  counsel  here  argues,  that  it  is  imma- 
terial whether  the  applicant  answers  truly,  if  he  answers  one  way,  to 
wit :  that  he  is  single  or  that  he  has  not  made  an  application  for  insur- 
ance. Whether  a  question  is  material  depends  on  the  question  itself. 
The  information  received  may  be  immaterial,  but  if  under  any  circum- 
stances it  can  produce  a  reply  which  will  influence  the  action  of  the 
company,  the  question  cannot  be  deemed  immaterial.  Insurance  com- 
panies sometimes  insist  that  individuals  largely  insured  upon  their  lives, 
who  are  embarrassed  in  their  affairs,  resort  to  self-destruction,  being 
willing  to  end  a  wretched  existence  if  they  can  thereby  bestow  comfort 
upon  their  families.  The  jury  would  be  likely  to  repudiate  such  a  theory 
on  the  ground  that  nothing  can  compensate  a  man  for  the  loss  of  his  life. 
The  jury  may  be  right  and  the  company  may  be  wrong,  but  the  company 
has  expressly  provided  that  their  judgment,  and  not  the  judgment  of  the 
juror,  shall  govern." 

But  suppose  that  the  applicant  does  tell  part  of  his  insurance  but 
omits  some.  In  that  case  it  would  come  under  the  head  of  partial  or  in- 
complete answers  (see  p.  504),  and,  if  warranted,  would  be  construed 
rigidly  against  the  insured.  This  j>omt  is  well  brought  out  in  the  case 
of  Brennan  vs.  Ins.  and  Annuity  Co.,  in  which,  on  appeal  to  a  higher  court 
(4  Daly  296),  it  was  held  as  follows :  "  The  judge  also  erred  in  refusing  to 
direct  the  jury  to  find  a  verdict  for  the  defendants  if  they  believed  the 
insured  withheld  from  the  defendants  the  fact  that  he  held  two  [undis- 
closed] policies  in  the  Guardian  and  Equitable  Companies,  shown  to  have 
been  for  $30,000  in  addition  to  the  $35,000  [disclosed],  but  referred  to 
his  previous  charge,  in  which  he  had  stated  that,  as  to  the  answer  of  the 
insured  to  the  twenty-fifth  question  in  the  application  ["  What  amounts 
are  now  assured  on  the  life  of  the  party,  and  in  what  company  ? "  the 
answer  being  "  ^tua,  $10,000 ;  Knickerbocker,  $15,000;  $10,000  addi- 
tional applied  for  in  JDtna"],  'if  they  found  that  George  Schott,  the 
assured,  when  he  made  that  answer  or  declaration  was  guilty  of  a  false 
or  fraudulent  representation,  and  that  such  representation  was  material 
in  the  judgment  of  the  insurers,  and  induced  them  to  take  the  risk,  then 
you  will  find  for  the  defendants.' 

"  In  this  there  was  a  disregard  of  the  contract  of  insurance  sued  on, 
in  which  it  was  expressly  stated  that  '  if  the  declarations  made  by  the 


5G4  ^   SYSTEM  OF  LEGAL  MEDICINE 

insured,  and  forming  part  of  this  contract,  and  upon  the  faith  of  which 
this  policy  is  made,  shall  be  found  in  any  respect  untrue,  then  and  in 
such  case  the  policy  shall  be  null  and  void,'  and  without  considering  that 
entire  truthfulness  of  such  declaration  was,  by  the  contract,  made  matter 
of  warranty,  or  condition  precedent  to  any  recovery  upon  it." 

This  question  is  construed  thus  closely  by  the  courts  because  there  is 
no  decent  excuse  for  any  misstatement  in  reference  to  it.  Ignorance 
cannot  be  pleaded,  and  any  negligence  in  reference  to  it  is  culpable. 

Prior  Rejection. — This,  like  the  preceding,  is  a  question  of  so  much 
moment  to  the  company  that  it  regularly  asks  in  the  application  about 
the  non-acceptance  of  the  risk  by  any  other  company,  or  even  if  the  risk 
has  been  accepted  at  a  higher  premium  than  was  applied  for.  Unless 
directly  asked  by  the  company,  it  is  not  material  for  the  applicant  to 
make  any  statement  concerning  his  prior  rejection  by  another,  as  was- 
decided  in  the  case  of  Goodwin  vs.  Life  Insurance  Co.,  18  L.  Can.  Jour.  1. 

But  if  the  question  is  asked,  absolute  accuracy  should  be  exercised  in 
answering  it,  for  the  courts,  regarding  this  as  a  matter  of  simple  fact,, 
have  been  quite  strict  in  construing  the  answer.  Thus,  in  the  case  of 
McDonald  vs.  Life  Insurance  Co.)  4  Bigelow's  Life  and  Ace.  Rep.  609, 
the  insured  denied  falsely  that  there  had  been  a  prior  rejection  by  another 
company.  It  was  held  that :  "  If  the  statement  is  not  in  every  respect 
true  in  fact — not  in  the  sense  if  it  be  fraudulent,  or  if  it  be  a  lie,  or  in 
the  sense  that  there  is  moral  culpability — then  the  policy  is  to  be  void."" 
This  rule  was  applied  with  great  severity  in  Edington  et  dl.  vs.  Life  In- 
surance Co.,  11  N.  Y.  564.  In  this  case  it  was  provided  in  the  applica- 
tion, which  was  expressly  made  part  of  the  policy,  that  if  any  of  the 
statements  were  "in  any  respect  false  or  fraudulent,"  the  policy  should 
be  void.  The  insured  was  asked,  "Has  any  application  been  made  to 
this  or  to  any  other  company  for  assurance  on  the  life  of  the  party  ?  If 
so,  with  what  result?"  He  answered,  "Yes,  and  always  successful. 
Yes,  accepted."  It  was  proven  that  the  insured,  one  Diefendorf,  filled 
up  and  signed  an  application  to  another  company.  He  went  with  the- 
agent,  one  Windsor,  to  the  examiner's  office,  and,  not  finding  him  in, 
decided  to  return  later.  The  agent  in  the  meantime  saw  the  examiner,, 
who  told  him  that  the  risk  was  a  bad  one,  that  the  examination  would 
be  a  farce  and  an  unnecessary  expense  to  the  company.  The  agent  then 
told  these  facts  to  the  applicant,  and  destroyed  the  application.  So  that 
the  applicant  was  never  examined,  and  no  record  was  received  by  the 
company.  Nevertheless,  the  court  held  as  follows :  "  This  evidence 
shows  beyond  question  that  an  application  for  insurance  in  the  New 
Jersey  Company  had  been  made,  and  that  it  had  not  been  successful. 
Windsor  was  agent  of  that  compairy  to  receive  such  applications.  When 
the  application  was  delivered  to  him  it  was  delivered  to  the  company, 
and  Diefendorf  had  done  all  he  could  do  or  was  required  to  do  to  place 
himself  in  the  attitude  of  an  applicant  for  insurance.  In  forwarding 
the  application  to  the  office  of  the  company,  Windsor  would  act,  not  as- 
his  agent,  but  as  agent  for  the  company.  The  medical  examination  was 
no  part  of  the  application.  That  was  something  to  be  done  after  the 
application  was  made.  It  was  an  act  to  be  done,  not  by  Diefendorf,  or 
at  his  expense,  but  by  the  medical  examiner,  as  the  agent  of  the  com- 
pany, and  at  its  expense.  The  doctor  knew  him  and  was  acquainted 
with  his  physical  condition,  and  pronounced  him  unfit  for  insurance 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  565 

without  an  examination.  That  left  the  case  precisely  as  if  an  examina- 
tion had  been  made  and  his  application  had  been  rejected.  It  was  just 
such  information  as  this  that  the  questions  put  to  the  assured  in  these 
applications  were  designed  to  elicit.  The  answers  were  clearly  untrue, 
no  matter  how  innocently  they  may  have  been  made.  There  was  nothing 
upon  this  branch  of  the  case  for  submission  to  the  jury,  and  the  judge 
should  have  held  that  these  answers  avoided  the  policies." 

The  case  was  brought  up  again  before  the  same  court  (100  X.  Y.  536), 
and  the  decision  above  given  was  affirmed  in  stronger  language :  "  The 
test  is  not  whether  Windsor  or  the  medical  examiner  had  authority  to 
finally  reject  the  application.  If  they  were  utterly  without  authority  to 
dispose  of  it,  and  so  the  company  never  acted  upon  it,  at  least  there  was 
an  application  to  the  company,  which  was  not  successful  and  did  not 
end  in  an  accepted  insurance." 

A  rather  fine  point  was  made  in  the  case  of  Langdon  vs.  Life  Insur- 
ance Co.,  14  Fed.  Rep.  272.  Here  the  question  was,  "  Has  any  application 
ever  been  made,  either  to  this  or  to  any  other  company,  upon  which  a 
policy  was  not  issued?"  This  was  answered  in  the  negative,  but  it  was 
proven  that  on  the  day  prior  to  his  taking  out  the  insurance  with  the 
above  company  he  made  application  to  another  company,  and  was  ex- 
amined for  it.  The  examiner  considered  the  risk  unsatisfactory,  and  so 
stated  in  his  report  to  the  company.  This  report  was  not  acted  on  until 
several  days  later.  In  view  of  these  facts  it  was  held  that:  "If  the 
question  had  been,  'Has  any  application  ever  been  made,  to  this  or  to 
any  other  company,  upon  which  a  policy  has  not  hern  issued  V  I  should 
have  had  little  difficulty  in  deciding  that  the  answer  was  false ;  but  I 
think  there  is  a  distinction  between  the  words  'was  not'  and  'has  not 
been '  issued.  I  think  a  person  of  ordinary  intelligence  might  answer  no 
to  the  first  form  of  the  question,  supposing  that  the  company  desired  to 
know  whether  an  application  had  been  made  and  rejected.  But  the  ap- 
plication in  this  case  had  not  been  rejected.  The  examining  surgeon 
had  no  authority  beyond  his  certificate  as  to  the  physical  condition  of  the 
party  examined.  Notwithstanding  this  certificate,  the  company  might 
have  issued  a  policy  if  it  had  chosen  to  do  so.  It  did  not,  in  fact,  reject 
the  application  until  some  time  after  the  application  in  this  case  had  been 
made  to  the  defendant.  The  question,  as  put,  was  somewhat  ambiguous, 
and  I  think  it  contemplates,  when  fairly  and  reasonably  construed,  that 
the  company  desired  to  know  whether  an  application  had  been  made  and 
rejected.  So  long  as  the  matter  was  still  pending,  it  does  not  seem  to 
me  that  a  negative  answer  to  the  question  was  an  improper  one." 

Suicide. — Iu  nearly  all  policies  nowadays  there  is  some  proviso  which 
tends  to  avoid  the  contract  in  case  of  the  suicide  of  the  policy-holder. 
Sometimes  this  restriction  extends  over  the  whole'  life  of  the  policy,  but 
more  commonly  it  is  limited  to  the  first  year  or  two.  Upon  the  interpre- 
tation of  these  clauses  has  been  expended  a  great  deal  of  judicial  learn- 
ing and  skill. 

It  is  usually  held  that  the  expressions  "  suicide,"  "  death  by  one's  own 
hand,"  and  "  taking  his  own  life."  are  synonymous.  Thus,  in  the  case 
of  Eastaorook  vs.  Life  Insurance  Co.,  54  Me.  224,  it  is  stated  as  follows: 
"The  terms  'suicide'  and  'dying  by  one's  own  hand'  are  generally  used 
synonymously.  Sometimes  one  form  of  expression  is  used  and  some- 
times the  other.     They  have  the  same  meaning.     '  Dying  by  one's  own 


56G  ^   SYSTEM  OF  LEGAL  MEDICINE. 

hand '  is  but  another  form  of  expression  for  suicide."  Again,  in  the  case 
of  Cooper  vs.  Life  Insurance  Co.,  102  Mass.  227,  the  Supreme  Court  of 
Massachusetts  held :  "  Upon  a  careful  consideration  of  the  elaborate  dis- 
cussion of  the  matter  in  the  eases  above  cited,  by  the  dissenting  judges 
as  well  as  by  those  in  the  majority,  we  think  that,  as  applied  to  this  case, 
there  is  no  substantial  difference  of  signification  between  the  phrases 
'  shall  die  by  his  own  hand,'  '  shall  commit  suicide,'  and  '  shall  die  by 
suicide.'" 

The  subject  is  so  large  and  important  that  it  must  be  very  consider- 
ably subdivided ;  but  the  decisions  have  been  so  numerous,  and  to  some 
extent  conflicting,  that  it  is  difficult  to  reduce  it  to  any  systematic  ar- 
rangement. 

1.  If  a  policy  is  taken  out  by  one  in  good  faith,  and  he  subsequently 
commits  suicide,  there  being  no  proviso  against  that  act,  it  seems  reasonable 
to  suppose  that  the  policy  woidd  not  be  avoided  by  such  act,  even  though 
it  was  done  voluntarily  and  while  in  full  possession  of  his  faculties.  This 
is  certainly  the  case  if  the  suicide  was  committed  while  the  insured  was 
insane,  and  has  been  so  decided  in  Horn  vs.  Life  Insurance  Co.,  2  Bige- 
low's  Life  &  Ace.  Cases  602. 

Concerning  the  other  phase  of  this  question,  dicta  were  laid  down  in 
Hartmann  vs.  Life  Insurance  Co.,  21  Pa.  St.  466,  as  follows:  "The  court 
was  very  plainly  right  in  charging  that  if  no  such  condition  had  been 
inserted  in  the  policy,  a  man  who  commits  suicide  is  guilty  of  such  a 
fraud  upon  the  insurers  of  his  life  that  his  representatives  cannot  recover 
for  that  reason  alone." 

Against  these  dicta,  which  had  no  bearing  on  the  ultimate  decision  in 
the  case,  are  the  rulings  in  the  case  of  Fitch  vs.  Life  Insurance  Co.,  59 
N.  Y.  557.  "  The  policy  contained  no  stipulation  that  it  should  be  void  in 
case  of  the  death  of  the  insured  by  suicide.  It  was  not  taken  out  for  the 
benefit  of  Fitch,  but  of  his  wife  and  children.  Although  they  were  bound 
by  his  representations  and  any  fraud  he  may  have  committed  while  tak- 
ing out  the  policy,  the  policy  having  been  obtained  through  his  agency, 
3?et  they  were  not  bound  by  any  acts  or  declarations  done  or  made  by 
him  after  the  issue  of  the  policy,  unless  such  acts  were  in  violation  of 
some  condition  of  the  policy." 

Similarly,  in  the  case  of  Milk  vs.  Bebstock,  29  Minn.  381,  it  was  held 
that  "where  the  constitutions  and  laws  of  the  association  contain  no 
provision  qualifying  the  right  of  recovery  in  case  of  suicide,  the  heirs  of 
a  member  are  entitled  to  recover  the  amount  stipulated,  irrespective  of 
the  mode  of  his  death." 

A  slight  modification  of  this  state  of  facts  existed  in  the  case  of  Har- 
row vs.  Fund  Society,  116  N.  Y.  537.  In  the  policy  was  a  proviso  against 
death  in  consequence  of  a  violation  of  the  law,  but  it  was  held  "  that  sui- 
cide was  no  defense  unless  it  came  within  some  condition  of  the  contract 
of  insurance  relieving  the  defendant  from  liability  in  such  a  case ;  that 
suicide  was  no  crime  in  this  State,  although  an  attempt  to  commit  sui- 
cide was." 

Still  another  idea  was  presented  in  the  case  of  Aid  Societi/  vs.Wanner, 
24  111.  App.  357.  Here  there  was  a  proviso  against  death  as  the  result 
of  any  immoral  practice,  but  it  was  held  "  that  an  act  of  suicide  was  not 
an  immoral  practice  within  the  meaning  of  the  certificate  covenanted 
against  by  the  assured."     These  rulings  are  sufficient  to  show  that  at 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  567 

present  a  policy  would  not  be  forfeited  by  suicide,  if  there  were  no  pro- 
visions in  it  against  that  mode  of  death,  unless  some  other  circumstances 
influenced  the  decision. 

2.  If  an  insurance  policy  is  taken  out  by  one  with  intent  to  commit 
suicide,  there  being  no  proviso  in  the  policy  against  that  form  of  death, 
would  it  be  avoided  by  that  act  ? 

Francis  (Annals  and  Anecdotes  of  Life  Insurance,  p.  310)  relates  an  an- 
ecdote of  a  case  of  this  kind  in  his  usual  interesting  style :  "  A  man  went 
and  insured  his  life,  securing  the  privilege  of  a  free-dying  Englishman, 
and  then  took  the  insurers  to  dine  at  a  tavern  to  meet  several  other  per- 
sons. After  the  dinner  he  said  to  the  underwriters,  '  Gentlemen,  it  is  fit 
you  should  be  acquainted  with  the  company.  These  honest  men  are  trades- 
men, to  whom  I  was  in  debt,  without  any  means  of  pajang  but  by  your 
assistance,  and  now  I  am  your  humble  servant.'  He  pulled  out  a  pistol 
and  shot  himself." 

Unfortunately,  Francis  deals  so  largely  in  romance  that  we  cannot 
vouch  for  the  accuracy  of  this  story,  especially  since  neither  the  name  of 
the  company  nor  of  the  insured  is  given. 

In  the  case  of  Smith  vs.  Benefit  Society,  51  Hun  575,  a  similar  state 
of  facts  received  judicial  consideration.  This  case  is  so  remarkable  in 
many  respects  that  it  is  worth  while  to  go  into  details.  In  the  first  six 
or  eight  months  of  1886,  John  Tyler  procured  insurance  on  his  life  to 
the  amount  of  $282,000,  divided  among  thirty-six  different  companies. 
In  none  of  the  policies  w;is  there  any  reference  to  suicide.  He  had  a 
family  dependent  on  his  efforts  to  earn  a  living.  These  efforts  had  not 
proved  successful.  He  was  in  considerable  debt,  and  had  no  way  by 
which  to  meet  his  obligations.  In  particular  he  owed  Frederick  H. 
Smith  about  $10,000,  and  to  meet  the  obligation  he  took  out  a  policy  for 
that  amount  in  the  National  Benefit  Society  of  New  York.  He  did  not 
disguise  the  object  for  which  he  was  seeking  this  insurance.  He  told 
friends  that  if  he  failed  to  raise  money  by  other  means  within  a  reason- 
able time  he  would  commit  suicide,  and  in  that  way  meet  his  obligations, 
and  at  the  same  time  assure  a  future  income  to  his  family.  He  also 
made  inquiries  as  to  the  easiest  method  of  producing  death.  His  finan- 
cial affairs  grew  no  better.  The  time  approached  when  the  second  pre- 
miums on  some  of  his  policies  would  fall  due.  It  became  necessary  for 
him  to  act.  On  November  9,  1886,  he  gave  the  proper  directions  for  his 
burial  and  said  that  he  assumed  responsibility  for  his  acts.  On  Novem- 
ber 10th  he  wrote  to  his  mother  and  told  her  that  his  policies  were  all 
in  companies  which  made  no  condition  as  to  cause  of  death ;  that  in  that 
way  his  plans  were  so  laid  that  if  he  could  not  benefit  or  help  himself  he 
•could  help  those  whom  he  ought  to  help.  On  the  next  day  he  committed 
suicide.  The  company  very  properly  resisted  the  payment  of  the  policy, 
and  proved  the  truth  of  the  foregoing  statements.  The  case  was  ap- 
pealed to  the  General  Term,  and  Judge  Barnard  gave  the  opinion  of  the 
court  (51  Hun  576) :  "  The  policy  was  clearly  a  fraud  upon  the  defendant 
without  any  condition  that  suicide  avoided  the  policy.  The  deceased  de- 
signed to  get  a  large  aggregate  of  insurance.  He  was  unable,  and  did 
not  intend,  to  continue  the  payment  of  the  premium  until  death  came 
naturally,  but  his  purpose  was  to  provide  for  creditors  and  family  by 
causing  his  own  death.  This  was  a  legal  fraud  in  its  inception,  and  a 
policy  thus  obtained  never  had  any  binding  force  in  his  hands.  .  .  .  The 


568  ^   SYSTEM  OF  LEGAL  MEDICINE. 

jury  were  told  that  if  the  deceased  took  out  the  policy  with  the  intent  to 
commit  suicide,  and  did,  in  fact,  commit  suicide  in  pursuance  of  that 
intent,  the  action  failed  if  the  deceased  was  sane  when  he  took  his  own 
life,  if  he  did  so  take  it.     This  covers  the  whole  case." 

The  case  was  finally  carried  to  the  Court  of  Appeals,  and  the  judgment 
was  affirmed  (123  N.  Y.  85).  Judge  Finch,  in  delivering  the  opinion, 
said:  "Some  of  this  evidence  was  resisted  on  the  ground  that  death  by 
suicide  was  no  defense  under  the  terms  of  the  policy.  That  is  true;  but 
the  defense  was  fraud,  and  suicide  the  ultimate  agency  by  which  the 
fraud  was  accomplished.  It  was  necessary,  therefore,  to  prove  it,  and 
in  such  a  manner  as  to  indicate  that  it  was  not  an  insane  or  sudden  im- 
pulse, but  the  culmination  and  effective  working  out  of  a  deliberately 
conceived  purpose  of  fraud.1' 

3.  If  there  is  a  proviso  in  the  policy  against  self-destruction,  and  the 
insured  commits  suicide  voluntarily  and  intentionally,  while  in  the  pos- 
session of  his  faculties  and  conscious  of  the  immoralities  of  the  act,  there 
is  no  difference  of  opinion.  Under  such  circumstances  the  policy  is  avoided,, 
and  all  authorities  agree  as  to  this.  It  makes  no  difference,  of  course,  in 
these  cases  whether  the  policy  was  taken  out  in  good  faith  or  with  intent 
to  defraud  the  company  by  committing  suicide. 

4.  On  the  other  hand,  even  though  there  is  a  proviso  against  self- 
destruction,  and  the  mode  of  death  is  by  the  insured's  own  hand,  this, 
does  not  avoid  the  policy  if  the  act  is  purely  accidental  and  uninten- 
tional. This  has  been  held  true  in  a  case  of  poisoning  by  mistake,  of 
accidental  shooting,  and  in  everv  case  where  the  act  of  self-destruction 
was  unintended  by  the  party  dying.  This  opinion  is  very  well  stated 
by  Judge  Rapallo  in  the  case  of  Penfold  vs.  Universal  Life  Ins.  Co.,  85 
N.  Y.  320,  as  follows :  "  The  policy  contained  a  condition  that,  if  the 
person  whose  life  was  insured  should  'die  by  his  own  hand  or  act,  vol- 
untary or  otherwise/  the  company  should  not  be  liable,  etc. 

"  The  sole  defense  to  this  action  is  the  alleged  violation  of  this  condi- 
tion, and  the  ground  of  appeal  is  that  the  court  gave  improper  instruc- 
tions to  the  jury  in  two  respects : 

"First,  the  defendant  contends  that  the  evidence  shows  conclusively 
that  the  deceased  came  to  his  death  by  taking  an  overdose  of  medicine 
which  had  been  prescribed  for  him  by  his  physician,  and  that  the  court 
therefore  erred  in  leaving  it  to  the  jury  as  an  open  question  to  say 
whether  or  not  the  death  arose  from  that  cause;  secondly,  that  the 
court  again  erred  in  instructing  the  jury  that  in  order  to  sustain  the 
defense  they  must  find  that  the  deceased  took  the  overdose  for  the  pur- 
pose of  destining  his  life,  voluntarily,  knowingly,  and  intentionally,  it 
being  conceded  that  there  was  no  evidence  of  insanity.  The  excep- 
tions to  these  two  portions  of  the  charge  raise  the  only  questions  to  be 
determined  on  this  appeal. 

"As  to  the  first  point  there  is  not  much  difficulty.  The  evidence 
strongly  tended  to  show  that  the  deceased  took  an  excessive  quantity  of 
the  medicine,  and  that  his  death  was  attributable  to  that  cause ;  but  there 
was  no  direct  evidence  of  either  of  these  facts. 

"  The  conclusions  in  respect  to  them  depended  upon  inferences  which 
it  was  within  the  province  of  the  jury  to  draw.  The  serious  question  in 
the  case  is  that  which  arises  upon  the  charge  that,  in  the  conceded  ab- 
sence of  any  insanity,  the  defendant  was  not  exempted  from  any  liability 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  569 

unless  the  deceased  took  the  overdose  for  the  purpose  of  destroying  his 
own  life,  knowingly,  voluntarily,  and  intentionally. 

"  The  ordinary  clause  in  life  policies,  that  the  insurer  shall  not  be 
liable  in  case  the  person  whose  life  is  insured  shall  die  by  his  own  hand 
or  act,  has  been  repeatedly  the  subject  of  judicial  construction,  and  it  is 
now  well  settled  that  it  is  not  to  be  construed  as  comprehending  every 
possible  case  in  which  life  is  taken  by  the  party's  act,  and  that  an  unin- 
tentional or  accidental  taking  of  one's  own  life  is  not  within  the  meaning 
of  the  clause.  .  .  . 

"  The  question  in  all  cases  of  this  character  is  the  proper  interpretation 
of  a  contract,  and  the  point  of  inquiry  is,  what  obligations  the  parties 
must,  from  the  language  used  with  relation  to  the  subject-matter  and 
the  circumstances,  be  reasonably  supposed  to  have  intended  to  assume. 
The  clause  against  suicide  is  clearly  intended  to  protect  the  insurance 
company  against  the  fraudulent  act  of  the  insured  whereby  he  may,  even 
at  the  sacrifice  of  his  own  life,  secure  a  benefit  to  those  whom  he  may 
desire  to  favor,  at  the  expense  of  the  insurance  company.  ...  At  a  later 
day  in  the  history  of  life  insurance,  some  companies,  for  the  purpose  of 
avoiding  the  difficulties  involved  in  the  inquiry  as  to  the  condition  of  the 
mind  of  the  person  committing  self-destruction,  stipulated  for  exemption 
from  liability  in  all  cases  of  suicide,  whether  'sane  or  insane.'  Others 
adopted  the  words  '  voluntary  or  involuntary ' ;  others,  as  in  the  present 
case,  'voluntary  or  otherwise.' 

"  It  would  not  be  a  fair  interpretation  of  this  clause,  in  either  of  the 
forms  mentioned,  to  hold  it  to  cover  the  case  of  a  purely  accidental  death 
from  poisoning  occurring  to  a  sane  person,  through  mistake  or  ignorance, 
though  his  own  hand  might  have  been  the  innocent  instrument  by  which 
the  deadly  potion  was  conveyed  to  his  lips.  Such  an  accident  cannot 
be  presumed  to  have  entered  into  the  minds  of  the  contracting  par- 
ties, or  to  have  been  intended  to  be  stipulated  against.  The  insurance 
was  intended  to  cover  the  risk  of  premature  death,  which  might  result 
from  any  of  the  casualties  to  which  human  life  is  subject — serf-destruc- 
tion being  excepted.  A  purely  accidental  act,  committed  by  a  sane  per- 
son with  no  idea  of  injuring  himself,  cannot  be  regarded  as  an  act  of 
self-destruction  within  the  meaning  of  such  a  contract.  Suicide  is  the 
act  stipulated  against.  The  words  '  voluntary  or  otherwise '  preclude  the 
parties  claiming  under  the  policy,  if  the  act  was  one  of  suicide,  from 
setting  up  the  condition  of  mind  of  the  party  committing  it,  and  con- 
tending that  it  was  an  involuntary  act  of  suicide.  But  still  it  must  be 
a  suicide,  and  who  would  contend  that  the  taking  of  poison  by  mistake, 
or  any  other  act  which  a  sane  person  might  innocently  commit,  though 
it  should  result  in  death,  was  what  is  ordinarily  understood  as  self- 
destruction  or  suicide  ?  It  is  unreasonable  to  suppose  that  one  effecting 
an  insurance  upon  his  life,  in  stipulating  against  death  by  his  own 
hand  or  act  could  intend  to  embrace  such  a  casualty,  or  that  the  insur- 
ance company  could  fairly  expect  him  so  to  understand." 

A  similar  ruling  was  given  in  the  case  of  Life  Insurance  Co.  vs. 
Hazelett,  105  Ind.  212.  Although  the  testimony  as  to  the  mode  of  death 
was  a  little  dubious,  it  was  held  that :  "  Death  resulting  from  accident 
or  from  an  act  which  at  the  time  it  was  entered  upon  or  engaged  in  was 
not  expected,  or  intended  to  produce  that  result,  cannot  be  said  to  be 
within  the  meaning  of  the  policy.  ...  It  is  not  averred  that  the  assured 


570  A   SYSTEM  OF  LEGAL  MEDICINE. 

was  insane.  From  causes  over  which  he  had  no  control  a  state  of  mental 
and  physical  weakness  resulted,  and  while  in  that  state  he  took  an  over- 
draught of  whiskey,  without  any  expectation  or  intention  of  destroying 
his  life.  Death  was  therefore  the  result  of  an  accident,  and  the  policy 
was  not  avoided." 

In  the  case  of  Edwards  vs.  Life  Insurance  Co.,  20  Fed.  Rep.  661,  it  was 
held  that  the  accidental  taking  of  poison  (prussic  acid)  was  not  iu eluded 
under  the  clause  "  shall  die  by  suicide,  whether  the  act  be  voluntary  or 
involuntary."  The  facts  in  the  case  were  somewhat  obscure,  but  the  jury 
found  that  death  was  accidental. 

5.  If  there  is  a  simple  proviso  against  self-destruction,  and  the  in- 
sured commits  suicide  while  insane,  the  determination  of  the  effects 
of  these  circumstances  has  been  different  in  different  courts.  The  de- 
cisions seem  to  agree  upon  one  point,  that  suicide  is  not  in  itself  any 
evidence  of  insanity.  Thus,  in  the  case  of  Coffey  vs.  Life  Insurance  Co., 
4  Bigelow's  Life  and  Ace.  Rep.  224,  it  was  held :  "  No  presumption  that 
insanity  exists  in  the  case  supposed  can  be  deduced  from  the  mere  fact 
that  the  death  of  the  person  was  caused  by  his  own  physical  act ;  for 
every  legal  presumption  of  a  fact  of  that  character  must  be  founded  and 
derived  from  some  other  fact  or  facts,  with  which  it  is  usually  or  always 
found,  as  the  result  of  general  experience  and  knowledge,  to  be  connected 
in  a  certain  relation." 

And  this  view  was  strongly  approved  in  the  later  case  of  Weed  vs. 
Life  Insurance  Co.,  70  N.  Y.  561,  in  which  this  language  was  used :  "  It  was 
also  held  in  the  same  case,  as  it  has  been  uniformly  held  in  other  cases,  that 
as  sanity  is  the  normal  condition  of  man,  it  is  presumed  as  to  each  indi- 
vidual, and  that  it  w as  incumbent  upon  the  plaintiff  to  overcome  this  pre- 
sumption by  proof  that  the  self-destruction  was  not  the  conscious,  volun- 
tary act  of  one  responsible  for  his  actions ;  that  the  insured  was,  in  fact, 
insane.  Insanity  cannot  be  presumed  from  the  mere  fact  of  suicide,  as 
was  said  by  Judge  Grover  in  the  case  cited,  for  the  reason  that  experience 
has  shown  that  self-destruction  is  often  perpetrated  by  the  sane." 

6.  Regarding  the  effect  which  the  suicide  of  the  policy-holder,  while 
insane,  has  in  avoiding  the  policy,  there  being  a  proviso  against  that 
mode  of  death,  the  decisions  can  be  divided  broadly  into  two  classes,  and 
will  be  so  discussed : 

(a)  If  an  individual  commits  suicide  voluntarily,  and  the  act  is  carried 
out  in  an  intelligent  and  purposeful  manner  in  pursuance  of  a  definite 
purpose,  it  is  suicide  on  the  part  of  the  insured,  even  if  he  is  urged 
thereto  by  an  insane  impulse,  or  if  insanity  exists  to  such  an  extent  that 
the  immorality  of  the  act  is  not  appreciated  by  him.  This  view  is  so 
ably  set  forth  in  the  case  of  Dean  vs.  American  Life  Ins.  Co.,  4  Allen 
(Mass.)  96,  by  the  Supreme  Court  of  Massachusetts,  as  to  serve  for  a 
model  of  reasoning.     It  proceeds  as  follows : 

"  There  can  be  no  doubt  that  the  facts  agreed  by  the  parties  concern- 
ing the  mode  in  which  the  insured  destroyed  his  own  life  bring  this  case 
within  the  strict  letter  of  the  proviso  in  the  policy,  by  which  it  was  stip- 
ulated that  it  should  be  void  and  of  no  effect  if  the  assured  should  '  die 
by  his  own  hand.'  The  single  question,  therefore,  which  we  have  to 
determine  is,  whether,  on  the  well-settled  principles  applicable  to  the  con- 
struction of  contracts,  we  can  so  interpret  the  language  of  the  policy  as 
to  add  to  the  proviso  words  of  qualification  and  limitation,  by  which  the 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  571 

natural  import  of  the  terms  used  by  the  parties  to  express  their  meaning 
will  be  so  modified  and  restricted  that  the  case  will  be  taken  out  of  the 
proviso,  and  the  policy  will  be  held  valid  and  binding  on  the  defendants. 
In  other  words,  the  inquiry  is  whether  the  proviso  can  be  so  read  that 
the  policy  was  to  be  void  in  case  the  assured  should  die  by  his  own  hand, 
he  being  sane  when  the  suicide  was  committed.  If  these  or  equivalent 
words  cannot  be  added  to  the  proviso,  or  if  it  cannot  be  held  that  the}' 
are  necessarily  implied,  then  it  must  follow  that  the  language  used  is  to 
have  its  legitimate  and  ordinary  signification,  by  which  it  is  clear  that 
the  policy  is  void. 

"  In  considering  this  question  we  are  relieved  of  one  difficulty  which 
has  embarrassed  the  discussion  of  the  same  subject  in  other  cases.  If 
the  proviso  had  excepted  from  the  policy  death  by  '  suicide,'  it  woidd 
have  been  open  to  the  plaintiffs  to  contend  that  this  word  was  to  have 
a  strict,  technical  definition,  as  meaning  in  a  legal  sense  an  act  of  crimi- 
nal self-destruction,  to  which  is  necessarily  attached  the  moral  responsi- 
bility of  taking  one's  life  voluntarily,  and  in  the  full  exercise  of  sound 
reason  and  discretion.  But  the  language  of  the  proviso  is  not  neces- 
sarily limited  by  the  mere  force  of  its  terms.  The  words  used  are  of 
the  most  comprehensive  character,  and  are  sufficiently  broad  to  include 
every  act  of  self-destruction,  however  caused,  without  regard  to  the 
moral  condition  of  the  mind  of  the  assured,  or  his  legal  responsibility 
for  his  acts. 

"  Applying,  then,  the  first  and  leading  rule  by  which  the  construction 
of  contracts  is  regulated  and  governed,  we  are  to  inquire  what  is  a  rea- 
sonable interpretation  of  this  clause  according  to  the  intent  of  the  parties. 
It  certainly  is  very  difficult  to  maintain  the  proposition  that,  where  par- 
ties reduce  their  contract  to  writing,  and  put  their  stipulations  into  clear 
and  unambiguous  language,  they  intended  to  agree  to  anything  different 
from  that  which  is  plainly  expressed  by  the  terms  used.  It  is,  however, 
to  be  assumed  that  every  part  of  a  contract  is  to  be  construed  with  ref- 
erence to  the  subject-matter  to  which  it  relates,  and  with  such  limitations 
and  qualifications  of  general  words  and  phrases  as  properly  arise  and 
grow  out  of  the  nature  of  the  agreement  in  which  they  are  found.  Giv- 
ing full  force  and  effect  to  this  rule  of  interpretation,  we  are  unable  to 
see  that  there  is  anything  unreasonable  or  inconsistent  writh  the  general 
purpose  wdiich  the  parties  had  in  view  in  making  and  accepting  the  pol- 
icy, in  a  clause  which  excepts  from  the  risk  assumed  thereby  the  death 
of  the  assured  by  his  own  hand,  irrespective  of  the  condition  of  his  own 
mind,  as  affecting  his  moral  and  legal  responsibility  at  the  time  the  act 
of  self-destruction  was  consummated.  Every  assurer,  in  assuming  a  risk, 
imposes  certain  restrictions  and  conditions  upon  his  liability.  Nothing 
is  more  common  than  the  insertion,  in  policies  of  insurance,  of  exceptions 
by  which  certain  kinds  or  classes  of  hazards  are  taken  out  of  the  general 
risk  which  the  insurer  is  willing  to  incur.  Especially  is  this  true  in  re- 
gard to  losses  which  may  arise  and  grow  out  of  an  act  of  the  party  in- 
sured. Such  exceptions  are  founded  on  the  reasonable  assumption  that 
the  hazard  is  increased  when  the  insurance  extends  to  the  consequences 
which  may  flow  from  the  acts  of  the  person  who  is  to  receive  a  benefit 
to  himself  or  confer  one  on  others  by  the  happening  of  a  loss  within  the 
terms  of  the  policy.  Where  a  party  procures  a  policy  on  his  life,  pay- 
able to  his  wife  and  children,  he  contemplates  that,  in  the  event  of  his 


572  -4   SYSTEM  OF  LEGAL  MEDICINE. 

death,  the  sum  insured  will  inure  directly  to  their  benefit.  So  far  as  a 
desire  to  provide  in  that  contingency  for  the  welfare  and  comfort  of  those 
dependent  on  him  can  operate  on  his  mind,  he  is  open  to  the  temptation 
of  a  motive  to  accelerate  a  claim  for  a  loss  under  the  policy  by  an  act  of 
self-destruction.  Against  an  increase  of  the  risk  arising  from  such  a 
cause,  it  is  one  of  the  objects  of  the  proviso  in  question  to  protect  the 
insurers.  Although  the  assured  can  derive  no  pecuniary  advantage  to 
himself  by  hastening  his  own  death,  he  may  have  a  motive  to  take  his 
own  life,  and  thus  to  create  a  claim  under  the  policy,  in  order  to  confer 
a  benefit  on  those  who,  in  the  event  of  his  death,  will  be  entitled  to  re- 
ceive the  sum  insured  on  his  life.  Unless,  then,  we  can  say  that  such  a 
motive  cannot  operate  on  a  mind  diseased,  we  cannot  restrict  the  words 
of  the  proviso  so  as  to  except  from  the  risk  covered  by  the  policy  only 
the  case  of  criminal  suicide,  where  the  assured  was  in  a  condition  to  be 
held  legally  and  morally  responsible  for  his  acts.  It  certainly  would  be 
contrary  to  experience  to  affirm  that  an  insane  person  cannot  be  influ- 
enced and  governed  in  his  actions  by  the  ordinary  motives  which  operate 
on  the  human  mind.  Doubtless  there  may  be  cases  of  delirium  or  rav- 
ing madness  where  the  body  acts  only  from  frenzy  or  blind  impulse,  as 
there  are  cases  of  idiocy  or  the  decay  of  mental  power,  in  which  it  acts 
only  from  the  promptings  of  the  lowest  animal  instincts.  But  in  the 
great  majorit}^  of  cases  where  reason  has  lost  its  legitimate  control,  and 
the  power  of  exercising  a  sound  and  healthy  volition  is  lost,  the  mind 
still  retains  sufficient  power  to  supply  motives  and  exert  a  direct  and 
essential  control  over  the  actions.  In  such  cases,  the  effect  of  the  dis- 
ease is  often  to  give  undue  prominence  to  surrounding  circumstances 
and  events,  and  by  exaggerating  their  immediate  effects  on  future  con- 
sequences to  furnish  incitement  to  acts  of  violence  and  folly.  A  person 
may  be  insane,  entirely  incapable  of  distinguishing  between  right  and 
wrong,  and  without  any  just  sense  of  moral  responsibility,  and  yet  re- 
tain sufficient  powers  of  mind  and  reason  to  act  with  premeditation,  to 
understand  and  contemplate  the  nature  and  consequences  of  his  own  con- 
duct, and  to  intend  the  results  which  his  acts  are  calculated  to  produce. 
Insanity  does  not  necessarily  operate  to  deprive  its  subjects  of  their 
hopes  and  fears,  or  the  other  mental  emotions  which  agitate  and  influ- 
ence the  minds  of  persons  in  the  full  possession  of  their  faculties.  .  .  . 

"  It  is  against  risks  of  this  nature — the  destruction  of  life  by  the  vol- 
untary and  intentional  act  of  the  party  assured — that  the  exception  in 
the  proviso  is  intended  to  protect  the  insurers.  The  moral  responsibility 
for  the  act  does  not  affect  the  nature  of  the  hazard.  The  object  is  to 
guard  against  loss  arising  from  a  particular  mode  of  death.  The  causa 
causans,  the  motive  or  influence  which  guided  or  controlled  the  will  of 
the  party  in  committing  the  act,  is  immaterial,  as  affecting  the  risk  which 
the  insurers  intended  to  except  from  the  policy.  This  view  is  entirely 
consistent  with  the  nature  of  the  contract.  It  is  the  ordinary  case  of  an 
exception  of  a  risk  which  would  otherwise  fall  within  the  general  terms 
of  the  policy.  These  comprehended  death  by  disease,  either  of  the  body 
or  the  brain,  from  whatever  cause  arising.  The  proviso  exempts  the  in- 
surers from  liability  when  life  is  destroyed  by  the  act  of  the  party  insured, 
although  it  may  be  distinctly  traced  as  the  result  of  a  diseased  mind.  It 
may  well  be  that  insurers  would  be  willing  to  assume  the  risk  of  the  re- 
sults flowing  from  all  diseases  of  the  body,  producing  death  by  the  opera- 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  573 

tion  of  physical  causes,  and  yet  deem  it  expedient  to  avoid  the  hazards 
of  mental  disorder,  in  its  effects  on  the  will  of  the  assured.  .  .  . 

"  It  was  urged  by  the  learned  counsel  for  the  plaintiffs  very  strongly 
that  this  view  of  the  construction  of  the  contract  was  open  to  the  fatal 
objection  that  it  would  necessarily  lead  to  the  absurd  conclusion  that 
death  occasioned  by  inevitable  accident  or  overpowering  force,  or  in  a 
fit  of  delirium  or  frenzy,  if  the  proximate  and  immediate  cause  was  the 
hand  of  the  person  insured,  would  be  excepted  from  the  risk  assumed 
by  the  defendants.  But  this  objection  is  sufficiently  answered  by  the 
obvious  suggestion  that  such  an  interpretation,  although  within  the  lit- 
eral terms  of  the  proviso,  would  be  contrary  to  a  reasonable  intent,  as 
derived  from  the  subject-matter  of  the  contract.  .  .  .  The  question  in 
such  cases  is  not  how  far  can  the  literal  meaning  of  words  be  extended, 
but  what  is  a  reasonable  limitation  and  qualification  of  them,  having  re- 
gard to  the  nature  of  the  contract  and  the  objects  intended  to  be  accom- 
plished  by  it.  Applying  this  principle  to  the  present  proviso,  and  assum- 
ing that  the  plaintiffs  are  right  in  their  position  that  the  words  used  are 
not  to  be  interpreted  literally,  it  would  seem  reasonable  to  hold  that  they 
were  intended  to  except  from  the  policy  all  cases  of  death  caused  by  the 
voluntary  act  of  the  assured,  when  his  deed  of  self-destruction  was  the 
result  of  intention,  by  a  person  knowing  the  nature  and  consequences  of 
the  act,  although  it  may  have  been  done  under  an  insane  delusion,  which 
rendered  the  party  morally  and  legally  irresponsible,  incapable  of  distin- 
guishing between  right  and  wrong,  and  which,  by  disturbing  his  reason 
and  judgment,  impelled  him  to  its  commission.  If  the  suicide  was  an 
act  of  volition,  however  excited  or  impelled,  it  may  in  a  just  sense  be  said 
that  he  died  by  his  own  hand.  But  beyond  this  it  would  not  be  reason- 
able to  extend  the  meaning  of  the  proviso.  If  the  death  was  caused  by 
accident,  by  superior  and  overwhelming  force,  in  the  madness  of  delirium, 
or  under  any  combination  of  circumstances  from  which  it  may  be  fairly 
inferred  that  the  act  of  self-destruction  was  not  the  result  of  the  will  or 
intention  of  the  party  adapting  means  to  the  end,  and  contemplating  the 
physical  nature  and  effects  of  the  act,  then  it  may  be  justly  held  to  be  a 
loss  not  excepted  within  the  meaning  of  the  proviso.  .  .  .  Those  familiar 
with  the  business  of  insurance,  and  with  the  result  of  actions  on  policies 
of  insurance  in  courts  of  law,  know  how  difficult  it  is  to  establish  a  case 
of  exemption  from  liability  under  an  exception  in  a  policy  where  it  de- 
pends on  a  question  of  fact  to  be  decided  by  the  verdict  of  a  jury.  If 
this  is  true  in  regard  to  ordinary  claims  under  policies,  it  is  obvious  that 
the  difficulty  would  be  greatly  enhanced  in  cases  like  the  present,  where 
it  would  be  sufficient,  in  order  to  take  a  case  out  of  the  operation  of  the 
proviso,  to  prove  that  self-destruction  was  the  result  of  insanity.  It 
would  not  be  hazardous  to  affirm  that,  in  all  cases  where  such  an  issue 
was  to  be  determined  by  a  jury  between  an  insurance  company  and  the 
representatives  of  the  deceased,  the  act  of  suicide  would  be  taken  as  proof 
of  insanity.  .  .  . 

"  The  learned  counsel  for  the  plaintiffs  have  insisted  with  great  force 
on  an  argument  drawn  from  the  context,  to  show  that  the  proviso  was 
intended  to  embrace  only  a  case  of  criminal  self-destruction  by  a  reason- 
able and  responsible  being.  But  it  seems  to  us  that  the  maxim  noscitur 
a  sociis,  on  which  they  rely,  does  not  aid  the  construction  for  which  they 
contend.     The  material  part  of  the  clause  is,  that  the  policy  shall  be  void 


574  A   SYSTEM  OF  LEGAL  MEDICINE. 

if  the  assured  '  shall  die  by  his  own  hand,  or  in  consequence  of  a  duel,  or 
by  the  hands  of  justice,  or  in  the  known  violation  of  any  State,  national, 
or  provincial  law.'  Now  the  first  and  most  obvious  consideration  sug- 
gested by  other  parts  of  this  clause  is,  that  in  enumerating  the  causes  of 
death  which  shall  not  be  deemed  to  be  within  the  risks  covered  by  the 
policy,  one  of  them  is  in  terms  made  to  depend  on  the  existence  of  a 
criminal  intention.  It  is  a  'known  violation  of  law'  which  is  to  avoid 
the  policy.  This  tends  very  strongly  to  show  that  where  an  act  produc- 
ing death  may  be  either  innocent  or  criminal,  if  it  is  intended  to  except 
only  such  as  involves  a  guilty  intent,  it  is  carefully  so  expressed  in  the 
proviso.  The  inference  is  very  strong  that  if  they  designed  to  confine 
the  exception  in  question  to  cases  of  criminal  suicide,  it  would  have  been 
so  provided  in  explicit  terms.  ...  It  seems  to  us  to  be  a  petitio  principii 
to  assume  that  death  in  consequence  of  a  duel  necessarily  implies  an  act 
for  which  the  party  would  be  criminally  responsible.  Why  is  not  this 
part  of  the  proviso  open  to  the  same  argument  as  that  which  is  urged  in 
regard  to  the  clause  relating  to  self-destruction  ?  A  duel  may  be  fought 
by  a  party  acting  under  duress,  or  impelled  thereto  by  an  insane  delu- 
sion, which  might  blind  his  moral  perceptions  and  render  him  legally  ir- 
responsible. If  so,  then  the  same  answer  to  a  defense  set  up  against  a 
claim  under  the  policy  would  be  open,  under  this  clause,  as  the  one  now 
urged  in  behalf  of  the  plaintiffs ;  and  the  argument  founded  on  the  as- 
sumption that  a  forfeiture  under  this  part  of  the  proviso  necessarily  in- 
volves a  criminal  violation  of  the  law  falls  to  the  ground.  Therefore 
the  inference  that  a  guilty  intention  is  communicated  from  this  branch 
of  the  proviso  to  that  relating  to  death  by  the  act  of  the  assured  seems 
to  us  to  be  unfounded.  The  only  remaining  clause  is  that  which  pro- 
vides for  the  case  of  death  by  the  hands  of  justice.  This  undoubtedly 
implies  that  the  person  insured  has  been  found  guilty  of  a  criminal  act 
by  a  judicial  tribunal,  according  to  the  established  forms  of  law.  But  it 
is  not  correct  to  say  that  it  involves  the  existence  of  a  criminal  intent, 
because  it  might  be  shown  that  the  conviction  of  the  assured  was  errone- 
ous, and  that  he  was  in  fact  innocent  of  the  crime  for  which  he  suffered 
the  penalty  of  death.  So  far,  therefore,  as  any  argument  can  be  justly 
drawn  from  the  connection  in  which  the  words  as  to  self-destruction 
stand  in  relation  to  other  parts  of  the  proviso,  it  leads  to  the  conclusion 
that  it  was  not  solely  death  occasioned  by  acts  of  the  assured  involving 
criminal  intent  or  a  willful  violation  of  the  law  by  a  person  morally  and 
legally  responsible,  which  was  intended  to  be  excepted  from  the  risks  as- 
sumed by  the  insurers ;  but  that,  with  the  exception  of  death  in  a  known 
violation  of  law,  the  proviso  embraces  all  cases  where  life  is  taken  in  con- 
sequence of  the  causes  specified,  without  regard  to  the  question  whether 
at  the  time  the  assured  was  amenable  for  his  act,  either  in  foro  conscientin *:, 
or  in  the  tribunals  of  justice.  .  .  . 

"  To  say  that  insanity  exonerates  a  party  from  a  forfeiture  under 
such  a  proviso  in  a  policy  is  ,to  assume  that  this  was  the  intention  of  the 
parties  when  the  contract  of  insurance  was  entered  into.  But  if  such 
was  not  the  intention,  then  it  follows  that  the  assured  gave  an  intelligent 
assent  to  a  contract  by  which  he  stipulated  that  if  he  took  his  own  life 
voluntarily,  knowing  the  consequences  of  his  act,  he  would  thereby  work 
a  forfeiture  of  his  claim  under  the  policy,  although  he  may  have  acted 
under  the  influence  of  insanity  in  committing  the  suicidal  act.     So  that. 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  575 

after  all,  we  are  brought  back  to  the  inquiry,  What  was  the  intention  of 
the  parties  to  the  contract  f  in  order  to  ascertain  the  true  construction 
of  the  proviso. 

"  The  result  to  which  we  have  come,  after  a  careful  and  deliberate 
consideration  of  the  question,  during  which  we  have  felt  most  sensibly 
the  very  great  difficulties  and  embarrassments  which  surround  the  sub- 
ject, is  that  the  plaintiffs  are  not  entitled  to  recover.  The  facts  agreed 
upon  by  the  parties  concerning  the  mode  in  which  the  plaintiffs'  intestate 
took  his  own  life,  leave  no  room  for  doubt  that  self-destruction  was  in- 
tended by  him,  he  having  sufficient  capacity  at  the  time  to  understand 
the  nature  of  the  act  which  he  was  about  to  commit,  and  the  conse- 
quences which  would  result  from  it.  Such  being  the  fact,  it  is  wholly 
immaterial  to  the  present  case  that  he  was  impelled  thereto  by  insanity, 
which  impaired  his  sense  of  moral  responsibility,  and  rendered  him  to  a 
certain  extent  irresponsible  for  his  actions." 

This  opinion  has  been  quoted  at  great  length,  because  it  seems  to  us 
to  be  the  only  logical  one  that  can  be  applied  in  these  cases ;  and  further, 
the  position  is  stated  with  such  clearness,  and  every  objection  is  answered 
so  ably,  that  it  seems  as  if  it  were  incontrovertible ;  but  human  tender- 
ness and  the  fact  that  corporations  have  no  soul  have  elsewhere  materi- 
ally modified  it,  as  we  shall  see  later.  In  1848  the  well-known  English 
case  of  Dormay  vs.  Borradaile,  5  M.  &  Gr.  380,  was  decided.  In  that  case 
the  jury  found  that  the  assured  "  voluntarily  threw  himself  into  the 
water,  knowing  at  the  time  that  he  should  thereby  destroy  his  life,  and 
intending  thereby  to  do  so;  but  at  the  time  of  committing  the  act  he 
was  not  capable  of  judging  between  right  and  wrong."  On  appeal  it 
was  held  by  three  out  of  four  judges  that  the  policy  was  avoided. 
Erskine,  J.,  said  "that  the  question  whether  at  the  time  he  was  capable 
of  understanding  the  moral  nature  and  quality  of  his  purpose  is  not 
relevant  to  the  inquiry  further  than  as  it  might  help  to  illustrate  the  ex- 
tent of  his  capacity  to  understand  the  physical  character  of  the  act 
itself."  This  was  substantially  repeated  in  the  case  of  Clift  vs.  Schwdbe, 
3  C.  B.  437,  and  may  be  considered  accepted  now  in  England ;  as  is 
indicated  in  the  case  of  Sformont  vs.  Waterloo  Life  and  Casualty  Ass. 
Co.,  3  Bigelow's  Life  &  Ace.  Cases  196,  where  the  court  instructed  the 
jury  that  "  the  question  is,  Did  the  assured  know  that  he  was  throwing 
himself  out  of  the  window  ?  If  he  did,  no  recovery  could  be  had  under 
the  policy." 

In  the  United  States  the  same  principle  has  been  again  followed  in 
Massachusetts  in  the  case  of  Cooper  vs.  Massachusetts  Mutual  Life  Ins.  Co., 
102  Mass.  227,  where  it  was  said :  "  In  the  present  case  there  was  no 
offer  to  prove  madness  of  delirium,  or  that  the  act  of  self-destruction  was 
not  the  result  of  the  will  and  intention  of  the  party,  adapting  the  means 
to  the  end,  and  contemplating  the  physical  nature  and  effects  of  the 
act.  The  insanity,  therefore,  was  not  such  as  to  take  the  case  out  of  the 
proviso." 

In  New  York  the  first  case  decided  was  against  this  view.  This  is 
the  famous  case  of  Breasted  vs.  Farmers'  Loan  and  Trust  Co.,  4  Hill  (X.  Y.) 
73  and  8  N.  Y.  299,  the  history  of  which  is  related  quite  fully  on 
page  577.  Even  in  this  case  three  out  of  eight  judges  held  a  dissenting 
opinion,  which  was  very  ably  expressed  by  Judge  Gardiner,  who  said : 
"It  is  by  the  finding  established  that  the  assured  cast  himself  into  the 


57G  A  SYSTEM  OF  LEGAL  MEDICINE. 

river  for  the  purpose  of  drowning  himself.  The  act  committed  by  him 
was  therefore  voluntary,  and  accompanied  by  so  much  intelligence  as  to 
enable  the  agent  to  contemplate  a  particular  result,  and  adopt  the  means 
requisite  to  accomplish  it.  His  object  was  self-destruction  by  drowning. 
For  this  purpose  he  cast  himself  into  the  river,  and  thereby  effected  it. 
If  this  was  not  '  dyiug  by  his  own  hand '  within  the  spirit  and  intent  of 
this  clause  of  the  policy,  it  is  difficult  to  attach  any  legal  significance  to 
such  language. 

"If,  under  the  same  circumstances,  the  assured  had  destroyed  the 
property  or  assaulted  the  person  of  a  citizen,  he  would  have  been  civilly 
responsible  for  all  the  damages  sustained  by  the  latter.  Insanity,  unless 
it  suspended  the  power  of  volition,  would  be  no  justification  ;  still  less  a 
want  of  moral  perception  to  distinguish  between  right  and  wrong. 

"  I  can  perceive  no  reason  why  upon  the  same  principle  he  should  not 
be  held  responsible  for  a  willful  breach  of  contract  resulting  from  self- 
destruction,  where  it  was  premeditated,  and  accomplished  by  means  usual 
and  appropriate  to  effect  his  design." 

At  a  later  date  this  view  prevailed  in  the  case  of  Van  Zandt  vs.  Life 
Insurance  Co.,  55  N.  Y.  169.  Here  it  was  held  that :  "  In  the  practical  ad- 
ministration of  justice  in  cases  of  this  description,  it  seems  to  us  a  dan- 
gerous doctrine  to  hold  that  the  attention  of  the  jury  should  be  directed 
principally  to  the  degree  of  appreciation  which  the  deceased  had  of  the 
moral  nature  of  his  act,  and  that  this  question,  most  speculative  and 
•difficult  of  solution,  should  be  made  the  test  by  which  it  should  be  de- 
termined whether  he  had  knowingly  and  voluntarily  violated  the  condi- 
tion of  his  insurance.  The  real  question  is  whether  he  did  the  act  con- 
sciously and  voluntarily,  or  whether  from  disease  his  mind  had  ceased  to 
•control  his  actions.  Supposing  a  man  to  be  in  the  possession  of  his  will 
and  of  the  ordinary  mental  faculties  necessary  for  his  self-preservation, 
but  that  his  mind  has  become  so  morbidly  diseased  on  the  subject  of  sui- 
cide that  he  cannot  appreciate  its  moral  wrong,  and  in  this  condition  of 
mind  he  takes  his  own  life  voluntarily  and  intentionally,  perhaps  with  the 
very  object  of  securing  to  his  family  the  benefits  of  an  insurance  upon  his 
life,  it  is  difficult  to  say  that  this  is  not  a  death  by  his  own  hand  within 
the  meaning  of  the  policy.  It  has  been  doubted  whether  public  policy 
would  permit  an  insurance  covering  the  case  of  intentional  suicide  by 
the  assured  while  sane.  But  however  this  may  be,  no  rational  doubt  can 
be  entertained  that  a  condition  exempting  the  insurers  from  liability  in 
■case  of  the  death  of  the  assured  by  his  own  hand,  whether  sane  or  insane, 
would  be  valid  if  mutually  agreed  upon  between  the  insurer  and  the  in- 
sured. When  nothing  is  said  in  the  policy  with  respect  to  insanity,  the 
words  '  die  by  his  own  hand/  in  their  literal  sense,  comprehend  all  cases 
of  self-destruction.  The  exceptions  which  have  been  grafted  upon  these 
words  by  judicial  decisions  must  rest  upon  the  ground  that  the  excepted 
cases  could  not  have  been  within  the  meaning  of  the  parties  to  the  policy. 
The  intent  on  the  part  of  the  insurer  in  inserting  the  condition  is 
■evident.  The  policy  creates  in  the  assured  a  pecuniary  interest  in  his 
own  death.  To  a  man  laboring  under  the  pressure  of  poverty  and  the 
urgent  wants  of  a  dependent  family,  or  of  inal  >ility  to  discharge  sacred 
pecuniary  obligations  or  other  similar  causes,  the  policy  offers  a  tempta- 
tion to  self-destruction.  To  protect  the  insurers  against  the  increase  of 
risk  arising  out  of  this  temptation  is  the  object  for  which  the  condition 


THE  MEDICAL  JURISPRUDENCE  OF  LIFE  INSURANCE.  577 

in  question  is  inserted.  The  condition  ought,  therefore,  to  be  so 
construed  as  to  exclude  only  those  cases  in  which  these  motives  could 
not  have  operated,  such  as  accident  or  delirium." 

The  views  stated  above  iu  this  section  are  those  held  also  by  the  best- 
known  text-books  on  life  insurance,  Biddle,  May,  and  Richards.  May 
says  that  "  to  hold  '  death  by  his  own  hand '  identical  with  criminal  sui- 
cide, and  to  require  freedom  from  irresistible  impulse,  is  clearly  making 
a  new  contract  very  different  from  the  plain  sense  and  spirit  of  the 
words.  It  is  a  question  if  any  impulse  that  causes  action  is  resistible. 
The  prospect  of  providing  for  wife  and  family  may  in  some  states  of 
mind  be  an  irresistible  motive,  yet  it  is  the  very  one  the  company  wishes 
to  exclude."  Holland,  France,  and  Germany  apparently  have  adopted 
the  same  construction  of  this  question.     (6  Ins.  L.  J.  719.) 

(b)  Unfortunately,  the  sanctity  of  such  motives,  as  providing  support 
for  wife  and  children,  and  possibly  other  considerations,  have,  in  another 
class  of  cases,  influenced  the  judicial  mind;  consequently  we  find  it  held 
that,  even  if  the  act  of  suicide  be  voluntary,  still,  to  bring  it  within  the 
exception  it  must  be  accompanied  by  an  understanding  of  its  normal 
aspect,  an  ability  to  distinguish  right  from  wrong,  and  also  a  freedom 
from  the  influence  of  an  irresistible  impulse. 

This  view  was  apparently  first  enunciated  in  1818  by  the  Chief -Justice 
of  Bengal,  in  the  case  of  Bayley  vs.  Alexander,  Biddle  on  Insurance,  sec. 
832.  It  therefore  has  whatever  merit  antiquity  may  lend  to  it.  The 
next  case  was  that  of  Breasted  vs.  Fanners'  Loan  and  Trust  Co.,  4  Hill 
(N.  Y.)  73,  the  dissenting  opinion  in  which  we  have  already  quoted.  In 
the  prevailing  opinion  it  was  held  that :  "  Suicide  involves  the  deliberate 
termination  of  one's  existence  while  in  the  possession  and  enjoyment 
•of  his  mental  faculties.  Self-slaughter  by  an  insane  man  or  a  lunatic 
is  not  an  act  of  suicide  within  the  meaning  of  the  law."  This  case  was 
finally  carried  to  the  Court  of  Appeals,  and  it  was  there  held  (8  N.  Y. 
299)  by  five  out  of  eight  judges  as  follows:  "The  connection  in  which 
they  are  used  in  this  policy  indicates  that  the  phrase  '  death  by  his  own 
hands '  meant  an  act  of  criminal  self-destruction.  .  .  .  The  connection 
in  which  they  stand  in  this  policy  favors  this  construction.  The  first 
four  exceptions  in  the  policy  are  of  acts  innocent  in  themselves,  three 
*of  which  become  inoperative  if  the  defendants  give  their  consent  and 
have  it  indorsed  on  the  policy.  Then  follow  the  last  four  exceptions, 
viz.,  if  he  shall  die  by  his  own  hand,  or  in  consequence  of  a  duel,  or  by 
the  hands  of  justice,  or  in  known  violation  of  any  law,  etc.  By  the 
acknowledged  rule  of  construction,  noscitur  a  sociis,  the  first  member  of 
the  sentence,  if  there  be  any  doubt  as  to  its  meaning,  should  be  con- 
trolled by  the  other  members,  which  are  entirely  unequivocal,  and  should 
be  construed  to  mean  a  felonious  killing  of  himself.  It  is  a  note  laid 
by  Lord  Bacon  that  copulatio  verborum  indicat  acceptionem  in  eodem 
sensu  ;  the  coupling  of  words  together  shows  that  they  are  to  be  under- 
stood in  the  same  sense.  And  when  the  meaning  of  any  particular 
word  is  doubtful  or  obscure,  or  when  the  expression,  taken  singly, 
is  inoperative,  the  intention  of  the  parties  using  it  may  frequently  be 
ascertained  and  carried  into  effect  by  looking  at  the  adjoining  words,  or 
at  expressions  occurring  in  other  parts  of  the  same  instrument,  for  qn<t> 
non  valeant  singula  juncta  juvant  Besides,  the  words  in  this  ease  are 
tho.se    of    the  insurer,  and   if   susceptible  of  two  meanings,  should  be 


578  A   SYSTEM  OF  LEGAL  MEDICINE. 

taken  strongly  against  him.  It  was  not  intended  on  the  part  of  the 
defendant  that  the  policy  would  be  avoided  by  a  mere  accidental 
destruction  of  life  by  the  party  himself.  It  was  urged  that  it  would 
be  if  the  act  was  done  intentionally,  although  under  circumstances  which 
would  exempt  the  party  from  all  moral  culpability.  It  was  insisted 
that  it  must  be  taken  to  mean  a  death  by  his  own  act.  It  seems  to  me 
that  this  is  a  yielding  of  the  whole  question.  An  insane  man,  incapable 
of  discerning  between  right  and  wrong,  can  form  no  intention.  His  acts 
are  not  the  result  of  thought  or  reason,  and  no  more  the  subject  of 
punishment  than  those  which  are  produced  by  accident.  The  acts  of  a 
madman,  which  are  the  offspring  of  the  disease,  subject  him  to  no  criminal 
responsibility.  If  the  insured,  while  engaged  in  his  trade  as  a  house- 
joiner,  had  accidentally  fallen  through  an  opening  in  the  chamber  of  a 
house  he  was  constructing  and  lost  his  life,  the  argument  concedes  that 
the  insurer  would  have  been  liable.  The  reason  is  that  the  mind  did  not 
concur  with  the  act.  How  can  this  differ  in  principle  from  a  death  in  a 
fit  of  insanity,  when  the  party  had  no  mind  to  concur  in  or  oppose  the 
act?  .  .  . 

"If  the  insured  was  compelled  hy  duress  to  take  his  own  life,  it  will 
hardly  be  contended  that  the  insurers  could  avoid  payment.  In  what 
consists  the  difference  between  the  duress  of  man  and  duress  of  Heaven  f 
Can  a  man  be  said  to  do  an  act  prejudicial  to  the  insured  when  he 
is  compelled  to  do  it  by  irresistible  coercion?  and  can  it  make  any 
difference  whether  this  coercion  came  from  the  hand  of  man  or  the 
visitation  of  Providence  ? " 

This  rule,  although  afterward  reversed  in  the  same  State  in  the  case 
of  Van  Zandt  vs.  Mutual  Benefit  Life  Insurance  Co.  (see  p.  576),  furnished 
a  precedent  that  has  been  elsewhere  eagerly  followed.  The  question  was 
brought  before  the  Supreme  Court  of  the  United  States  in  the  case  of 
Mutual  Life  Insurance  Co.  vs.  Terry,  15  Wall.  580.  The  dicta  in  this 
case  are :  "  The  propositions  embodied  in  the  charge  before  us  are  in 
some  respects  different  from  each  other,  but  in  principle  they  are  identi- 
cal. They  rest  upon  the  same  basis,  the  moral  and  intellectual  capacity 
of  the  deceased.  In  each  case  the  physical  act  of  destruction  was  that 
of  George  Terry.  In  neither  was  it  truly  his  act.  In  the  one  supposi- 
tion he  did  it  when  his  reasoning  powers  were  overthrown,  and  he  had 
not  the  power  or  capacity  to  exercise  them  upon  the  act  he  was  about  to 
do.  It  was  in  effect  as  if  his  intellect  and  reason  were  blotted  out  or 
had  never  existed.  In  the  other,  if  he  understood  and  appreciated  the 
effect  of  his  act,  an  uncontrollable  impulse,  caused  by  insanity,  compelled 
its  commission.  He  had  not  the  power  to  refrain  from  its  commission 
or  to  resist  the  impulse.  Each  of  the  principles  put  forth  by  the  judge 
rests  upon  the  same  basis,  that  the  act  was  not  the  voluntary,  intelligent 
act  of  the  deceased.  .  .  . 

"  "We  hold  the  rule  on  the  question  before  us  to  be  this :  If  the  assured, 
being  in  the  possession  of  his  ordinary  reasoning  faculties,  from  angerr 
pride,  jealousy,  or  a  desire  to  escape  from  the  ills  of  life  intentionally 
takes  his  own  life,  the  proviso  attaches,  and  there  can  be  no  recovery. 
If  the  death  is  caused  by  the  voluntary  act  of  the  assured,  he  knowing 
and  intending  that  his  death  shall  be  the  result  of  his  act,  but  when  his 
reasoning  faculties  are  so  far  impaired  that  he  is  not  able  to  understand 
the  moral  character,  the  general  nature,  consequences,  and  effect  of  the 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  579 

act  he  is  about  to  commit,  or  when  he  is  impelled  thereto  by  an  insane 
impulse,  which  he  has  not  the  power, to  resist,  such  death  is  not  within 
the  contemplation  of  the  parties  to  the  contract,  and  the  insurer  is  liable." 

It  will  be  noticed  that  this  is  even  more  liberal  than  the  preceding 
case,  for  it  brings  in  the  idea  of  an  irresistible  impulse  as  well  as  a  lack 
of  appreciation  of  the  moral  consequences  of  the  act.  To  the  average 
juryman  in  such  a  case  the  convincing  proof  of  the  irresistibility  of  an 
impulse  would  be  the  fact  that  it  was  not  resisted.  It  seems  to  us  hardly 
worth  the  while  to  separate  these  decisions  of  such  marked  leniency  into 
separate  classes.  One  or  both  of  them  has  been  adopted  in  the  following 
cases:  Life  Insurance  Co.  vs.  Groom,  86  Pa.  St.  92;  Schultz  vs.  Insurance 
Co.,  40  Ohio  St.  217  ;  Hathaway  vs.  Insurance  Co.,  48  Vt.  335  ;  Life  Insur- 
ance Co.  vs.  Brouijhton,  109  U.  S.  121 ;  Eastabrooh  vs.  Life  Insurance  Co., 
54  Me.  224 ;  Blue-stone  vs.  Standard  Co.,  74  Mich.  593 ;  Life  Assn.  vs. 
Waller,  57  Ga.  533;  Knickerbocker  Insurance  Co.  vs.  Peters,  42  Md.  414; 
Scheffer  vs.  National  Co.,  25  Minn.  534. 

The  situation  in  New  York  State  is  rather  interesting.  In  the  case 
of  Breasted  vs.  Farmers1  Loan  and  Trust  Co.,  4  Hill  (N.  Y.)  73,  the  court, 
as  we  have  seen,  made  a  most  liberal  decision,  but  this  was  overruled  in 
Van  Zandt  vs.  Life  Insurance  Co.,  55  N.  Y.  169.  Although  in  this  latter 
•decision  the  idea  that  moral  irresponsibility  excused  the  act  of  suicide  is 
distinctly  rejected,  the  doctrine  of  irresistible  impulse  is  faintly  outlined. 
This  grew  into  large  proportions  in  the  case  of  Newton  vs.  Life  Insurance 
Co.,  76  N.  Y.  426,  and  became  the  predominant  thought  in  the  ruling ; 
thus  :  "  Without  referring  to  the  evidence  in  detail,  our  conclusion  is  that 
although  it  might  have  required  the  jury  to  find  that  Ross  was  aware 
when  he  took  the  laudanum  that  it  would  terminate  his  life,  yet  it  would 
also  have  justified  a  finding  that  he  acted  under  the  control  of  an  insane 
impulse  caused  by  disease  and  derangement  of  his  intellect,  which  de- 
prived him  of  the  capacity  of  governing  his  own  conduct  in  accordance 
with  reason.  An  act  committed  under  such  circumstances  cannot  be  re- 
garded as  voluntary  or  within  the  proviso  of  the  policy." 

This  view  was  affirmed  in  the  case  of  Meacham  vs.  Benevolent  Associa- 
tion, 120  N.  Y.  237,  where  it  was  held  that :  "  Unless,  therefore,  such  self- 
destruction  was  the  result  of  accident,  mistake,  or  insanity,  or  was  invol- 
untary because  he  was  driven  to  it  by  an  insane  impulse,  which  disabled 
him  from  controlling  his  own  actions,  Hay  committed  suicide  within  the 
meaning  of  the  policy  and  it  became  void."  This  was  a  question  of  fact 
for  the  jury  to  determine,  which  they  did  in  the  usual  way. 

At  this  time  we  must  range  New  York  with  the  liberals  in  this  matter. 
It  is  not  worth  while,  for  practical  purposes,  to  separate  cases  of  "  moral 
irresponsibility"  from  those  of  "irresistible  impulse."  The  result  is  the 
same,  for  the  question,  being  one  of  fact,  is  left  to  the  jury,  and  they  al- 
ways find  for  the  plaintiff  in  these  cases. 

7.  In  order  to  obviate  the  difficulties  mentioned  in  the  previous 
section,  the  companies  have  inserted  additional  qualifying  words,  com- 
monly "sane  or  insane."  The  following  expressions  have  been  con- 
sidered as  synonymous  with  that :  "  self-destruction,  felonious  or  other- 
wise," "while  insane,"  "dying  by  his  own  act  or  intention,  whether  sane 
or  insane."  But  the  meaning  must  be  very  clearly  expressed,  or  the  courts 
will  disregard  the  apparent  intention  of  the  insurers  and  rule  against  them, 
for,  as  has  been  already  stated,  it  is  well  understood  that,  in  case  of  any 


580  ^   SYSTEM  OF  LEGAL  MEDICINE. 

doubt,  the  interpretation  of  the  contract  will  be  adverse  to  the  insurers,, 
as  they  were  the  ones  who  drew  it  up.  Consequently,  the  following  clauses- 
have  not  been  held  to  make  any  additional  restriction :  "  dying  by  his 
own  hand  or  act,  voluntarily  or  otherwise  "  (Jacobs  vs.  Life  Insurance  Co., 
5  Bigelow's  Life  &  Ace.  Cases  42),  "  under  any  circumstances  die  by  his- 
own  act  or  hand"  (Schultz  vs.  Insurance  Co.,  40  Ohio  St.  217). 

These  additional  qualifying  words  first  quoted  have  been  interpreted 
in  two  different  ways  : 

(a)  By  some  it  is  held  that  all  acts  of  self-destruction  not  accidental 
were  included  in  the  proviso.  In  the  case  of  De  Gorgoza  vs.  Life  Insur- 
ance Co.,  Go  N.  Y.  232,  the  restricting  clause  was  ''die  by  his  own  hand,. 
sane  or  insane,"  and  it  was  held  as  follows :  "  I  shall  assume  that  the  jury 
found  that  when  the  hand  of  the  assured  delivered  the  fatal  shot  he  was 
wholly  bereft  of  reason.  ...  If  the  words  mean  anything,  it  is  just  what 
they  commonly  import,  and  that  is,  if  death  ensues  from  any  physical 
movement  of  the  hand  or  body  of  the  assured,  proceeding  from  a  partial 
or  total  eclipse  of  the  mind,  the  insurer  goes  free.  .  .  .  We  are  of  the 
opinion  that,  in  the  common  judgment  of  mankind,  it  will  be  consid- 
ered that  when  a  totally  insane  man  blows  his  brains  out  with  a  pistol 
he  will  be  said  to  have  died  by  his  own  hand  within  the  meaning  of  a 
policy  such  as  we  have  now  under  consideration."  In  this  case  the  deci- 
sion was  rendered  by  three  out  of  five  judges.  In  the  case  of  Riley  vs. 
Insurance  Co.,  25  Fed.  Rep.  315,  the  restricting  clause  was  "  self-destruc- 
tion, felonious  or  otherwise,"  and  it  was  held  that,  no  matter  under  what 
circumstances  he  killed  himself,  no  recovery  could  be  had  under  the  pol- 
icy, but  of  course  that  did  not  mean  accidental  death.  In  the  case  of 
Scarth  vs.  Insurance  Co.,  75  Iowa  346,  the  clause  was  "  suicide,  felonious- 
or  otherwise,  sane  or  insane."  This  was  held  to  cover  "  all  suicidal  acts, 
whether  such  as  are  denominated  criminal,  or  such  as  are  the  offspring 
of  insanity,"  and  a  very  similar  view  was  held  in  the  case  of  Salentine  vs. 
Insurance  Co.,  24  Fed.  Rep.  159. 

(b)  In  the  other  set  of  cases  the  additional  restrictions  are  considered 
apparently  to  cover  the  case  of  intentional  suicide,  but  not  if  the  indi- 
vidual is  unconscious  of  the  physical  nature  of  his  act  and  its  results, 
nor  perhaps  if  he  is  acting  under  an  irresistible  impidse.  Thus  in  Pierce 
vs.  Insurance  Co.,  34  Wis.  389,  the  restricting  clause  was  "die  by  suicide, 
felonious  or  otherwise,  sane  or  insane,"  and  it  was  held :  "  The  condition 
here  relieves  the  company  from  liability  only  where  the  self-destruction 
was  intentional,  or  committed  by  a  party  who  was  conscious  of  the  nature 
of  the  act  he  was  committing,  or  about  to  commit,  and  conscious  of  its- 
direct  and  immediate  consequences,  though  the  act  may  have  been  unac- 
companied by  any  criminal  or  felonious  intent  or  purpose."  Similar  lan- 
guage, though  not  quite  as  explicit,  was  used  in  Bigelow  vs.  Insurance 
Co.,  93  U.  S.  284,  and  Streeter  vs.  Insurance  Society,  65* Mich.  199.  In  the 
case  of  De  Gorgoza  vs.  Insurance  Co.  two  judges  dissented  from  the  pre- 
vailing opinion  and  held  views  similar  to  the  above. 

8.  In  spite  of  all  restricting  words  and  provisos,  there  has  been  found 
a  way  to  get  around  the  exception  in  some  cases,  and  that  has  been  by 
the  expedient  of  calling  the  suicide  an  accident.  Generally  speaking,  that 
is  a  question  of  fact,  and  as  such  is  presented  to  the  jury  for  its  consid- 
eration. And  there  hardly  exists  a  jury  which  will  hesitate  in  a  choice 
between  suicide  and  accident  as  the  cause  of  death  of  one  of  their  neigh- 


THE  MEDICAL  JURISPRUDENCE   OF  LIFE  INSURANCE.  581 

bors.  The  good  old  principle,  de  mortuis  nil  nisi  bonum,  will  allow  but 
one  conclusion. 

Of  course,  if  the  facts  are  susceptible  of  two  explanations,  the  natural, 
legal,  and  judicial  presumption  is  that  a  case  is  one  of  accident  rather 
than  of  suicide.  Thus,  in  Mallory  vs.  Insurance  Co.,  55  N.  Y.  52,  it  was 
held  that :  "  Death  was  caused  by  such  an  injury  or  the  suicidal  act  of 
the  deceased ;  but  the  presumption  is  against  the  latter.  It  is  contrary 
to  the  general  conduct  of  mankind ;  it  shows  gross  moral  turpitude  in  a 
sane  person."  Similarly,  in  the  case  of  Insurance  Co.  vs.Delpeuch,  82  Pa. 
St.  225,  it  was  held  that :  "  The  party  alleging  suicide  must  prove  it.  The 
mere  fact  of  death  in  an  unknown  manner  creates  no  legal  presumption 
of  suicide.  Upon  evenly  balanced  testimony  the  law  assumes  innocence 
rather  than  crime.  Preponderating  evidence  is  necessary  to  establish 
the  latter." 

The  following  cases  show  the  present  method  of  avoiding  this  issue. 
In  the  case  of  Keels  vs.  Fund  Association,  29  Fed.  Rep.  198,  the  insured 
had  been  suffering  for  some  months  from  mental  aberration  due  to 
softening  of  the  brain.  One  afternoon  his,  body  was  found  in  a  past- 
ure, near  a  fence  from  which  he  had  apparently  fallen,  with  a  bullet-hole 
in  his  head  and  a  pistol  in  his  hand.  The  restricting  proviso  avoided 
the  policy  in  case  of  "  death  by  his  own  hand,  sane  or  insane,  voluntary 
or  involuntary."  The  jury  found  for  the  plaintiff,  on  the  ground  that  it 
was  an  accident.  On  appeal  it  was  held :  "  Accidental  or  unintentional 
self-killing  is  not  within  a  condition  forfeiting  a  policy  for  suicide  or 
taking  one's  own  life,  whether  such  death  results  from  taking  poison  by 
mistake,  supposing  it  a  wholesome  medicine,  or  from  an  act  done  in 
frenzy  or  delirium,  as  by  leaping  from  a  window,  tearing  off  a  bandage 
from  an  artery,  or  from  an  act  done  under  the  stress  of  an  overpowering 
force.  ...  If  it  were  intended  by  this  policy  to  include  death  by  acci- 
dent, it  was  easy  enough  to  say  so."  Of  course  tins  ruling  sounds  and 
reads  very  nicely,  and  one  might  imagine  from  it  that  a  cruel,  grasping 
corporation  was  trying  to  defraud  the  beneficiary  out  of  her  lights  on  a 
mere  technicality.  But  it  appears  that  in  the  proofs  of  death  which  the 
beneficiary  submitted  to  the  company  she  declared,  over  her  own  signa- 
ture, that  her  husband's  death  was  due  to  suicide,  superinduced  by  de- 
mentia. Also  this  was  the  verdict  of  the  coroner's  jury,  which  was  pre- 
sumably held  within  a  short  time  after  the  death,  and  therefore  while 
the  circumstances  were  fresh  and  capable  of  accurate  consideration. 
When  one  regards  these  facts  there  is  but  little  justice  in  the  decision, 
however  correct  it  may  have  been  legally. 

In  the  case  of  Pit  Mips  vs.  Life  Insurance  Co.,  21  Am.  Eep.  549,  it  was 
held  that  if  the  defendant  was  insane  when  lie  committed  the  act  of  self- 
destruction,  no  responsibility  could  be  attached  to  his  act.  But  it  was 
also  held  that  there  was  a  reasonable  doubt  as  to  the  proof  of  his  having 
committed  suicide.  The  facts  were,  that  he  retired  to  bed,  and  about 
1  o'clock  a.m.  a  pistol  shot  was  heard.  The  inmates  of  the  house  rushed 
in  and  found  he  was  shot  in  the  mouth  and  a  pistol  was  lying  on  the 
floor  near  by.  It  was  considered  possible  that  an  enemy  might  have 
shot  him  or  that  he  might  have  done  it  accidentally.  The  burden  of 
proof,  of  course,  was  on  the  insurers. 

9.  Our  own  view  can  be  summed  up  in  a  few  words.  We  do  not  think 
that  the  ordinary  rules  of  criminal  responsibility  which  are  applied  to  the 


582  A   SYSTEM  OF  LEGAL  MEDICINE. 

insane  should  be  considered  adequate  in  these  cases.  The  contract  is  a 
definite  one,  and  it  is  never  assumed  that  the  individual,  when  he  signed 
it,  was  anything  but  perfectly  sane.  What  other  contracts  are  avoided 
under  similar  circumstances  ?  He  assumed  this  contract  knowingly  and 
intelligently.  It  was  understood  by  him  that  there  was  a  proviso  in  it 
that  the  policy  should  be  forfeited  if  he  died  by  his  own  hand.  It  was 
reasonable  for  him  and  for  any  one  else  to  suppose  that  this  did  not  in- 
clude death  by  accident  under  airy  circumstances.  The  only  question 
left,  then,  is  to  construe  what  the  term  "  accident"  means.  When  an  act 
is  done  involuntarily  and  unintentionally,  or  by  an  individual  who  is  not 
able  to  form  an  idea  of  the  physical  sequence  of  cause  and  effect  with 
reference  to  this  particular  act,  such  an  act  could  well  be  included  under 
the  term  "accident." 

In  the  language  of  the  Supreme  Court  of  Massachusetts,  "  If  the  death 
be  by  accident,  by  superior  and  overwhelming  force,  in  the  madness  of 
delirium,  or  under  any  combination  of  circumstances  from  which  it  may 
be  fairly  inferred  that  the  act  of  self-destruction  was  not  the  result  of 
the  will  or  intention  of  the  party  adapting  means  to  the  ends,  and  con- 
templating the  physical  nature  and  effects  of  the  act,  then  it  may  be 
justly  held  to  be  a  loss  not  excepted  within  the  meaning  of  the  proviso." 

But  it  is  said  that  an  insane  delusion  or  an  irresistible  impulse  may 
be  so  marked  as  to  preponderate  over  the  rest  of  the  intellect,  so  that 
the  subject  is  no  longer  responsible  for  his  acts.  That  is  true,  but  if  it 
leave  him  with  sufficient  intelligence  to  adapt  means  to  ends  and  to  know 
the  result  of  a  contemplated  act,  such  a  grade  of  irresponsibility  certainly 
should  not  abrogate  this  contract,  made  in  good  faith  while  he  was  per- 
fectly sane,  and  set  up  in  its  stead  another  contract  of  very  different  im- 
port. If  the  delusion  or  impulse  is  so  marked  that  he  no  longer  under- 
stands the  physical  nature  of  the  act,  then  it  might  be  called  an  accident, 
and  as  such  would  not  be  included  within  the  proviso. 


ACCIDENT  INSURANCE  AND  BENEFIT  ASSOCIATIONS 

BY 

CORTLANDT  F.  BISHOP,  Ph.D. 


In  a  treatise  on  medical  jurisprudence  it  is  necessary  to  consider  but 
one  branch  of  accident  insurance,  namely,  that  relating  to  the  insurance 
of  human  beings  against  casualty.  From  this  point  of  view  accident 
insurance  is  really  a  branch  of  life  insurance,  and  is  therefore  to  a  cer- 
tain extent  governed  by  the  same  rides.  The  ordinary  life  policy  grants 
relief  in  case  of  death,  however  caused,  or  in  the  event  of  the  assured's 
reaching  a  certain  age.  Accident  insurance,  on  the  other  hand,  provides 
against  loss  arising  from  death  or  disability  caused  by  violent  and  ex- 
ternal means  rather  than  by  disease,  the  latter  being  particularly  the 
province  of  insurance  by  beneficial  societies. 

The  first  question  that  presents  itself  is  one  of  definition.  What  is 
an  accident  ?  The  Supreme  Court  of  Pennsylvania  has  declared  that  it 
is  "  an  event  that  takes  place  without  one's  foresight  or  expectation,  an 
event  which  proceeds  from  an  unknown  cause,  or  is  an  unusual  effect  of 
a  known  cause  and  therefore  not  expected."  (North  American  Life  and 
Accident  Company  vs.  Burroughs,  G9  Pennsylvania  State,  43.)  It  will  be 
noted  that  the  word  is  used  in  its  popular  sense,  the  element  of  the  un- 
foreseen being  always  present. 

A  contract  of  accident  insurance  is  not  one  of  indemnity,  for  a  per- 
son cannot  be  indemnified  for  the  loss  of  life  or  limb  as  he  can  for  the 
loss  of  a  house  or  ship.  The  allowance  for  disabling  injuries,  though 
usually  so  called,  is  not  really  an  indemnity,  for  in  most  policies  it  is 
limited  to  a  certain  fixed  sum  per  week,  always  less  than  the  wages  or 
income  of  the  assured.  In  one  of  the  few  known  cases  of  accident 
insurance  in  the  form  of  an  indemnity  contract,  the  Court  of  the  Ex- 
chequer held  that  the  insurer  was  bound  to  indemnify  the  assured  for 
the  costs  of  medical  attendance  and  expenses  to  which  he  was  put  by  the 
accident,  and  not  for  loss  of  time  or  profits.  (Theobold  vs.  Railway  Pas- 
senger's, etc.,  Company,  10  Exchequer,  45.)  The  modern  form  of  policy  is 
more  convenient  in  that  it  does  away  with  the  necessity  of  going  into 
the  assured's  private  affairs. 

The  applicant  for  accident  insurance  is  seldom,  if  ever,  required  to 
submit  to  a  medical  examination.  His  application  is  based  on  a  warranty 
of  the  truth  of  certain  facts  concerning  his  condition.  Among  these  are 
physical  and  mental  soundness,  correct  and  temperate  habits,  and  entire 
freedom  from  fits  or  disorders  of  the  brain.  It  is  frequently  stipulated 
that  any  medical  adviser  of  the  insurer  shall  be  permitted  as  often  as 

583 


5S4  A   SYSTEM  OF  LEGAL  MEDICINE. 

required  to  examine  the  person  or  body  of  the  insured  in  respect  to- 
alleged  injury  or  cause  of  death. 

In  addition  to  answering  inquiries  regarding  other  insurance,  the 
applicant  is  obliged  to  state  that  he  has  no  special  journey  or  hazardous 
undertaking  in  contemplation.  The  companies  are  in  the  habit  of  divid- 
ing occupations  into  classes,  each  of  which  is  insured  at  a  given  rate  in 
proportion  to  the  hazard.  The  policy  is  not  avoided  in  case  of  a  change 
of  occupation,  but  the  insured  agrees  that  if  injured  while  engaged  in 
work  classed  as  more  hazardous,  he  shall  be  entitled  to  recover  only  such 
an  amount  as  the  premium  paid  by  him  would  purchase  at  the  rates 
fixed  for  such  increased  hazard.  {Standard  Life  and  Accident  Insurance 
Company  vs.  Martin,  33  Northeastern,  105.)  As  in  the  case  of  life  poli- 
cies, the  applicant  may  designate  a  beneficiary  to  take  in  case  of  death. 
Some  accident  companies  will  only  insure  persons  between  the  ages  of 
eighteen  and  seventy,  and  refuse  to  insure  women  of  any  age  or  men 
of  sixty-five  or  more  against  anything  but  death.  Other  companies 
refuse  to  deal  with  cripples,  deaf,  dumb,  or  blind  persons,  or  those  who 
are  reckless  or  without  visible  means  of  support. 

Accident  policies  resemble  marine  policies  in  that  they  may  be  for  a 
time  or  for  a  particular  voyage.  Voyage  policies  may  or  may  not  be 
limited  in  point  of  time,  but  are  always  made  to  cover  a  prescribed  jour- 
ney, and  deviation  is  not  permissible.  In  recent  years,  examples  of  acci- 
dent insurance  on  a  large  scale  have  presented  themselves.  In  consider- 
ation of  a  premium  the  insurer  agrees  to  insure  a  railroad  company,  for 
example,  against  claims  arising  from  personal  injuries  received  by  its 
passengers  (South  Staffordshire  Tramways  vs.  Sichiess  and  Accident  Asso- 
ciation  (1891),  1  Queen's  Bench,  402),  or  an  employer  against  claims  aris- 
ing under  the  Employer's  Liability  Act.  Such  insurance  is  not  regarded 
as  opposed  to  public  policy,  and  in  England  is  sanctioned  by  statute.  (44 
and  45  Victoria,  cap.  xli.) 

The  word  "accident"  is  so  broad  in  its  meaning  that  the  companies 
have  sought  to  limit  its  scope  by  inserting  in  their  policies  numerous 
exceptions,  and  it  is  the  construction  of  general  restrictive  clauses  that 
makes  up  the  greater  portion  of  the  case  law  of  the  subject.  So  much 
depends  upon  the  particular  phraseology  employed  that  it  is  a  difficult 
matter  to  formulate  any  general  rules.  It  may  be  said  generally  that  the 
burden  of  bringing  the  accident  within  one  of  the  exceptions  rests  on  the 
insurer.  (Badenfield  vs.  Massachusetts  Mutual  Accident  Association,  154 
Massachusetts,  77.)  A  policy  covering  accidents  caused  by  "external" 
means  was  lately  construed  by  the  Court  of  Appeal  in  England.  The 
assured  stooped  to  pick  up  a  marble,  and  in  so  doing  dislocated  the  car- 
tilage of  his  knee.  He  had  never  had  any  weakness  in  that  limb,  and 
the  court  held  that  the  word  "  external "  was  used  in  contradistinction 
to  an  internal  cause,  such  as  disease,  and  that  therefore  the  injured  per- 
son could  recover.  (Hamhjn  vs.  The  Crown  Accidental  Insurance  Com- 
pany, Limited  (1893),  1  Queen's  Bench,  750.) 

In  1892  a  curious  case  arose  in  London.  The  defendants  offered  one 
hundred  pounds  to  any  one  who  contracted  influenza  after  taking  a  cer- 
tain patent  medicine.  The  plaintiff  took  the  medicine  according  to  direc- 
tions, but,  nevertheless,  caught  influenza.  He  sued  for  the  reward,  and 
one  of  the  defenses  set  up  was  that  it  was  a  contract  of  accident  insur- 
ance, and  therefore  unenforceable  because  not  in  the  statutory  form. 


ACCIDENT  INSURANCE  AND  BENEFIT  ASSOCIATIONS.  585 

But  the  court  overruled  the  objection.  (Carlitt  vs.  Carbolic  Smoke  Ball 
Company  (1892),  2  Queen's  Bench,  484.) 

An  accident  policy  does  not  usually  cover  death  resulting  from  dis- 
ease, and  it  therefore  frequently  becomes  of  importance  to  determine 
what  was  the  cause  of  the  loss  complained  of.  A  recent  case  on  this 
point  is  Bacon  vs.  United  States  Mutual  Accident  Association  (123  New 
York,  304).  The  assured  died  of  malignant  pustule,  which  the  expert 
medical  witnesses  refused  to  characterize  as  a  disease.  They,  however, 
admitted  that  it  was  a  "  pathological  condition."  The  lower  court  ruled 
that  the  deceased  came  to  his  death  by  accident,  but  the  Court  of  Appeals, 
by  a  divided  vote,  reversed  the  decision,  and  held  that  malignant  pustule 
was  a  disease. 

Sunstroke  is  not  an  accident,  but  a  disease.  (Sinclair  vs.  Maritime 
Passenger 's  Assurance  Company,  3  Ellis  &  Ellis,  478 ;  Bozier  vs.  Fidelity 
and  Casualty  Company,  46  Federal  Reporter,  446.)  Though  a  known 
consequence  of  undue  exposure  to  the  heat,  it  could  not  have  been  fore- 
seen, and  was  undoubtedly  caused  by  external  means,  which  is  the  defini- 
tion usually  given  in  contracts  of  accident  insurance.  The  English  court, 
however,  went  upon  the  ground  that  a  disease  produced  by  known  means- 
could  not  be  considered  as  accidental.  The  American  case  was  decided 
partly  on  precedent,  but  largely  on  the  authority  of  Niemeyer  and  Ober- 
nier,  who  classed  sunstroke  as  a  disease  of  the  brain,  and  held  that  the- 
rays  of  the  sun  were  not  essential  to  its  occurrence. 

If,  however,  the  disease  is  the  result  of  an  accident,  the  insurer  is 
held  liable.  So  a  death  from  peritonitis,  due  to  a  violent  blow  on  the 
stomach  (Worth  American  Life  and  Accident  Company  vs.  Burroughs,  69 
Pennsylvania  State,  43),  or  from  hernia  brought  on  by  an  accidental  fall 
(Fitten  vs.  Accidental  Death  Insurance  Company,  17  Common  Bench,  New 
Series,  122 ;  Traveler's  Insurance  Company  vs.  Murray,  16  Colorado,  296), 
is  covered  by  an  accident  policy.  The  question  is  one  of  proximate 
cause,  and  is  often  of  considerable  nicety.  Thus  a  death  from  erysipelas- 
brought  about  from  a  wound  by  a  cut  was  considered  the  result  of  the 
disease  rather  than  of  the  wound.  (Smith  vs.  Accident  Insurance  Company, 
Law  Reports,  5  Exchequer,  302.  See  also  Young  vs.  Accident  Insurance 
Company  of  Worth  America,  6  Law  Reports,  Superior  Court,  Montreal,  3.) 
Porter,  in  his  work  on  Insurance  (second  edition,  p.  457),  cites  two  Eng- 
lish cases  on  this  subject  which  are  difficult  to  reconcile.  In  the  one,, 
gangrene  from  a  cut  was  held  to  be  an  accident ;  and  in  the  other,  death 
by  dislodgment  of  a  gall-stone,  the  result  of  a  fall,  was  held  not  a  death 
by  accident.  In  a  recent  New  York  case,  the  insured  died  of  blood-poi- 
soning, following  upon  a  wound  in  his  right  hand.  Some  time  previ- 
ously he  had  injured  his  other  hand,  and  it  was  an  open  question  whether 
or  no  the  pus  from  the  first  wound  had  entered  the  second  and  caused 
the  poisoning.  The  death  being  charged  to  the  second  wound,  the  court 
held  that  it  was  for  the  jury  to  determine  whether  or  no  death  was  due 
to  the  accident.     (Martin  vs.  Equitable  Accident  Association,  61  Hun,  467.) 

Several  cases  have  arisen  in  which  a  fit  cooperated  to  produce  the  death 
of  the  assured,  and  yet  his  representative  was  allowed  to  recover  under 
a  policy  in  which  a  fit  was  an  excepted  cause.  In  three  instances  the  de- 
ceased fell  into  a  pool  of  water  and  was  drowned.  (Reynolds  vs.  Accident 
Insurance  Company,  22  Law  Times,  N.  S.,  820;  Winspear  vs.  Accident  In- 
surance Company,  6  Queen's  Bench  Division,  42;  Tennant  vs.  Iran  la's 


586  A   SYSTEM  OF  LEGAL  MEDICINE. 

Insurance  Company,  31  Federal  Reporter,  322.)  In  another  case  the  in- 
sured was  seized  with  a  fit  while  standing  on  the  platform  of  a  railway 
station.  He  fell  on  the  track  as  a  train  was  approaching-,  and  was  killed. 
{Laurence  vs.  Accident  Insurance  Company,!  Queen's  Bench  Division,  216.) 
The  ground  for  these  decisions  seems  logical,  for  the  deaths  were  not  the 
necessary  results  of  the  fits,  but  were  caused  by  an  accident,  i.e.,  the  way 
in  which  the  deceased  fell.  It  has  been  intimated  that  the  rupture  of  a 
blood-vessel  while  using  Indian  clubs  is  not  an  accident  unless  some  un- 
foreseen and  involuntary  movement  of  the  body  occurred.  If  the  death 
were  caused  by  inflammation  of  the  lungs  consequent  upon  such  rupture, 
an  accident  policy  would  cover  the  loss.  (McCarthy  vs.  Traveler's  Insur- 
ance Company,  8  Bissell,  362.) 

The  insurer  is  generally  not  liable  when  a  supervening  disease  aggra- 
vates the  original  injury  and  produces  death.  On  the  other  hand,  when 
the  insured  died  from  pneumonia,  which  he  contracted  while  in  a  weak- 
ened condition  from  an  injury  to  his  shoulder,  it  was  held  that  as  disease 
and  subsequent  death  could  not  have  occurred  but  for  the  accident,  the 
insurer  was  liable.  (Isitt  vs.  Railway  Passenger's  Assurance  Company,  22 
Queen's  Bench  Division,  504.)  This  distinction,  though  apparently  well 
founded,  may  be  difficult  in  its  practical  application. 

Death  from  drowning,  even  when  in  bathing,  is  an  accident  (Knicker- 
bocker Casualty  Insurance  Company  vs.  Jordan,  11  Insurance  Law  Jour- 
nal, 475),  and  so  is  death  from  asphyxiation,  whether  by  natural  (Pickett 
vs.  Pacific  Mutual  Life  Insurance  Company,  144  Pennsylvania  State,  79) 
or  by  illuminating  gas.  (Paul  vs.  Traveler's  Insurance  Company,  112 
New  York,  472.  In  this  case  the  Court  of  Appeals  made  a  distinction 
between  breathing  gas  involuntarily  and  inhaling  gas,  the  latter  being 
excepted  by  a  clause  in  the  policy.)  Death  from  a  pistol-shot  fired  by 
another  person  is  an  accidental  death,  even  if  the  shooting  is  intentional. 
(Supreme  Council,  Order  of  Chosen  Friends  vs.  Garrigus,  104  Indiana,  133.) 
But  as  a  matter  of  fact,  accidents  arising  from  intentional  injuries, 
whether  caused  by  the  insured  or  by  another  person,  are  excepted  in  the 
policies  of  many  companies.  Other  customary  exceptions  are  injuries 
happening  while  under  or  through  medical  and  surgical  treatment  (except 
amputations  necessitated  solely  by  injuries,  and  made  within  a  certain 
period  after  the  accident),  and  while  under  the  influence  of  intoxicating 
liquors  or  narcotics. 

In  construing  exceptions  with  regard  to  poison,  the  courts  have  been 
very  strict,  attributing  to  the  word  its  popular  conception.  Accordingly, 
malignant  pustule  caused  by  contact  with  the  flesh  of  a  putrid  animal 
was  not  poison  within  such  a  clause.  (Bacon  vs.  United  States  Mutual  Ac- 
cident Association,  44  Hun,  599 ;  123  New  York,  304.)  But  poison  taken 
by  mistake  for  medicine  (Cole  vs.  Accident  Insurance  Company,  61  Law 
Times  Reports,  227)  is  within  the  clause.  An  accidental  overdose  of 
opium,  a  proper  dose  having  been  prescribed,  will  prevent  recovery 
under  a  clause  excepting  death  caused  wholly  or  in  part  by  medical 
treatment.  (Bayless  vs.  Traveler's  Insurance  Company,  14  Blatchford, 
143.)  On  the  other  hand,  in  case  the  exception  is  to  operate,  if  the  in- 
sured "  die  by  his  own  hand  or  act,  voluntary  or  otherwise,"  it  is  held 
that  death  from  an  overdose  of  medicine  will  not  avoid  the  policy,  as  the 
clause  is  evidently  intended  to  cover  suicidal  self-destruction.  (Penfold 
vs.  Universal  Life'  Company,  85  New  York,  317.) 


ACCIDENT  INSURANCE  AND  BENEFIT  ASSOCIATIONS.  537 

Some  policies  stipulate  that  the  injury  shall  not  be  one  of  which 
there  is  no  external  or  visible  sign.  The  courts  are  not  apt  to  favor 
such  clauses,  perhaps  because  they  are  an  attempt  to  construe  the  laws 
of  evidence.  Accordingly,  a  late  New  York  case  decided  that  an  injury 
to  the  diaphragm  and  contiguous  muscles  which  was  not  visible  to  the 
eye,  but  could  only  be  ascertained  by  applying  the  hand  to  the  exterior 
of  the  body,  was  not  within  the  proviso.  (Gale  vs.  Mutual  Aid  and  Acci- 
dent Association,  66  Hun,  600  (1893).)  When  the  deceased  was  found 
dead  in  bed  with  the  gas  turned  on,  the  court  held  the  company  liable 
on  a  similar  policy,  though  there  was  no  visible  or  external  sign  on  his 
body.  The  ground  of  the  decision  was  that  the  clause  applied  only  to 
an  accident  not  causing  death.  (Paul  vs.  Traveler's  Insurance  Company, 
112  New  York,  472.)  Soreness  is  not  a  visible  sign,  and  in  a  case  where 
the  body  was  covered  with  red  spots  and  there  was  bloody  froth  at  the 
mouth,  the  question  was  left  to  the  jury.  (United  States  Mutual  Accident 
Association  vs.  Newman,  84  Virginia,  52.) 

Generally  an  accident  policy  will  cover  injuries  resulting  from  the 
negligence  of  the  assured.  Nice  questions  often  arise  when  the  policy 
excepts  such  injuries.  Thus,  when  the  assured,  after  he  had  seen  two 
men  jump  safely  five  feet  from  a  platform  to  the  ground,  followed  their 
example,  and  received  a  stricture  of  the  duodenum  resulting  in  death,  it 
was  held  a  question  for  the  jury  as  to  whether  there  was  an  accident. 
(Association  vs.  Barry,  131  United  States,  100.)  "Voluntary  exposure  to 
unnecessary  danger"  is  a  common  clause;  and  "walking  or  being  on  a 
railroad  track  or  bridge "  are  also  often  forbidden.  But  getting  on  a 
slowly  moving  train  is  not  within  the  first  clause  (Schneider  vs.  Provident 
Life  Insurance  Company,  24  Wisconsin,  28),  and  it  would  seem  that  cross- 
ing: a  railroad  track  to  reach  a  railroad  station  is  not  necessarily  within 
the  prohibition  of  that  last  mentioned.  (Duncan  vs.  Preferred  Mutual 
Accident  Association  of  New  York,  59  New  York  Superior  Court  Reports, 
145.)  Injuries  resulting  from  a  violation  of  law  are  also  frequent  excep- 
tions. Thus,  an  accident  from  slipping  upon  frozen  ground  while  re- 
turning from  hunting  on  Sunday  (Duran  vs.  Standard  Life  and  Accident 
Insurance  Company,  20  Insurance  Law  Journal,  1035,  Vt.),  or  while  en- 
gaged in  a  horse-race  (Insurance  Company  vs.  Seaeer,  19  Wallace,  531), 
both  acts  being  illegal  by  statute,  discharged  the  insurers. 

Some  policies  only  cover  accidents  while  traveling  by  public  or  pri- 
vate conveyance.  It  has  been  held  that  such  a  policy  covers  an  accident 
caused  by  walking  from  a  steamboat  while  en  route  to  a  train,  even 
though  the  assured  could  have  ridden  in  a  hack.  (Northrup  vs.  Railway 
Passenger's  Assurance  Company,  43  New  York,  516.)  Generally  speaking, 
however,  walking  is  not  traveling  in  the  manner  indicated.  (Ripley  vs. 
Insurance  Company,  16  Wallace,  336.) 

The  so-called  indemnity  is  usually  given  in  case  the  assured  is  "  wholly 
disabled."  Usually  this  would  mean  disability  from  performing  one's 
usual  vocation,  and  not  a  total  disability  for  any  kind  of  labor.  (Hooper 
vs.  Accidental  Death  Insurance  Company,  5  Hurlstone  &  Norman,  546.) 
The  loss  of  one's  fingers  or  hand  does  not  ordinarily  constitute  total 
disability.  (Hutchinson  vs.  The  Supreme  Tent  of  the  Knights  of  the  Mac- 
cabees of  the  World,  68  Hun,  355.) 

Throughout  the  United  States  and  England  there  exist  a  vast  num- 
ber of  beneficial  societies  engaged  in  the  business  of  insurance  against 


588  A   SYSTEM  OF  LEGAL  MEDICINE. 

death,  accident,  or  sickness.  These  associations  are  really  insurance  com- 
panies  on  a  cooperative  plan  without  shareholders,  the  insured  and  in- 
surer being  members  of  the  same  organization,  and  each  member  being 
an  insurer  of  all  his  associates.  A  loss  on  the  part  of  one  member  is 
paid  by  means  of  an  assessment  upon  the  others,  the  purpose  of  such 
societies  being  benevolent,  and  not  the  earning  of  a  profit.  Generally 
speaking,  insurance  by  these  societies  is  governed  by  the  same  rules 
as  the  business  of  the  regular  stock  companies,  and  in  the  absence  of 
special  provisions  the  courts  hold  that  it  is  subject  to  the  same  statutory 
regulations.  (See  Biddle  on  Insurance,  §  67.)  A  certificate  of  member- 
ship in  such  an  association  is  virtually  a  policy,  and  the  constitution  and 
by-laws  are  always  a  part  of  the  contract  of  insurance.  The  tendency 
of  the  courts  is  to  limit  benevolent  societies  strictly  to  the  classes  of 
beneficiaries  designated  in  their  charters,  and  any  insurance  for  the 
benefit  of  persons  not  of  those  classes  is  void.  (Biddle  on  Insurance, 
§  GO.)  Whenever  a  particular  method  of  nominating  and  appointing  ben- 
eficiaries has  been  adopted,  it  is  held  to  exclude  all  others,  and  a  person 
improperly  designated  cannot  take  the  benefit  of  the  insurance.  (Biddle 
on  Insurance,  §§  135,  137.) 

Insurance  by  beneficial  societies  is  now  generally  regulated  by  special 
statutes  (for  the  English  law,  see  the  elaborate  Friendly  Societies  Act,  38 
and  39  Victoria,  cap.  lx.),  and  the  recently  adopted  "Insurance  Law"  of 
the  State  of  New  York  may  be  taken  as  an  example  of  the  most  advanced 
thought  upon  this  subject.  "Fraternal  Beneficiary  Societies,  Orders,  or 
Associations "  is  the  caption  of  the  seventh  article  of  "  The  Insurance 
Law."  (Laws  1892,  chapter  690 ;  chapter  38,  General  Laws.)  It  is  pro- 
vided that  nine  or  more  persons  may  become  a  corporation  for  relief  by 
insurance  upon  the  mutual  or  assessment  plan  of  members  or  benefi- 
ciaries in  the  case  of  sickness,  disability,  or  death.  A  certificate  must 
be  filed  with  the  superintendent  of  insurance,  and  accompanied  by  the 
sworn  statement  of  at  least  three  subscribers,  to  the  effect  that  two  hun- 
dred eligible  persons  have,  bona  fide,  made  written  application  for  mem- 
bership. These  two  hundred  persons  must  subscribe  an  aggregate 
amount  of  $400,000,  and  pay  m  cash  one  full  assessment  amounting  to 
at  least  one  percent,  of  their  subscriptions.  Foreign  corporations  can- 
not do  business  in  the  State  until  they  have  filed  similar  papers.  When 
these  requirements  have  been  complied  with,  a  license  is  issued  by  the 
superintendent  of  insurance,  and  the  association  can  begin  business. 
(Ibid.,  §§  230-232  inclusive.) 

With  three  exceptions,  all  beneficiary  societies,  whether  voluntary  or 
incorporated,  doing  any  business  authorized  by  this  article,  i.e.,  busi- 
ness not  for  profit  or  for  gain,  and  the  members  of  which  are  proposed, 
elected,  and  initiated  in  subordinate  lodges,  councils,  or  similar  bodies 
according  to  prescribed  rites  and  ceremonies,  are  declared  to  be  mutual 
benefit  fraternities,  and  exempt  from  the  other  insurance  lawrs  of  the 
State.  (Ibid.,  §§  233,  239.)  Each  society  may  adopt  a  constitution  or 
by-laws,  not  inconsistent  with  the  statutes  of  the  State.     (Ibid.,  §  234.) 

A  benefit  association  may  make  such  agreements  as  it  pleases  with  its 
members  for  the  payment  of  benefits,  although  a  member  is  permitted 
to  change  his  beneficiary  at  any  time  without  the  latter's  consent,  It  is, 
however,  forbidden  to  issue  certificates  for  the  payment  of  a  greater  sum 
of  money  than  could  be  raised  by  one  assessment  upon  all  the  members, 


ACCIDENT  INSURANCE  AND  BENEFIT  ASSOCIATIONS.  589 

or  for  the  payment  of  a  gross  sum  upon  the  expiration  of  a  fixed  period 
of  less  than  five  years.  The  reason  for  every  assessment,  as  well  as  the 
precise  amount  thereof  to  be  used  for  the  payment  of  other  than  bene- 
ficiary claims,  must  be  truthfully  stated  in  the  notices.  Benefit  societies 
are  permitted  to  distribute  their  revenues  in  accordance  with  their  con- 
stitutions so  long  as  no  money  collected  for  the  payment  of  beneficiary 
claims  is  otherwise  appropriated.  All  moneys  or  other  benefits  to  be 
paid  by  these  societies  are  exempt  from  execution  or  from  seizure  by 
process,  either  legal  or  equitable,  for  the  purpose  of  paying  a  debt  or 
liability  of  any  member  or  beneficiary.  (Ibid.,  §§  235,  236,  238.)  All 
benefit  associations  are  required  to  make  detailed  annual  reports,  and 
.are,  in  fact,  closely  under  the  supervision  of  the  superintendent  of  insur- 
ance. Their  books  and  papers  are  at  all  times  open  to  the  inspection  of 
State  officers,  and  they  are  liable  to  a  fine  in  case  they  neglect  or  fail  to 
perform  a  duty  imposed  by  law.  The  superintendent  is  also  empowered 
to  revoke  the  license  of  any  society  which  conducts  its  business  improp- 
erly, and  the  attorney-general  is  authorized  to  proceed  at  once  against  a 
■delinquent  association.     (Ibid.,  §§  232,  237.) 


THE   OBLIGATION  OF  THE  INSURED  AND  THE 

INSURER. 

BY 

R.   C.    McMURTRIE,    Esq. 


With  regard  to  the  relations  of  the  medical  profession  to  life  insur- 
ance, they  occur  in  the  formation  of  the  contract  and  in  the  inquiry  into 
causes  of  death. 

1.  As  the  contract  is  based  on  the  average  duration  of  human  life, 
the  known  conditions  that  tend  to  shorten  it  are  essential  in  forming  a 
judgment  as  to  the  probability  of  the  particular  life  that  is  to  be  insured 
coming  up  to  the  avei-age  or  falling  short. 

These  facts  cannot  practically  be  obtained  from  any  one  but  the  ap- 
plicant or  person  whose  life  is  to  be  insured,  i.e.,  on  the  termination  of 
whose  life  a  payment  is  to  be  made.  The  facts  when  thus  ascertained 
are  made  the  subject  of  examination  by  medical  experts.  Accuracy  is 
essential,  as  it  is  in  all  cases  where  inferences  are  dependent  on  facts. 
But  the  limitation  of  accuracy  is  the  capacity  of  the  person  examined  to 
give  the  information.  This  the  insurer  takes  on  himself  unless  the  con- 
tract interferes.  The  insured,  on  the  other  hand,  takes  on  himself  the 
burden  of  answering  truthfully. 

Obviously  there  are  likely  to  occur  cases  where  the  answers  are  per- 
fectly truthful  and  yet  absolutely  untrue.  The  insured  assumes  this 
peril  where  the  contract  stipulates  for  accuracy  as  a  basis  of  contracting. 
The  person  inquired  of  may  have  forgotten  absolutely  or  temporarily  a 
most  important  fact,  or  he  may  have  been  misinformed  on  a  matter  which 
he  never  could  know  saving  b}r  information,  but  which  all  of  us  speak 
of  as  if  Ave  knew ;  e.g.,  our  age  and  the  ages  of  ancestors,  even  relation- 
ship and  parentage,  are  mere  matters  of  hearsay,  and  yet  are  always 
spoken  of  as  known  facts.  So  they  are  practically ;  but  it  is  evident 
that  if  they  prove  to  be  untrue  there  has  been  a  misrepresentation  in  an 
essential  fact  which  is  the  agreed  basis  of  the  contract.  But  this  depends 
on  the  contract. 

There  is,  then,  another  and  a  distinct  class  of  facts,  which  are  subject, 
however,  to  the  same  rule.  It  frequently  happens  that  a  fact  is  not 
supposed  to  be  material,  and  is  therefore  omitted. 

On  the  other  hand,  it  is  plain  that  as  the  insurer  is  the  questioner  and 
proposes  to  act  on  the  information  received,  he  must  so  frame  his  ques 
tions  that  men  must  be  able  to  comprehend  what  facts  they  include. 

Now  here  there  must  come  in  the  same  rule  that,  strangely  enough, 

591 


592  A   SYSTEM  OF  LEGAL  MEDICINE. 

seems  to  have  surprised  the  legal  profession  when  enunciated  in  Peel"  vs. 
Derri/,  14  Appeal,  337. 

Even  where  there  is  a  warranty  of  the  truth  of  the  answers,  this  rule 
must  be  applied  where  the  answer  is  literally  correct  but  is  liable  to  the 
charge  of  being  an  evasion.  The  insurer  is  entitled  to  a  truthful  answer ; 
but  whether  the  question  has  been  truthfully  answered  must  depend  on 
what  was  understood  by  the  question.  It  is  impossible  that  the  insured 
can  be  held  to  warrant  the  truth  of  the  answer  if  no  person  but  a  highly 
educated  expert  could  have  supposed  it  included  an  inquiry  as  to  a  par- 
ticular fact.  This  question  is  one  for  the  jury — the  answer  being  liter- 
ally accurate — Did  the  man  believe  what  he  said,  or  did  he  knowingly 
conceal  or  suppress  with  intent  to  deceive  by  evasion  ?  It  is  not  what 
somebody  else  thinks  he  ought  to  have  known  from  the  information  he 
had.  This  would  make  the  matter  turn  on  a  false  issue,  and  substitute 
the  comprehension  of  a  judge  or  jury  for  that  of  the  man  who  spoke, 
which  is  near  to  requiring  a  warranty  of  truth  irrespective  of  the  compre- 
hension of  the  question.  It  is  obviously  the  same  thing  as  what  occurred 
in  Peek  vs.  Berry.  The  question  was  whether  there  was  a  fraudulent 
and  deceitful  representation.  The  court  below  held  there  was  a  liability 
if  the  representation  was  founded  on  information  which  ought  not  to 
have  been  believedr  or  was  quite  insufficient  to  warrant  the  statement,  it 
being  such  as  no  prudent  man  would  have  acted  on.  The  court  subse- 
quently disclaimed  all  intention  to  assert  willful  and  conscious  false- 
hood. 

In  the  House  of  Lords  it  was  ruled,  and  it  is  now  the  settled  law  of 
England — till  it  shall  have  been  changed  by  act  of  Parliament — that 
while  the  frivolity  of  the  evidence  on  which  a  man  is  said  to  have  made 
a  representation  is  a  ground  for  refusing  belief  to  his  assertion  that  he 
did  rely  on  it,  still  there  can  be  no  action  for  deceit  unless  there  was  in- 
tentional or  conscious  falsehood.  It  is  difficult  to  resist  the  argument 
that  a  fraudulent  deceit  involves  moral  turpitude,  and  that  to  substitute 
another's  judgment  as  to  the  sufficiency  of  the  evidence  to  found  belief 
omits  the  essential  ingredient  of  the  charge.  Whether  this  will  be  ac- 
cepted in  this  country  or  the  old  formula  will  be  preferred,  however  in- 
accurate, is  of  course  an  open  question.  This  line  of  reasoning  emphat- 
ically applies  to  all  cases  of  inquiries  on  which  it  is  proposed  to  contract. 
If  converted  into  warranties,  as  they  are  when  recited  in  the  contract  or 
referred  to  as  a  basis  of  contracting,  no  doubt  the  fact  asserted  must  be 
literally  true;  but  whether  the  answers  are  also  truthful  answers  must 
depend  on  the  intention  of  the  speaker.  They  may  seem  to  be  evasive — 
especially  when  the  judgment  is  aided  by  competent  counsel — but  it  is 
evident  that  must  depend  on  the  capacity  of  the  speaker  to  comprehend 
the  purport  of  the  question,  not  on  the  capacity  of  a  jury  to  see  a  mean- 
ing when  aided  by  the  trained  dialectician. 

No  better  illustration  can  be  given  than  Huchnan  vs.  Fernie,  3  M.  and 
W.  505,  4  H.  and  H.  149,  where  the  question  was,  "  Who  was  the  usual 
medical  attendant  of  the  life  about  to  be  insured  ?"  That  person  had  been 
attended  for  many  years  by  a  physician  for  a  chronic  disorder.  Within 
a  short  time  that  physician  had  retired  from  practice  and  another  was 
employed  by  the  family,  but  who  had  seen  the  life  insured  only  in  refer- 
ence to  a  matter  of  no  moment.  In  reply  the  name  of  this  gentleman 
was  given.   It  is  quite  plain  that  to  any  one  who  comprehended  the  object 


THE   OBLIGATION  OF  THE  INSURED  AND   THE  INSURER.        593 

of  the  question  this  was  absolutely  false  while  literally  true,  and  so  it  was 
held  by  the  court  in  banc. 

It  may  be,  though,  that  all  these  distinctions  are  useless,  because  if 
there  is  a  question  for  the  jury  it  will  always  be  answered  in  one  way. 
There  is  no  doubt  about  the  fact  that  justice  is  very  unfairly  administered 
by  juries  if  we  mean  justice  according-  to  law,  and  there  can  be  no  other 
standard  in  a  court.  But  to  a  great  extent  the  courts  are  themselves  to 
blame  for  the  miscarriage.  If  they  would  compel  a  categorical  answer 
by  the  jury  to  the  crucial  question  of  fact,  there  would  be  much  less 
probability  of  a  false  verdict.  When  juries  are  permitted  to  render  a 
general  verdict  hypothetically  based  on  their  findings  of  certain  facts,  it 
is  much  more  likely  that  what  has  been  stated  as  a  condition  will  be 
overlooked  or  disregarded ;  that  when  they  are  asked  to  say,  "  Did  A  be- 
lieve that  statement  to  be  true,  or  did  he  intend  to  mislead  f "  it  may  be 
■doubted  whether  this  is  not  the  only  mode  in  which  an  ordinary  jury  can 
be  used  to  advantage. 

2.  The  medical  profession  is  also  intimately  connected  with  the  in- 
quiry into  the  causes  of  death.  They  are  necessarily  experts  in  the 
proper  inference  to  be  drawn  from  facts  ascertained  after  the  event  as  to 
the  condition  of  things  before  the  death.  Do  these  prove  that  the  answers 
of  the  insured  were  false  1  Or  wherever  medical  testimony  as  such  can 
be  pertinent  to  the  issues  raised  in  actions  on  policies,  these  necessarily 
include  all  things  relating  to  the  causes  of  death  where  they  are  relevant 
to  the  issues. 

These  statements  seem  to  be  supported  by  authority : 

(1)  If  there  is  a  warranty  or  a  contract  that  a  fact  is  true  and  it  is 
made  a  condition,  the  materiality  is  unimportant.  A  fortiori  is  the  in- 
tention to  deceive. 

Anderson  vs.  Fitzgerald,  4  H.  L.  Cases,  484 ;  Fowlces  vs.  Manchester,  3  B„ 
and  Sin.  917 ;  Jones  vs.  Provincial,  3  C.  B.  N.  S.  65  ;  Wheeler  vs.  Hardest//, 
•8  Ellis  and  Bl.  332  ;  McDonald  vs.  Law  Union,  9  L.  R,  Q.  B.  328. 

(2)  But  where  there  is  a  mere  representation  or  where  the  contractual 
representation  is  so  qualified  as  to  be  evidently  a  mere  representation,  as 
where  "  believed  "  is  inserted,  then  materiality  and  intentional  deceit  are 
essential. 

Huckman  vs.  Fernie,  3  M.  and  W.  505 ;  and  1  H.  and  Hurles,  149.  It 
appears  to  be  implied  in  Parke's,  B.,  remark  in  WainwrigM  vs.  Bland, 
1  M.  and  W.  35 ;  British  Eg.  vs.  G.  W.  By.,  38  L.  J.  Chan.  316 ;  Buckertt 
vs.  Williams,  4  Tyr.  242. 

(3)  That  an  evasion  must  have  been  known  to  be  such  where  the 
statement  is  literally  true.  Maynard  vs.  Bhode,  1  C.  and  P.  360,  where 
it  is  rested  on  the  contract.  Geach  vs.  Ingall,  14  M.  and  W.  93  ;  P<  rrans 
vs.  The  Marine  and  General  Travelers'  Insurance  Co.,  2  E.  and  E.  317; 
British  vs.  G.  W.  Bij.,  38  Law  Jour.  Chan.  132,  314 ;  General  Prov.  in  re 
Damdriel,  18  W.  R.  396  ;  Fowlces  vs.  The  Manchester,  3  Fost,  and  Fin.  440 ; 
3  B.  and  Sm.  916.  It  seems  to  be  plain  that  if  incorrectness  is  in  itself 
sufficient  to  avoid  the  contract,  it  is  misleading  to  call  attention  to  the 
effect  of  the  contract  on  making  the  truth  of  the  statement  a  basis  of  the 
contract,  and  therefore  essential,  or,  in  the  language  of  pleading,  -a  mate- 
rial  averment. 

(4)  Where  there  is  an  ambiguity  the  paper  is  to  be  read  against  the 
company  who  prepares  it.     Anderson  vs.  Fitzgerald,  4  H.  L.  Cas.  484-507. 


OF  CERTAIN  LEGAL  RELATIONS  OF  PHYSICIANS 

AND  SURGEONS  TO  THEIR  PATIENTS  AND 

TO  ONE  ANOTHER. 

BY  WILLIAM  A.    PURRINGTON,  Esq. 


Of  Legislative  Restrictions  on  Medical  Practice. — To  restrict  need- 
lessly the  free  use  of  his  powers  and  talents  is  a  wrong  to  the  individual ; 
it  is  also  an  injustice  to  the  community.  That  every  man  should  have 
as  free  scope  to  earn  a  livelihood  or  widen  the  field  of  knowledge  as  is 
consistent  with  the  common  welfare,  is  a  truism.  But  it  has  been  clev- 
erly pronounced  an  easier  task  to  renounce  the  devil  and  all  his  works 
than  to  know  them  when  met  with ;  so  that  while  none  will  dispute  the 
initial  proposition,  many  controversies  have  arisen,  and  many  will  arise, 
over  the  need  of  restrictions.  It  is  no  new  theory  that  an  ignoramus 
should  not  be  allowed  to  practice  medicine.  Socrates,  wishing  in  his 
amiable  way  to  ridicule  Euthydemus,  the  handsome,  likened  that  un- 
fortunate youth  to  a  supposititious  quack  who  should  seek  appointment 
as  a  health  officer  upon  the  ground  that,  although  ignorant  of  medicine, 
he  could  soon  learn  all  about  it  by  practicing  upon  the  Athenians;  at 
which  illustration  the  gossips  burst  into  laughter,*  and,  as  a  consequence, 
Euthydemus  probably  found  something  not  entirely  displeasing  to  him 
in  the  episode  of  the  hemlock  prescription.  But  the  thoughts  of  all  men 
do  not  widen  with  the  process  of  the  suns,  and  the  advocates  of  ignorance 
as  a  qualification  for  medical  practice  have  gone  in  late  years  far  beyond 
this  merry  reductio  ad  dbsurdum;  for  with  solemn  faces  they  presented  to 
the  New  York  legislature  of  1884  a  memorial  in  favor  of  repealing  the 
Medical  Practice  Acts,  which  declared  that  such  powers  as  that  of  healing 
by  "the  laying  on  of  hands"  "cannot  be  imparted  or  increased  by,  but 
are  more  likely  to  he  diminished  by,  the  course  of  study  required  by  the 
medical  collegesP  Herein  is  the  unconscious  admission  of  one  advan- 
tage of  medical  legislation :  for  while  it  would  be  manifestly  undesirable, 
even  if  lawful,  for  a  statute  to  ordain  that  any  system  of  therapeutics 
should  be  followed  exclusively,!  since  this  would  stifle  experiment  and 
progress,  nevertheless  it  is  reasonably  certain  that  by  requiring  of  all 
who  begin  to  practice  medicine  a  fair  acquaintance  with  the  human  sys- 

*  Memorabilia,  Bk.  IV.  c.  2,  3-5. 

t  Section  23  of  the  British  Medical  Act,  21  &  22  Vict.  c.  90,  provides  that  any  body 
•entitled  to  grant  qualifications  under  the  act  shall  forfeit  its  right  if  it  persist  in 
requiring  as  a  condition  of  its  examination  or  certificates,  that  the  candidate  shall 
"  adopt  or  refrain  from  adopting  the  Practice  of  any  particular  Theory  of  Medicine  or 
Surgery." 

595 


596  -4   SYSTEM   OF  LEGAL  MEDICINE. 

tern  and  the  past  and  present  condition  of  medical  knowledge,  the  law 
protects  the  public  in  some  degree  against  the  imposture  and  ignorance 
of  those  who  pretend,  in  good  or  bad  faith,  to  substitute  mysterious 
'•  gifts"  for  skill  and  learning. 

The  history  of  medical  legislation  is  a  story  of  reactions.  An  era  of 
universal  privilege  to  practice  medicine,  subject  only  to  the  risk  of  suits 
for  malpractice,  breeds  a  pest  of  quackery  and  an  appeal  for  protection 
to  the  law-making  power.  A  too  rigorous  enforcement  of  the  letter  of 
license  laws  begets  counter-reaction.  In  the  beginning  of  the  eighteenth 
century  the  prosecution,  by  the  College  of  Physicians,  of  Apothecary 
Rose  for  prescribing  a  bolus  to  Seale,  the  butcher,  although  successful 
in  the  Court  of  Kings  Bench,*  failed  in  the  House  of  Lords,t  because  it 
seemed  intolerable  to  the  peers  that  every  one,  their  servants  and  the 
poor  included,  should  be  compelled  in  sickness  to  call  in  a  physician  to 
prescribe,  an  apothecary  to  dispense,  and  perhaps  a  surgeon  to  let  blood. 
This  victory  made  the  apothecary  a  general  practitioner  in  England,  and 
such  he  is  to-day.  But  a  century  of  quackery  drove  the  apothecaries 
themselves  to  procure  an  act  f  in  the  early  part  of  this  century  forbid- 
ding any  one  to  practice  their  art  without  the  license  of  their  company.§ 

The  reaction  against  the  fierce  opposition  to  homeopathy,  and  a  few 
other  "  pathies,"  in  New  York  brought  about  a  modification  of  the  medi- 
cal law  of  that  State  by  the  act  of  1844,  making  an  unlicensed  physician 
a  misdemeanant  only  in  case  of  gross  malpractice. ||  That  act,  in  turn,, 
has  been  repealed  by  subsequent  legislation  making  all  unlicensed  prac- 
tice a  misdemeanor.^]  And  if  there  is  any  lesson  to  be  learned  from 
studying  the  attempts  to  regulate  medical  practice,  it  is  this :  that  when- 
ever it  is  generally  believed  that  such  a  regulation  is  only  enforced  either 
to  benefit  physicians,  by  limiting  competition  or  regulating  fees,  or  to 
suppress  schismatic  opinion,  the  law  falls  into  disfavor  and  is  repealed 
or  becomes  unenforceable. 

Theory  and  Constitutionality  of  Medical  License  Laws. — Under 
the  governmental  theories  obtaining  throughout  the  United  States,  any 
statute  obviously  enacted  to  favor  either  physicians  as  a  class  in  disre- 
gard of  public  right,  or  one  class  of  physicians  at  the  expense  of  others,, 
would  be  unconstitutional.**  Medical  license  laws  are  defensible  solely 
on  the  ground  that  they  are  a  fair  exercise  of  the  police  power  to  protect 
the  public  health.  It  has  been  forcibly  argued  that  their  scope  should  be 
limited  to  punishing  fraudulent  pretenses  of  a  nature  to  deceive  persons 
of  ordinary  intelligence  and  care,  such  as  the  false  assumption  of  med- 
ical titles ;  but  should  not  be  extended  to  forbidding  the  practice  of  un- 
licensed persons.  Thus  the  purpose  of  the  British  Medical  Act  of  1858,1+ 
as  stated  in  its  preamble,  is  "to  enable  persons  requiring  medical  aid  to 

*  3  Salk.  17 ;  6  Mod.  44.  t  5  Bro.  Pari.  Cases,  553. 

t  55  Geo.  III.  c.  194.  This  act  is  not  repealed  by  the  Medical  Act,  c.  90,  21  &  22 
Vict.     Davies  vs.  Makuna,  53  L.  T.  314 ;  29  Ch.  D.  596. 

§  For  an  account  of  this  struggle  between  the  physicians  and  apothecaries  see 
"The  Evolution  of  the  Apothecary,"  Medical  Record,  Sept.  11,  1886,  by  the  writer. 

||  See  history  of  New  York  Medical  Legislation  prior  to  1887  in  the  Medical  Record 
of  Oct,  23,  1886,  by  the  writer. 

If  Laws  of  1874,  1880,  1887,  1892,  and  1893,  the  last  statute  being  now  in  force. 

**  State  vs.  Pennoyer,  65  N.  H.  113 ;  18  Atl.  878;  State  vs.  Hinman,  65  N.  H.  103  ; 
State  vs.  Fleischer,  41  Minn.  69. 

tt  21  &  22  Vict,  c.  90. 


LEGAL  BELATLONS   OF  PHYSLCIANS  AJSfD  SURGEONS.  597 

distinguish  qualified  from  unqualified  practitioners."  Those  who  hold 
that  this  is  as  far  as  the  law  should  go  argue  that  fools  can  only  be  pro- 
tected by  incarceration,  and  that  it  is  an  ancient  privilege  to  be  cheated 
if  you  wish  to  be.* 

The  Apothecaries  Act  of  1815,t  on  the  other  hand,  forbade  unlicensed 
persons,  under  civil  penalties  for  disobedience,  to  act  as  apothecaries; 
and  this  statute  rather  than  the  former  has  been  followed  and  exceeded 
in  our  medical  legislation,  which,  in  nearly  all  the  States,  makes  a  crim- 
inal offense  of  unlicensed  practice.  The  constitutionality  of  this  prohi- 
bition has  been  directly  passed  upon  and  affirmed  by  the  highest  courts 
of  most  of  these  jurisdictions  and  by  the  Supreme  Court  of  the  United 
States ;  and  by  their  decisions  it  is  settled  that  such  legislation  is  not  a 
taking  of  property  without  due  process  of  law,!  that  the  fact  of  having 
been  engaged  in  medical  practice  for  years  prior  to  the  enactment  of  a 
licensing  act  does  not  create  a  vested  right  to  continue  in  practice  con- 
trary to  the  new  statute,§  and  that  the  exemption  of  persons  in  practice 
prior  to  the  date  of  the  law  from  the  examination,  etc.,  required  of  per- 
sons thereafter  beginning  to  practice  does  not  create  a  "privileged 
class."  || 

Among  the  various  statutory  provisions  that  have  been  held  valid  by 
the  courts  are  the  following :  forbidding  any  one  to  practice  medicine 
if  neither  graduated  from  the  Harvard  Medical  School  nor  licensed  by 
the  Massachusetts  Medical  Society  ;<]  confining  examinations  by  a  State 
Board  of  Examiners  to  persons  holding  diplomas  ;**  making  residence  in 
the  State  for  a  term  of  years  a  condition  of  the  license  ;tt  permitting  all 
persons  actually  in  practice  at  the  date  of  the  enactment  to  continue 
practicing  upon  registration  and  the  payment  of  a  fee  of  three  dollars, 
but  requiring  of  all  commencing  practice  thereafter  a  diploma,  registra- 
tion, and  a  fee  of  ten  dollars  ;tf  forbidding  licensed  physicians  from 
opening  shops  for  retailing,  disbursing,  or  compounding  medicines  or 
poisons  except  in  compliance  with  the  pharmacy  law ;  §§  exempting  from 
the  statute's  operation  all  persons  in  practice  within  the  State  for  ten 
years  prior  to  its  enactment  ;|j||  permitting  physicians  of  another  State  to 
visit  the  enacting  State  for  consultation  without  the  registration  required 
of  resident  practitioners  ;flff  and  creating  a  Board  of  Medical  Examiners 

*  Analysis  of  Sir  James  Graham's  Bill  liy  John  Davis,  M.D.,  in  his  Exposition  of 
the  Laws-  which  Relate  to  the  Medical  Profession  in  England,  London,  1844;  ef.  Smith  vs. 
Lane,  24  Him,  632. 

t  55  George  III.  c.  194. 

t  Bent  vs.  State  of  TV.  Va.,  129  U.  S.  114;  State  vs.  Green,  112  Ind.  462;  14  N.  E. 
352;  Williams  vs.  People,  121  Ills.  84;  11  N.  E.  881;  People  vs.  Phippin,  70  Mich.  6; 
37  N.W.888;  Hardina  vs.  People,  10  Col.  387;  15  Pac.  727;  Hewitt  vs.  Charier.  (Mass.) 
16  Pick,  353;  State  vs.  Board  of  Errs.,  32  Minn.  324;  34  Minn.  387;  ex  parte  Spinney, 
10  Nev.  323;  ex  parti  Smith,  L0  Wend.  449;  Logan  vs.  State,  5  Tex.  Ap.  306;  State  vs. 
Pennoyer,  65  N.  H.  113;  State  vs.  Hinman,  65  N.  H.  103;  18  Atl.  R.  194.  The  New 
Hampshire  statute  alone  lias  been  held  unconstitutional. 

v\   Dent  vs.  West  Va.,  supra.;  People  vs.  Fulda,  52  Him,  65. 

||   State  vs.  Green  ;  Fox  vs.  Territory,  supra. 

51  Hewitt  vs.  Charier,  16  Pick,  353. 

**  State  vs.  Vandersluis,  42  .Minn.  129;  43  X.  W.  789. 

H  State  vs.  Green,  112  Ind.  462 ;  14  X.  E.  352 ;  State  vs.  Hathaway,  (Mo.)  21  S.  W.  1081. 

\X  State  vs.  Creditor,  24  Pac.  346  (Kansas). 

*hS   People  vs.  Moorman,  86  Midi.  4:;:; ;  49  X.  W.  263. 

||li    Williams  vs.  People,  121  111.  84;   17  111.  Ap.  274;  11  X.  E.  881. 

HH  State  vs.  Van  Doran,  109  X.  C.  864. 


598  ^   SYSTEM  OF  LEGAL   MEDICINE. 

without  providing  for  equality  of  representation  upon  it  of  the  different 
medical  "  schools."  * 

Licenses  and  Examining  Boards. — A  diploma  conferring  the  degree 
of  doctor  of  medicine  from  an  incorporated  college  is  still  a  sufficient 
qualification  to  practice  in  most  of  the  United  States ;  t  and  if  the  statute 
requires  a  mere  diploma,  one  of  Buchanan's  manufacture  has  been  held 
to  answer;|  but  there  is  a  growing  tendency  to  require  all  candidates  for 
license,  including  graduates  of  medical  colleges,  to  pass  the  examinations 
of  State  boards.  Even  where  diplomas  are  still  accepted  as  licenses  it  is 
not  unusual,  owing  to  the  number  of  worthless  soi-disant  medical  schools, 
to  require  that  they  be  issued  by  colleges,  "  reputable "  or  in  "  good 
standing/'  and  it  has  been  held  that  corporations  formed  under  a  general 
act  to  incorporate  literary,  scientific,  and  charitable  institutions  cannot 
confer  the  degree  of  "  M.D."§  Where  the  required  license  is  the  diploma 
of  a  "  reputable  college,"  examining  boards  have  power  to  establish  the 
criterion  of  what  is  "  reputable  "  or  "  in  good  standing,"  ||  and  the  exercise 
of  their  functions  will  not  be  reviewed  by  the  courts,  unless  manifestly 
an  abuse  of  discretion ;  such  as  the  exercise  of  power  either  arbitrarily 
or  for  selfish  motives.  And  under  an  Illinois  decision,  the  function  of 
the  board  cannot  be  delegated  to  a  national  association  composed  largely 
of  men  without  the  State.fl  A  board  that  has  once  recognized  a  school 
to  be  in  good  standing  cannot  thereafter  arbitrarily  refuse  to  certify  the 
latter's  graduates  without  a  redetermination  of  the  rating;**  but  it  may 
establish  a  standard  of  minimum  requirements  to  which  all  schools  "  in 
good  standing  "  must  conform,**  and,  if  empowered  to  administer  oaths 
and  take  testimony,  may,  after  notice  to  the  accused,  act  upon  charges 
against  a  school,  and  if  satisfied  of  its  low  standing,  refuse  to  certify  its 
graduates.**  In  Colorado  certificates  of  a  de  facto  board,  although  ille- 
gally organized,  will  protect  their  holders.tt 

A  medical  law  may  provide  not  only  for  the  refusal  of  a  license,!!  but 
also  for  its  revocation§§  for  unprofessional  conduct.||||    But  the  candidate 

*  Brown  vs.  People,  11  Col.  109  ;  17  Pae,  104. 

t  It  does  not  seem  wise  to  consume  space  by  setting  forth  the  laws  of  the  various 
States,  or  even  making  a  synopsis  of  them.  They  are  now  in  a  transition  state,  and 
likely  to  be  changed  by  every  legislature.  In  New  York,  for  example,  the  law  of  1880 
was  altered  in  1887,  1890,  1893,  and  is,  as  this  book  goes  to  press,  likely  to  be  revised 
again.  The  Illinois  State  Board  of  Health  publishes  from  time  to  time  an  admirable 
report  showing  the  medical  legislation  of  different  States  and  their  existing  medical 
colleges.  But  the  only  safe  guide  to  the  requirements  of  licentiates  in  any  State  is 
examination  of  its  statutes  in  force. 

X  Holmes  vs.  Haldc,  74  Me.  28. 

§  People  vs.  Gunn,  96  N.  Y.  317;  Townshend  vs.  Gray,  (Vt.)  19  Atl.  635. 

||  Barmore  vs.  Board  of  Exrs.,  21  Or.  301;  State  vs.  Bd.  of  Health  Hudson  Co.,  22 
Atl.  226. 

H  III.  St.  Bd.  of  Dent.  Ex.  vs.  People,  123  111.  227 ;  13  N.  E.  201.  The  same  rule 
applies  to  granting  diplomas  by  Medical  Colleges  :  People  vs.  N.  T.  Homoeopathic  College 
and  Hospital,  20  N.  Y.  Supl.  379;  People  vs.  Bellevue  Hospital  Med.  Col.,  60  Hun,  107; 
128  N.  Y.  621 ;  cf.  State  vs.  Gregory,  83  Mo.  123. 

**  Ioiva  Eclectic  Med.  Col.  Ass'n  vs.  Schrader.,  55  N.  W.  24. 

tt  Brown  vs.  People,  11  Col.  109 ;  17  Pae,  104. 

XX  State  vs.  Med.  Ex.  Bd.,  32  Minn.  324 ;  20  N.  W.  238. 

§§  State  vs.  Med.  Ex.  Bd.,  34  Minn.  387  ;  26  N.  W.  123  ;  ex  parte  Smith,  10  Wend.  449. 

Illl  Under  the  British  Medical  Act  the  General  Council  of  Education  are  sole  judges 
whether  a  practitioner  has  been  guilty  of  infamous  conduct  justifying  the  erasure  of 
his  name  from  the  registry,  and  the  courts  will  not  interfere.  Ex  parte  Lamert,  9  L. 
T.  N.  S.  410. 


LEGAL   RELATIONS   OF  PHYSICIANS  AND  SURGEONS.  599 

for  license,  or  licentiate,  must  have  notice  and  opportunity  to  answer  the 
■charges  against  him.* 

In  New  Hampshire  it  was  held  that  a  license  coidd  not  be  refused 
solely  on  the  ground  that  the  applicant  was  unworthy  of  public  confi- 
dence.! And  under  the  California  act,  which  provided  a  penalty  only 
for  practicing  without  having  obtained  a  certificate,  it  was  held  that  one 
who  had  obtained  the  requisite  certificate  might  coutinue  to  practice  not- 
withstanding its  revocation.^  A  like  result  was  arrived  at  in  an  Illinois 
case,  wherein  it  was  held  that  because  the  statute  made  the  conferment 
of  a  diploma  "  conclusive  "  of  the  right  to  practice,  therefore  the  board 
■could  not  revoke  the  licenses  of  graduates,  but  only  those  of  non-gradu- 
ates^ These  and  other  grotesque  modern  instances  go  to  show  what  a 
•clumsy  instrument  legislation  is  when  applied  to  restrain  the  customary 
actions  of  mankind ;  and  when  it  attempts  to  regulate  matters  of  taste 
and  professional  deportment  the  courts  are  not  always  ready  to  adopt 
the  medical  criterion  of 

Unprofessional  Conduct. — Thus  where  the  question  arose  in  Cali- 
fornia whether  a  practitioner  was  guilty  of  such  conduct  in  advertising 
himself  as  a  specialist,  one  of  the  Supreme  Court  judges  said,  obiter  to  be 
sure  :  "  As  well  might  the  board  declare  that  wearing  any  other  hat  than 
one  of  white  color,  by  a  physician,  should  be  unprofessional  conduct, 
and  cause  it  to  be  punished  as  a  misdemeanor.  The  advertisement  of 
the  character  mentioned  does  no  harm  to  any  one.  It  maybe  of  benefit 
to  the  public  by  giving  to  the  subject  of  the  diseases  mentioned  informa- 
tion of  the  existence  and  residence  of  a  person  who  has  peculiar  skill  in 
euring  them.  Such  laws  are  passed  to  prevent  injury  to  the  public,  not 
to  prevent  or  exclude  a  benefit  to  it."  ||  It  appeared  in  the  case  of  The 
People  vs.  McCoy  fl  that  defendant's  license  had  been  revoked  under  the 
Illinois  statute  on  the  charge  of  "  unprofessional  and  dishonorable  con- 
duct "  in  making  statements,  in  reference  to  curing  the  sick,  calculated 
to  defraud  the  public.  The  gravamen  of  the  offense  was  an  advertise- 
ment under  the  caption,  "A  Surgical  Triumph."  The  Appellate  Court, 
although  resting  its  decision  on  the  point  of  lack  of  notice  to  defendant, 
said  that  the  statute  must  have  a  reasonable,  not  a  capricious,  construc- 
tion ;  and  that  "  unprofessional "  and  "  dishonorable  "  meant  what  would 
be  so  considered  "  in  common  judgment."  So,  in  the  case  of  a  physician 
refused  admission  to  a  medical  society  because  some  years  before  he  had 
advertised,  the  New  York  Court  of  Appeals  affirmed  the  order  of  the 
Supreme  Court  granting  a  writ  of  mandamus  commanding  the  society 
to  admit  the  relator  to  membership  on  the  ground  that  his  advertising 
was  per  se  "  neither  immoral  nor  illegal,"  the  advertisement  being  decent 
in  terms,  while  the  provisions  of  the  medical  code  of  ethics  had  "the 
force  neither  of  general  law,  nor  of  a  rule  of  private  morality,"  and  were 
not  binding  upon  any  but  members  of  the  society.**  But  the  court 
thought  otherwise  in  the  case  of  Dr.  Hunter,**  who  advertised  extensively 

*  State  vs.  Med.  Ex.  Bd,,  32  Minn.  324;  People  vs.  McCoy,  125  111.  289;  30  111.  Ap. 
272  ;  State  vs.  Schidtz,  28  Pac.  643. 

t  Gage  vs.  Censors,  63  N.  H.  92. 

t  Ex  parte  McNulty,  19  Pac.  237;  77  Cal.  164. 

§    Williams  vs.  People,  17  111.  Ap.  274. 

||  Ex  parte  McNulty,  77  Cal.  164.  H  125  111.  289;  30  111.  Ap.  272. 

**  People  ex  ret  Bartlett  vs.  Med.  Soc.  of  Erie,  32  N.  Y.  187.  But  it  was  admitted 
that  advertising  was  ground  for  expulsion  from  medical  societies  that  forbid  it  in 


COO  A   SYSTEM  OF  LEGAL  MEDLCLNE. 

in  London  the  fact  that  he  was  about  the  only  physician  that  knew  how 
to  cure  consumption.  This  was  prior  to  the  discovery  of  the  bacillus, 
and  Hunter's  method  was  by  an  inhalation  of  oxygen.  He  scorned  to 
pass  examinations,  having  already  a  diploma.  The  Fall  Mall  Gazette  in 
the  cause  of  virtue  attacked  him  viciously.  He  brought  an  action  for 
libel,  and  Coleridge,  his  counsel,  urged  in  behalf  of  the  advertising  that 
plaintiff  was  an  American,  and  only  followed  the  custom  of  his  country. 
As  to  which  plea  said  Lord  Cockburn  :  "  It  is  said  then  in  excuse  that  he 
comes  from  America,  and  that  there  it  [advertising]  is  usual ;  but  how- 
ex  er  that  may  be,  happily  its  practice  has  not  extended  itself  here.  .  .  . 
If  it  were  open  to  professional  men  here  thus  to  advertise  themselves, 
the  dignity  and  honor  of  a  noble  profession  would  be  tarnished  and  soiled, 
.  .  .  whatever  may  be  the  practice  in  America  (and  I  cannot  believe  that 
such  practices  are  resorted  to  there  by  members  of  the  medical  profes- 
sion or  any  other  liberal  profession).  I  hope  it  never  will  be  deemed 
consistent  with  professional  honor  in  this  country  to  resort  to  such  prac- 
tices." At  the  close  of  the  trial,  which  lasted  four  days,  it  appearing 
that  Coleridge,  with  great  finesse,  had  tried  the  case  for  plaintiff  on  an 
issue  that  neither  his  adversary  nor  the  chief -justice  had  perceived,  Lord 
Cockburn  considered  that  "  the  best  course  would  be  to  take  the  opinion 
of  the  jury,"  and  those  twelve  good  men  found  a  verdict  for  plaintiff; 
damages,  one  farthing.  As  a  matter  of  fact,  in  America  false  advertis- 
ing has  been  held  to  be  dishonorable  conduct,  justifying  the  revocation 
of  a  license;  as  where  one  Powell,  styling  himself  "the  white  beaver  of 
the  Winnebagos,"  pretended  to  have  a  specific  that  would  cure  cholera 
morbus  if  taken  internally,  and  rheumatism  if  applied  externally*  It 
has  been  held  not  to  be  dishonorable  conduct  or  ground  for  expulsion 
from  a  medical  society  for  a  member  to  take  less  than  a  minimum  fee- 
fixed  by  its  tariff,  such  a  tariff  itself  being  against  public  poliey.t  It  is 
obvious  that  the  question  of  what  constitutes  unprofessional  conduct 
must  be  one  of  fact  in  every  instance,  and,  necessarily,  decided  largely 
upon  the  circumstances  of  each  case  and  the  point  of  view  of  the  judges. 
The  only  rule  to  be  adduced  from  the  adjudicated  cases  seems  to  be,  that 
it  is  not  every  violation  of  medical  ethics,  but  only  acts  dishonorable 
when  tried  by  common  standards,  that  will  be  considered  "  unprofessional 
conduct  "by  the  courts  in  construing  statutes  inflicting  a  penalty  for 
such  behavior ;  but  in  medical  societies  members  must  observe  all  valid 
rules  and  by-laws  under  penalty  of  discipline  for  disobedience. 

Registration. — As  already  pointed  out,  the  purpose  of  the  British 
Medical  Act  is  to  give  publicity  to  the  qualification  of  practitioners  and 
punish  false  pretenses  in  that  regard,  rather  than  to  forbid  unqualified 
persons  to  practice  upon  those  who,  with  open  eyes,  wish  to  employ 
them.  To  this  end  all  duty  qualified  practitioners  are  required  to  register- 
under  the  supervision  of  "  The  General  Council  of  Medical  Education 
and  Registration  of  the  United  Kingdom."  The  register  is  published  an- 
nually, as  it  exists  on  the  first  day  of  January  of  the  year  of  publication, 
and  is  admitted  as  evidence  in  the  courts.  Provision  is  made  for  erasing 
the  names  of  those  who  die,  those  who  are  either  convicted  of  felonies  or 

their  by-laws ;  and  see  the  opinion  in  this  same  case  of  Davis,  P.  J.,  25  How.  333 ;  of. 
Hunter  vs.  Sharpc,  4  F   &  F.  983,  referred  to  in  the  text. 

*  State  vs.  State  Bd.  Ex.,  32  Minn.  324;  Same  vs.  Same,  34  Minn.  387. 

t  People  cxrcl  Gray  vs.  Med.  Soc.  of  Erie,  24  Barb.  570. 


LEGAL  RELATIONS  OF  PHYSICIANS  AND  SURGEONS.  G01 

misdemeanors,  or  adjudged  by  the  council  guilty  of  "  infamous  conduct 
in  a  professional  respect,"*  and  those  who  neglect  for  six  months  to 
answer  letters  of  inquiry  addressed  to  them  by  the  registrars.  Only 
registered  practitioners  can  collect  fees,  claim  exemption  as  medical  men 
from  jury  duty,  hold  appointments  in  the  military  or  naval  service,  on 
vessels  merchant,  or  in  certain  public  institutions,  or  sign  the  certificates 
required  of  medical  men  by  the  various  statutes.  The  act  also  makes  it 
a  penal  offense  to  assume  any  title  falsely  indicating  that  its  bearer  is 
registered,  or  entitled  to  be  registered,  under  the  law.  Accordingly  it 
was  held  unlawful  that  Thomas  Andrews  should  append  the  letters 
"  M.D. "  to  his  name,  although  he  produced  by  way  of  defense  a  nicely 
engraved  diploma  purporting  to  confer  upon  him  the  degree  of  doctor 
from  the  University  of  Philadelphia,  an  eclectic  concern  now  happily 
extinct,  but  at  that  time  doing  a  brisk  business  in  parchment.  It  did 
not  appear  that  Thomas  had  ever  been  beyond  the  seas,  and  the  court 
declined  to  recognize  title  by  purchase  in  medical  degrees ;  thus  inflict- 
ing a  severe  blow  upon  the  promising  diploma  industry.f  However, 
another  titulary  of  a  different  eclectic  factory,  now  also  only  a  memory, 
who  in  circulars  of  a  not  uncommon  but  somewhat  offensive  nature  ad- 
vertised himself  as  "John  Hamilton,  doctor  of  medicine  of  the  Metro- 
politan Medical  College  of  New  York,"  fared  better,  since  he  only  claimed 
a  title  that  he  possessed,  and  one  upon  its  face  not  purporting  to  be  a 
qualification  under  the  act.!  Violations  of  the  British  Medical  Act  are 
not  indictable  misdemeanors,  but  are  punished  by  civil  penalties.  Where 
the  registration  system  prevails  in  this  country  the  unregistered  practi- 
tioner is  usually  punished  by  fine,  sometimes  a  penalty,  generally  of  fifty 
dollars  for  the  first  offense.  It  is  not  customary  to  print  the  registers, 
but  it  is  a  general  requirement  that  a  physician,  surgeon,  or  dentist 
must  be  registered  in  the  offices  of  the  clerk  of  each  county  wherein  he 
practices  or  has  an  office.§  This  has  been  held  frequently  in  unreported 
cases  to  be  the  rule  in  New  York,  although  there  is  a  reported  opinion 
of  the  General  Term  to  the  contrary,  which  seems,  however,  to  have  been 
based  upon  a  loose  construction  of  the  law  of  1880,  which  had  been  re- 
pealed by  the  statute  of  1887  prior  to  the  trial.  ||  The  present  statute  is 
explicit  on  this  point.  In  Georgia  a  physician  was  said  not  to  be  respon- 
sible for  non-registration  due  solely  to  the  county  clerk's  neglect  to  pro- 
vide a  proper  book  for  that  purpose  ;fi  and  in  Texas  one  who  had  sent 
his  certificate  by  messenger  to  be  filed  with  the  clerk  was  held  not  liable 
for  practicing  under  the  impression  that  it  was  recorded. 


*# 


*  Leeson  vs.  General  Council  of  Med.  Ed.  $  Ren.,  61  L.  T.  849;  L.  K.  Ch.  D.  366. 

t  Andrews  vs.  Styrap,  26  L.  T.  N.  S.  704  Exch. 

t  Carpenter  vs.  Hamilton,  37  L.  T.  N.  S.  157  Exeh.  Cf.  Reg.  vs.  Tefft,  45  Upper 
Canada  Q.  B.  144,  where  one  partner,  being  registered,  had  his  name  on  the  sign 
followed  by  the  letters  "M.D.  ;  M.C.  P.  &  S.  Out.";  and  the  other,  being  non-regis- 
tered, had  his  name  followed  only  by  the  letters  "M.D.,"  Held  that  the  latter  did 
not  use  a  sign  calculated  to  imply  registration.  In  England  a  licentiate  of  the  Apothe- 
caries Co.  cannot  append  M.D.  to  his  name  and  hold  himself  out  as  a  physician.  Reg. 
vs.  Baker  et  ah.  66  L.  T.  416. 

§  Orr  vs.  Meek,  111  Ind.  40  ;  11  N.  E.  7S7 ;  Ege  vs.  Commonwealth,  9  Atl.  471 ;  mi- 
liar<1  vs.  State,  7  Tex.  Ap.  69. 

||  Martina  vs.  Eirl;  8  N.  Y.  Supl.  758 ;  55  Hun,  474 ;  cf.  Hayes  vs.  Webster  Dailu  Rec/., 
Jan.  26,  1884. 

H  Parish  vs.  Foss,  75  Ga.  439.     Cf.  Carberry  vs.  People,  39  111.  Ap.  506  infra. 

**  Pettit  vs.  State,  28  Tex.  Ap.  240 ;  14  S.  W.  127. 


602  A   SYSTEM  OF  LEGAL  MEDICINE. 

Legal  Disabilities  of  Irregular  Practitioners. — In  addition  to  direct 
punishment  by  fines  and  penalties,  there  are  serious  indirect  consequences 
of  illegal  practice.  Without  the  prescribed  license  and  registration  a 
physician  cannot  maintain  an  action  to  recover  his  fees ;  *  although  it 
has  been  held  under  the  Wisconsin  and  Maine  statutes  that  one  who 
could  not  recover  fees  for  lack  of  a  diploma  might,  nevertheless,  sue  for 
damages  on  account  of  an  injury  preventing  his  practice  ;t  but  the  stat- 
utes under  which  those  cases  were  decided  did  not  make  the  practice 
unlawful,  but  only  affected  a  civil  remedy.  In  the  United  Kingdom,  as 
we  have  seen,  those  failing  to  comply  with  the  law  are  specificall}-  forbid- 
den to  hold  medical  appointments.  Even  in  the  absence  of  such  prohi- 
bition, however,  practically  the  result  would  be  the  same ;  for  it  is  not 
likely  that  an  open  violator  of  the  statute  would  be  appointed  to  office, 
or  even  that  his  testimony  as  an  expert  would  not  be  more  or  less  dis- 
credited on  cross-examination,  if  it  should  appear  that  he  was  practicing 
contrary  to  law.  This  phase  of  the  registry  system  was  illustrated  in 
an  assault  case  tried  at  Circuit,  in  Herkimer,  N.  Y.,  wherein  an  important 
issue  was  the  possibility  of  deciding  from  the  external  appearances  of 
the  gum  two  years  after  the  occurrence  whether  a  tooth  had  been  pushed 
in  or  pulled  out.  Each  party  called  a  dentist  as  an  expert.  The  plaintiff's 
witness  falsely  qualified  as  a  graduate  of  a  dental  college,  while  the 
defendant's  admitted  that  he  had  received  only  office  instruction.  The 
plaintiff  prevailed.  An  examination  of  the  dental  registry  would  have 
shown  the  perjury  of  the  plaintiff's  expert,  and  might  have  changed  the 
result.f  An  unlicensed  practitioner,  moreover,  is  not  entitled  to  such 
privileges  as  exemption  from  jury  service :  nor  may  he  sign  death-certifi- 
cates. Communications  between  himself  and  his  patients  are  not  privi- 
leged^ He  may  not  maintain  an  action  for  slander  if  an  amiable  rival 
denounce  him  as  a  "  quack."  |[  And  in  many  indirect  ways  he  may  suffer. 
But  a  license  will  be  presumed  where  that  question  arises  collaterally,  as 
where  a  physician  is  called  as  a  witness ;  and  the  burden  of  proof  in 
civil  cases  has  been  held  to  be  on  him  who  denies  the  license,  although 
in  prosecutions  for  violation  of  the  medical  laws  the  rule  is  otherwise.^] 

What  Constitutes  Proof  of  Practice  of  Medicine. — Celsus  truly 
says  that  the  different  branches  of  medicine  are  indissolubly  bound  to- 
gether.**    Nevertheless  there  has  been  always  a  separation  of  medical 

*  Fox  vs.  Dixon,  34  N.  Y.  St.  R.  710 ;  12  N.  Y.  Supl.  267 ;  Haworth  vs.  Montgomery, 
91  Tenn.  16 ;  18  S.  W.  399. 

t  McNamara  vs.  Clintonville,  62  Wis.  207 ;  Holmes  vs.  Halde,  74  Me.  28. 

t  Merville  vs.  Merville  Herkimer  Circuit,  Nov.  21,  1887  (unreported).  Some  statutes 
forbid  the  unlicensed  medical  practitioner  to  testify  as  an  expert ;  e.g.,  see  Annotated 
Statutes,  Wisconsin,  §  1436. 

vS    Wiel  vs.  Cowles,  45  Him,  307. 

||  Hargan  vs.  Purdy,  20  S.  W.  432;  SMrving  vs.  Boss,  31  Upper  Can.  C.  P.  423; 
Collins  vs.  Carnegie,  1  A.  &  E.  695.  Aliter  if  he  charge  him  with  killing  patients  by- 
malpractice  :  Marsh  vs.  Davison,  9  Paige,  580  ;  but  it  is  not  libelous  to  publish  a  true 
account  of  the  action  of  the  General  Council  of  Education,  etc.,  declaring  plaintiff's 
conduct  infamous:  Allbut  vs.  G.  C.  M.  E.  cf  B.,  61  L.  T.  585;  58  L.  J.  Q.  B.  606;  cf. 
Fawcett  vs.  Charles,  13  Wend.  473  infra. 

H  City  of  Chicago  vs.  Wood,  24  111.  Ap.  40;  No.  Chic.  St.  By.  Co.  vs.  Cotton,  29  N.  E. 
899;  140  111.  486;  People  vs.  Fulda,  52  Hun,  65;  and  see  below  under  the  heading 
"Criminal  Offenses." 

f  "  Illud  ante  omnia  scire  convenit  quod  onmes  medicines  partes  inexce  sunt,  ut  ex  toto 
separari  non  possint." 


LEGAL  RELATIONS   OE  PHYSICIANS  AND  SURGEONS.  603 

men  by  specialization,  both  upon  broad  and  somewhat  distinct  lines,  into 
physicians,  surgeons,  dentists,  and  pharmacists,  all  of  whom  would  mutu- 
ally poach  one  on  another's  domain  if  there  were  a  serious  attempt  to 
fix  the  boundary  lines  of  each  specialty,  and  also  upon  those  narrower 
lines  by  winch  in  these  days  each  of  our  mortal  parts  bids  fail*  to  be- 
come the  sole  charge  of  a  separate  practitioner.     Moreover,  "  schools," 
"  pathies,"  and  "  systems  "  arise  and  fall,  and  will  continue  to  do  so  while 
greed  and  credulity  survive ;  which  will  be,  probably,  for  some  time  to 
come.     It  is  plain,  therefore,  that  what  constitutes  the  practice  of  medi- 
cine in  any  jurisdiction  must  be  a  question  of  fact  as  interpreted  by  the 
law  of  the'  place.     Whatever  "  system  "  the  practitioner  may  adopt,  pro- 
vided he  be  qualified  under  the  law,  the  courts  will  recognize  him  as  a 
physician,  and  will  not  favor  one  " school "  at  the  expense  of  another* 
If  the  statute  undertakes  to  define  practice,  no  acts  will  be  punishable 
not  falling  within  the  definition ;  as  where  an  element  of  the  offense  is 
receipt  of  fees  or  appending  the  letters  "  M.D."  to  the  name.t     But  under 
a  statute  forbidding  practice  for  reward  it  was  held  that  actual  receipt 
of  money  need  not  be  proved  where  intent  to  take  compensation  could 
be  presumed  from  the  facts ;%  and  the  medicine  prescribed  need  not  be 
offered  as  evidence^  for  it  would  not  seem  to  be  a  defense  to  a  charge  of 
illegal  practice  that  the  pretended  drug  was  a  bread  pill ;  notwithstand- 
ing that  it  was  said  in  a  New  York  case  that  the  purpose  of  medical 
legislation  is  "not  to  prevent  persons  being  made  the  subjects  of  mere 
imposition,"  but  "to  confine  the  use  of  medicines  and  the  operations 
of  surgery  to  a  class  of  persons  who  upon  examination  should  be  found 
competent  and  qualified  to  follow  their  professional  pursuits";  where- 
fore it  was  held,  in  this  case,  that  one  who  pretended  to  cm-e  only  by 
manipulation  was  not  practicing  medicine  within  the  meaning  of  the  act, 
"  although  if  his  pretensions  were  well  founded  then  diseases  would  no 
longer  be  formidable,  and  even  death  itself  would  be  deprived  of  its  ter- 
rors." ||     In  Maine  it  was  held  to  be  medical  practice  for  a  clairvoyant  to 
prescribe  remedies  ;fl  but  under  the  peculiar  statute  of  that  State,  allow- 
ing any  one  to  receive  compensation  for  medical  service  if  he  has  a  cer- 
tificate of  good  moral  character  from  the  municipal  officers  of  his  town, 
a  "  Christian  scientist "  who  had  filed  such  a  certificate  prevailed  in  an 
action  for  fees.**    The  conviction  of  a  "  magnetic  healer,"  who  held  him- 
self out  as  a  doctor  and  gave  a  death-certificate,  was  affirmed  under  the 
Michigan  act  ;tt  and  in  Indiana  it  was  held  that,  whether  or  not  the  opium 
habit  was  a  disease,  Mr.  Benham,  not  having  complied  with  the  medical 
laws,  should  be  punished  for  issuing  bill-heads  and  circulars  fortified  with 
certificates  of  his  great  skill  in  curing  that  evil  practice,  all  bearing  his 
name  as  "Dr.  Benham."||     To  administer  electricity §§  and  to  prescribe 

*  Corsi  vs.  Maretzek,  4  E.  D.  Smith,  1 ;  Patten  vs.  Wiggin,  51  Me.  594  ;  Force  vs.  Greg- 
ory, (Conn.)  27  Atl.  1116;  White  vs.  Carroll,  42  N.  Y.  161. 

t  State  vs.  Carey,  30  Pac.  729.  X  State  vs.  Hale,  15  Mo.  606. 

§    V.  S.  vs.  Williams,  5  Cranch  C.  Ct.  62.  ||  Smith  vs.  Lane,  24  Hun,  632. 

H  Bibber  vs.  Simpson,  59  Me.  181.  But  in  Wood  vs.  0? Kelly  (8  Cush.),  62  Mass.  406, 
a  mere  clairvoyant  was  said  not  to  be  a  physician. 

**   Wheeler  vs.  Sawyer,  15  Atl.  67. 

ft  People  vs.  Phippin,  70  Mich.  6  ;  37  N.  W.  888. 

tt  Benham  vs.  State,  116  Ind.  112;  18  N.  W.  454. 

§§  Davidson  vs.  Bohlman,  37  Mo.  Ap.  576;  cf.  Nelson  vs.  Harrington,  72  Wis.  59L 
40  N.  W.  228. 


G04  A  SYSTEM  OF  LEGAL  MEDICINE. 

under  the  guise  of  selling  patent  medicines  or  drugs*  constitute  medical 
practice.  A  single  act  of  unauthorized  medical  attendance  under  cir- 
cumstances showing  intent  to  act  as  a  physician  is  sufficient  proof  of 
practice,  and  under  the  North  Carolina  act,  which  prohibits  an  attempt  to 
practice,  it  is  sufficient  to  prove  that  defendant  held  himself  out  as  a 
physician  and  solicited  patients.t  In  the  absence  of  any  special  medical 
law  such  holding  out  and  practice  are  prima  facie  proof  of  the  profes- 
sional character  of  a  party  to  a  suit.f  But  a  farrier  who  occasionally 
prescribes  for  human  beings  is  not  a  practicing  apothecary  within  the 
exemption  clause  of  the  British  act.§  Under  the  general  term  "practice 
of  medicine,"  acts  of  surgery  are  included,  unless  a  contrary  intent  by 
both  parties  is  clear. ||  Farmer  Musser,  who  seems  to  have  been  well 
named,  held  himself  out  as  a  "  cancer  doctor,"  and  pretended  to  special 
skill  in  treating  cancers  by  a  wonderful  recipe.  Mrs.  Chase,  who  had  a 
pimple  on  her  nose,  submitted  to  his  treatment.  He  removed  the  pimple, 
and  incidentally  the  nose.  This  was  held  to  be  practice  of  medicine.fi 
But  it  was  held  not  to  be  such  a  practice  for  one  accustomed  to  gather 
herbs,  and  called  doctor  in  his  vicinity,  to  give  remedies  to  and  advise  a 
sick  friend  as  a  neighborly  act  without  fee.**  Many  medical  laws  ex- 
pressly exempt  from  their  operation  certain  classes  of  persons,  as  the 
medical  staffs  of  the  navy  and  incorporated  hospitals  and  persons  acting 
in  "emergency";  but  Lee  Wah  invoked  this  emergency-saving  clause  of 
the  California  statute  in  vain,  when  he  claimed  that,  as  his  patient's  case 
had  been  pronounced  hopeless  by  all  the  Caucasian  practitioners,  an 
emergency  existed  wherein  his  eastern  arts  might  be  gratuitously  prac- 
ticed. The  court,  taking  judicial  cognizance  perhaps  of  the  fact  that 
the  cure  of  patients  is  not  the  sole  reason  for  the  existence  of  physicians, 
held  that  "emergency"  under  the  act  meant  inability  to  get  a  qualified 
practitioner,  not  inability  of  the  doctor  to  cure  the  patient. tt 

The  Contract  and  Fees. — Under  the  Roman  and  civil  law,  and  for- 
merly in  England,  the  services  of  a  physician  to  his  patient  were  in  legal 
contemplation  honorific,  like  those  of  an  advocate  or  barrister.!!    Any 

*  Alcott  vs.  Barber,  1  Wend.  526 ;  Thompson  vs.  Staats,  15  Wend.  395 ;  Smith  vs. 
Tracci/,  2  Hall  (N.  Y.)  465  ;  Underwood  vs.  Scott,  43  Kan.  714 ;  23  Pac.  942  ;  State  vs.  Fan 
Doran,  109  N.  C.  864. 

t  Anile  vs.  State,  6  Tex.  Ap.  202;  Ellison  vs.  State,  6  Tex.  Ap.  249;  State  vs.  Van 
Doran,  supra.  In  a  recent  English  case,  however  (Apothecaries  Co.  vs.  Jones  (1893), 
1  Q.  B.  89 ;  5  R.  101),  it  was  held  that  to  advise,  prescribe  for,  and  dispense  medicine 
to  three  separate  persons  on  one  day  did  not  constitute  three  separate  offenses.  Haw- 
kins, J.,  said :  "The  statutes  contemplate  habitual  conduct,  not  isolated  acts.  ...  It 
is  idle  to  lay  down  a  golden  rule  upon  the  subject ;  each  case  must  depend  upon  the 
particular  circumstances  attending  it."  And  in  a  very  late  New  York  case  an  agree- 
ment not  to  pi'actice  within  a  certain  radius  was  held  to  contemplate  practice  as  a 
custom.  Greenfield  vs.  Oilman,  140  N.  Y.  168 ;  cf.  Pedgrift  vs.  Chevallier,  8  C.  B.  N.  S. 
240._  In  Luck  vs.  Bipon,  52  Wis.  196,  the  court  declined  to  discuss  whether  acting  as 
a  midwife  was  practice  of  medicine. 

X  Reynolds  vs.  Graves,  3  Wis.  416 ;  Brown  vs.  Mims,  2  Mill  Con.  (S.  C.)  235 ;  Sutton  vs. 
Facey,  1  Mich.  243. 

§  Apoth.  Co.  vs.  Warburton,  3  Barn  &  Ad.  40 ;  cf.  Steed  vs.  Henley,  1  C.  &  P.  574. 

||  Wctherell  vs.  Marion  Co.,  28  Iowa,  22;  Clinton  Co.  vs.  Ramsey,  20  111.  Ap.  577; 
Stewart  vs.  Raab,  (Minn.)  56  N.  W.  256. 

H  Musser's  Executor  vs.  Chase,  29  Ohio  St.  577. 

**  Nelson  vs.  State,  (Ala.)  12  So.  421. 

tt  People  vs.  Lee  Wah.  71  Cal.  80;  11  Pac.  851. 

XX  Boucher  vs.  Norman,  3  B.  &  C.  744. 


LEGAL  EELATIONS   OF  FHYSICIAXS  AXD  SUEGEOXS.  605 

•one  might  give  medical  advice.  The  relation  of  physician  and  patient 
established  of  itself  no  right  to  compensation  for  services.  And  an 
action  for  fees  could  not  be  maintained  by  a  physician  on  an  implied 
contract,  as  might  be  done  by  apothecaries  and  surgeons,*  who,  being  in 
England  successors  to  the  grocer  and  barber,  were  viewed  rather  as 
tradespeople.  But  if  an  express  contract  were  made  by  the  patient  to 
pay  for  the  services,  an  action  would  lie  to  enforce  it.t  Since  the  passage 
of  the  Medical  Act,  any  one  registered  thereunder  may  bring  an  action  to 
recover  fees  upon  the  implied  contract  unless  the  by-laws  of  his  college 
forbid  him  to  sue,  in  which  event  such  prohibition  may  be  pleaded  in 
bar .|  Such  a  by-law  was  made  by  the  Royal  College  of  Physicians,  pur- 
suant to  the  permission  of  the  act,  to  wit:  "No  fellow  of  the  college 
shall  be  entitled  to  sue  for  professional  aid  rendered  by  him;"  but  this 
prohibition  applies  only  to  fellows,  not  to  members.§  In  the  United 
States  the  honorarium  theory  has  never  been  favored ;  the  relation  of 
physician  and  patient  has  been  regarded  in  law  as  merely  contractual ; 
and  in  the  absence  of  special  agreement  an  action  will  He  upon  the  im- 
plied contract,  1 1  which  is  on  the  physician's  part  that  when  he  profes- 
sionally attends  a  patient,  at  the  latter's  request  or  with  his  assent, 
whether  for  compensation  or  not  is  immaterial^]  he  undertakes  not  to 
insure  or  guarantee  a  cure,**  but,  first,  that  he  possesses  that  reasonable 
•degree  of  learning  and  skill  which  is  ordinarily  possessed  by  members 
of  his  profession  and  is  regarded  by  the  community  and  by  those  con- 
versant with  the  employment,  as  necessary  to  qualify  him  to  engage  in 
medical  practice ;  second,  that  he  will  use  reasonable  and  ordinary  care 
and  diligence  in  the  exercise  of  his  skill  and  the  application  of  his  knowl- 
edge to  accomplish  the  purpose  for  which  he  is  employed ;  third,  to  use 
his  best  judgment  in  the  exercise  of  his  skill  and  the  application  of  his 
diligence.  Such  is  the  rule  laid  down  in  a  strenuously  contested  mal- 
practice case  in  the  State  of  New  York,tt  in  which  the  decision  followed 
along  the  lines  of  a  leading  New  Hampshire  case4|  The  same  rule  has 
been  laid  down  in  other  jurisdictions  with  slight  modifications;  thus  it 
has  been  said  that  the  degree  of  skill  and  knowledge  required  in  any 
locality  must  be  that  ordinarily  possessed  by  physicians  in  the  like  gen- 
eral neighborhood  and  lines  of  practice,§§  having  regard  to  the  advanced 
state  of  the  profession  at  the  time ;  ||||  it  being  manifestly  unfair  to  exact 
the  same  degree  of  attainment,  especially  in  surgical  skill,  of  a  practi- 

*  Dixon  vs.  Bell,  1  Stark  N.  P.  287 ;  Chorlei/  vs.  Bolcott,  4  T.  R.  317. 

t   reitchvs.  Eussell,  12  L.  J.  Q.  B.  513. 

X  Gibbon  vs.  Budd,  32  L.  J.  Ex.  182 ;  21  &  22  Vict.  c.  90,  s.  31. 

$   Gibbon  vs.  Budd,  supra  (note). 

||  Peck  vs.  Hutchinson,  (Iowa)  55  N.  W.  511 ;  Garrey  vs.  Stadia;  67  Wis.  512 ;  30  N. 
W.  787. 

f  This  seems  to  have  been  doubted,  but  it  is  the  true  modern  and  humane  rule, 
DuBois  vs.  Decker,  130  N.  Y.  325;  Becker  vs.  Jminski,  15  N.  Y.  Supl.  675;  27  Ab.  N. 
€.  45;  McCandless  vs.  McWha,  22  Pa.  St.  261 ;  McXevins  vs.  Lowe,  40  111.  209;  Gladwcll 
vs.  Steggall,  5  Bing.,  (N.  C.)  733. 

**  Hesse  vs.  Knippel,  1  Mich,  nisiprius,  109 ;  Becker  vs.  Janinski,  supra;  Teft  vs.  Wil- 
cox, 6  Kan.  46;  Lanphier  vs.  Fliipos,  8  C.  &  P.  475. 

tt  Carpenter  vs.  Blake,  10  Hun,  358;  afd.  75  N.  Y.  12  (see  Same  Case,  60  Barb.  488; 
rev'd  50  N.Y.  696) ;  and  cf.  Link  vs.  Sheldon,  136  N.Y.  1 ;  Brannervs.  Stormont,  9  Kan.  51. 

XX  Leighton  vs.  Sargent,  27  N.  H.,  (7  Post.)  460. 

§§  Small  vs.  Howard,  128  Mass.  131 ;  Hitchcock  vs.  Burgett,  38  Mich.  501. 

Jill   Gates  vs.  Fleischer,  67  Wis.  504;  30  N.  W.  674 ;  Small  vs.  Howard,  128  Mass.  131. 


606  A  SYSTEM  OF  LEGAL   MEDICINE. 

tioner  in  a  sparsely  settled  country  devoid  of  libraries  and  hospitals,  as 
may  be  properly  expected  of  one  practicing  in  a  great  city.  But  it  was 
held  erroneous  and  misleading  to  charge  that  a  defendant  was  only 
bound  to  employ  the  degree  of  skill  ordinarily  exercised  in  the  locality 
wherein  he  practiced,  for  it  might  happen  that  there  were  none  but 
quacks  practicing  in  the  vicinity,*  and  proper  to  charge  that  he  should 
have  the  average  skill  possessed  by  the  profession  as  a  body,  having  re- 
gard to  the  advanced  state  of  the  profession  at  the  time  of  treatment,! 
or  ordinarily  possessed  by  physicians.^  So  it  has  been  said  that  the  true 
standard  by  which  to  determine  the  skill  to  be  expected  of  a  physician 
is  not  that  of  the  thoroughly,  moderately,  or  well  educated,  but  of  the 
average.§  The  law  recognizes  both  that  a  small  matter  if  worth  doing- 
is  worth  doing  well,  and  that  in  a  grave  cause  one  can  only  do  his  best, 
and  therefore  it  has  been  held  error  to  charge  that  the  degree  of  care 
and  skill  required  of  a  surgeon  should  be  proportionate  to  the  severity 
of  the  injury.||  And  a  refusal  to  call  in  other  medical  aid  by  one  who 
considers  himself  competent  to  treat  the  case  neither  increases  nor  dimin- 
ishes a  physician's  liability ,1]  for  the  patient's  privilege  is,  if  dissatisfied, 
to  dismiss  the  doctor,  not  to  force  him  to  call  for  aid  that  in  his  judg- 
ment is  unnecessary.  The  physician's  contract,  too,  is  to  be  construed  by 
the  standards  of  his  "  school,"  for  the  law  recognizes  no  particular  system 
of  practice  as  infallible.** 

There  is  no  legal  obligation  upon  a  physician  to  obey  a  call  ;tt  although 
it  is  readily  conceivable  that  such  a  refusal  might  be  inhuman  and  in 
violation  of  the  honorable  standards  and  traditions  of  the  profession.  It 
was  formerly  said  that  legally  the  obligation  of  the  physician  is  in  the 
nature  of  the  mandate  of  the  civil  law,  because  its  assumption  is  volun- 
tary, and  under  the  honorarium  practice  gratuitous,  and  therefore  when 
medical  services  were  uncompensated  that  the  physician  was  only  liable 
for  gross  negligence.  But  it  is  now  considered  that  his  duty  must  be 
properly  fulfilled ;  and  a  physician  is  bound,  if  he  undertakes  a  case, 
even  though  gratuitously,  to  remain  in  charge  of  it  as  long  as  his  care 
is  needed,  unless  he  be  dismissed  or  sever  his  relations  upon  due  notice  ;|t 
and  the  fact  that  the  patient,  a  married  woman,  is  removed  from  her 
husband's  house  during  the  attendance  does  not  of  itself  dissolve  the 
relation.§§  It  has  been  held,  as  a  matter  of  pleading,  that  under  an  alle- 
gation of  "  carelessness,  negligent,  and  unskillful  conduct,"  abandonment 
may  be  shown  ;||||  but  the  defendant  may  testify  that  he  abandoned  the 
case  because  a  third  person  told  him  that  he  was  discharged ;  although 
he  cannot  repeat  the  conversation  unless  it  took  place  in  plaintiff's  pres- 
ence.||||  Whether  or  not  there  was  an  abandonment  must  in  almost  all 
cases  become  a  question  for  the  jury,  as  in  a  recent  New  York  action  for 

*  Gramm  vs.  Boener,  56  Ind.  497. 
t  Peck  vs.  Hutchinson,  (Iowa)  55  N.  W.  511. 
X  Hewitt  vs.  Eisenbart,  (Neb.)  55  N.  W.  252. 

§  Smothers  vs.  Hanks,  34  Iowa,  286  ;  Almond  vs.  Nugent,  34  Iowa,  300. 
||    Utley  vs.  Burns,  70  111.  162.  H  Potter  vs.  Warner,  91  Penn.  St.  362. 

**  Patten  vs.  Wiggin,  51  Me.  594 ;  Bowman  vs.  Woods,  1  Greene,  (Iowa)  441. 
tt  Becker  vs.Janinski,  15  N.  Y.  Supl.  675;  cf.  Carpenter  vs.  Blake,  75  N.  Y.  12. 
XX  Ballon  vs.  Prescott,  64  Me.  305;  Dale  vs.  Donaldson  Lumber  Co.,  48  Ark.  188; 
2  S.  W.  703 ;  Becker  vs.  Janinski,  supra ;  and  see  note  to  this  case  in  27  Ab.  N.  C.  45. 
§§  Potter  vs.  Virgil,  67  Barb.  578. 
Illl  Lawson  vs.  Conaivay,  37  W.  Va.  159. 


LEGAL  RELATIONS   OF  PHYSICIANS  AND  SURGEONS.  607 

damages,  resulting  from  a  surgeon's  alleged  failure  to  discover  a  fracture 
of  the  arm.  Defendant,  who  was  in  this  corroborated  by  another  sur- 
geon, testified  that  the  swollen  condition  of  the  arm  when  he  was  called 
in  made  it  impossible  at  that  time  to  discover  the  extent  of  the  injury; 
that  he  gave  proper  instructions  for  reducing  the  swelling,  and  on  his 
second  visit  was  told  not  to  call  again.  This  the  plaintiff  denied,  but 
the  jury  believed  the  doctor  and  gave  him  their  verdict,  which  was  sus- 
tained* It  follows  from  what  has  been  said,  and  is  also  common  sense, 
that  a  physician  is  the  best  judge  of  the  number  <>t'  visits  necessary.} 
Whenever  the  question  of  lack  of  skill  or  qualification  arises  in  mal- 
practice, the  burden  of  proof  is  on  him  who  alleges  it;t  it  being  a  cor- 
ollary to  the  principle  that  a  physician  is  not  an  insurer  of  success, 
that  lack  of  skill  will  not  be  inferred  from  a  bad  result,  but  must  be 
proved  positively.§  Such  being  the  physician's  obligation,  that  of  the 
patient  is,  first,  to  tell  the  physician  frankly  all  about  the  case ;  second, 
to  follow  directions,  if  they  be  such  as  a  physician  of  ordinary  skill 
would  sanction ; ||  and  failure  in  tins  regard  will  subject  him  to  no  other 
penalty  than  dying  or  getting  well,  whichever  be  the  worse,  accord- 
ing as  the  physician's  skill,  the  patient's  constitution,  and  Providence 
may  determine ;  third,  and  not  least  important,  to  pay  the  doctor  for  his 
services^]  an  obligation  which,  should  the  patient  die,  survives  to  his  per- 
sonal representatives. 

Apart  from  this  implied  contract,  it  is  competent,  of  course,  for  doc- 
tor and  patient,  like  any  other  persons,  to  make  whatever  special  con- 
tract may  please  them.  The  Chinese  plan  of  paying  the  medical  man 
by  the  year,  deducting  all  the  time  during  which  he  suffers  the  patient 
to  be  ill,  is  not  without  merit,  albeit  founded  on  an  estimate  at  once 
cynical  and  exalted  of  medical  character  and  capability.  This  ''no 
cure  no  pay"  system  is  highly  favored  in  rural  communities  where 
faith  in  panaceas  flourishes.  In  Alabama,  Dr.  King  contracted  in  this 
form  to  cure  one  Jones  of  his  sickness  by  divers  clysters.  Prompt  suc- 
cess not  crowning  King's  efforts,  Jones  refused  to  submit  further  to  the 
treatment  unless  informed  what  manner  of  stuff  was  injected  into  him. 
King  refused  to  say  more  than  that  it  was  a  good  thing,  though  his  own ; 
but  finding  his  honor,  his  nostrum,  and  above  all  his  fee,  in  danger,  he 
brought  an  action  to  recover  of  Jones  one  hundred  dollars ;  whereupon 
Jones  pleaded  in  defense  that  the  panacea  was  no  panacea  at  all,  but  a 
worthlessness.  King  got  a  verdict,  but  the  Appellate  Court  reversed  the 
judgment  because  Jones  was  not  allowed  on  cross-examination  to  ask 
what  the  ingredients  of  the  clyster  were.**  From  such  examples  it  would 
seem  that  the  practical  English  custom  of  stationing  an  incorruptible  boy 

-   Gedney  vs.  Eingsley,  62  Hun,  620;  16  N.  Y.  Supl.  792. 

+  Todd  vs.  Myers,  40  Cala.  355 ;  Ballon  vs.  Prescott,  64  Me.  305. 

t  State  vs.  Housekeeper,  70  Md.  162  ;  16  Atl.  382. 

§  Pettigrew  vs.  Lewis,  46  Kan.  78 ;  26  Pae.  458 ;  Sims  vs.  Parker,  41  111.  Ap.  284 ; 
Lawson  vs.  Conaway,  37  W.  Va.  159. 

||  Potter  vs.  Warner,  91  Pa.  St.  362  ;  Young  vs.  Mason,  35  N.  E.  521 ;  cf .  Carpenter  vs. 
Blake,  75  N.  Y.  12 ;  and  see  article  on  malpractice  on  the  point  of  how  far  failure  to 
obey  instructions  is  a  defense  to  that  action. 

H  Peek  vs.  Hutchinson,  55  N.  W.  511 ;  Garro/  vs.  Stadler,  67  Wis.  512  ;  30  N.  W.  787. 

**  Jovas  vs.  King,  81  Ala.  285;  1  So.  591;  cf.  Smith  vs.  Hyde,  19  Vt.  54;  Mock  vs. 
KeUy,  3  Ala.  387.  to  the  effect  that  a  promise  to  cure  savors  of  false  pretense,  see 
Hupe  vs.  Phelps,  2  Stark.  480. 


G08  A  SYSTEM  OF  LEGAL  MEDICINE. 

in  the  hall  to  take  fees  in  advance,  or  directing  the  patient  to  place  the 
guinea  stealthily  somewhere  in  sight,  preserves  at  once  the  dignity  of  the 
honorarium  and  secures  the  compensation  of  the  physician  even  better 
than  does  the  right  to  go  to  law.  Another  instance  points  the  same 
moral,  that  it  is  wise  to  secure  payment  betimes.  Nowadays,  when  wealth 
accumulates  and  rich  men  are  unwilling  to  decay,  it  is  not  uncommon  for 
Midas  to  cany  ^Esculapius  with  him  en  voyage,  to  their  mutual  pleasure 
and  profit.  Accordingly,  when  an  amiable  banker  of  New  York,  about 
sailing  for  Europe,  asked  his  friend  and  family  physician  to  accompany 
him,  giving  to  the  doctor  also  a  check,  a  letter  of  credit,  and  tickets  for 
himself  and  wife,  it  seemed  to  the  medical  man  that  he  might  safely  re- 
linquish his  excellent  practice  for  a  while.  Unfortunately,  the  patient 
was  in  good  health,  and  very  considerately  declined  to  exact  personal  at- 
tendance of  the  doctor  all  the  time,  though  expressing  much  pleasure  in 
the  latter's  s<  >ciety  and  a  desire  to  have  him  within  telegraphic  communi- 
cation. The  physician  and  patient,  therefore,  traveled  separately,  and 
while  abroad  met  but  three  times,  on  none  of  which  were  medical  services 
rendered.  After  the  banker's  death  the  physician  sued  the  estate  for  the 
value  of  his  services,  and  a  referee  nonsuited  him.  The  General  Term 
of  the  Supreme  Court  held,  very  reluctantly,  owing  to  the  physician's 
high  character,  that  as  there  was  no  contract  upon  these  facts,  and  no 
service  had  been  rendered,  there  could  be  no  valid  claim  against  the  ex- 
ecutor.* But  the  Court  of  Appeals  held  the  nonsuit  to  be  erroneous, 
and  on  a  new  trial  plaintiff  secured  a  verdict.  A  somewhat  similar  case 
arose  in  Louisiana,  whence  a  physician,  practicing,  however,  as  a  dentist, 
was  called  to  Atlanta  by  a  dying  aunt  to  look  after  her  affairs.  He  ren- 
dered medical  services  to  the  invalid  and  charged  the  estate  therefor ; 
but  the  court  refused  to  allow  his  bill,  because  he  was  not  in  attendance 
.as  a  physician. t     The  question, 

Who  is  liable  for  the  fees?  has  often  arisen.  In  a  New  York  case, 
which  has  never  been  cited  as  authority,  the  court  went  so  far  as  to 
hold  that  one  who,  in  behalf  of  another,  went  for  a  physician  and  in 
the  latter's  absence  left  his  card  with  the  following  message,  "  Call  on 
Mrs.  Day,  at  No.  7G9  Broadway,"  was  liable  for  the  doctor's  services 
rendered  to  Mrs.  Day ;  this  on  the  ground  that  the  messenger  did  not 
reveal  his  agency.J  If  this  be  good  law,  who  can  safely  take  a  message 
to  a  physician?  In  a  North  Carolina  case  of  like  nature  the  jury 
reached  a  more  sensible  conclusion,  and  considered  the  defendant  a  mere 
messenger  and  not  liable ;  there  seems  to  be  lacking  in  the  former  case 
that  which  is  of  the  essence  of  all  contract,  a  meeting  of  the  minds  of 
the  parties  on  the  same  agreement  and  mutual  consideration,  actual  or 
justly  inferable.  And  the  New  York  Court  of  Appeals,  a  few  months 
after  that  decision,  which  was  not  appealed,  reversed  a  similar  but  less 
unreasonable  judgment  of  the  General  Term  of  the  Supreme  Court.     It 

*  Forbes  vs.  Chichester,  8  N.  Y.  Supl.  747  ;  revd.  125  N.  Y.  769 ;  retried  as  Forbes  vs. 
Kennedy,  76  Hun,  39. 

t  Succession  of  Dickey,  60  So.  798;  41  La.  An.  1010. 

i  Bradley  vs.  Dodge,  45  How.  Pr.  57.  But  the  same  court  held  that  one  who  left 
with  a  physician  a  telegram  from  his  sick  brother  was  not  liable  to  the  doctor  for  ser- 
vices rendered  pursuant  to  the  message  ;  Buck  vs.  Amidon,  41  How.  Pr.  370.  So  where 
a  plantation  physician  sent  for  a  surgeon  to  operate  on  a  slave  he  was  held  not  liable  ; 
Guerard  vs.  Jenkins,  1  Strobh.  (S.  C.)  171. 


LEGAL  RELATIONS   OF  PHTSICIAXS  AND   SUBGEONS.  G09 

appeared  in  this  latter  case  that  Mrs.  Martine,  thirty  years  of  age,  whose 
husband  was  alive,  lay  ill  at  the  house  of  her  father,  Mr.  Bandouine,  who 
employed  two  physicians  to  attend  her.  Like  many  another  man,  Mr. 
Bandouine  grew  anxious  and  told  a  neighbor,  Mrs.  Louther,  that  he 
wasn't  satisfied,  and  wished  that  her  doctor  might  see  his  daughter. 
Mrs.  Louther  said  her  physician  was  Dr.  Crane.  Mr.  Bandouine  spoke 
in  like  fashion  to  Mr.  Louther,  who  said  that  Dr.  Crane  was  "  a  first-rate 
physician";  whereupon  Bandouine  said  he  had  an  idea  of  sending  for 
him.  Subsequently  a  man,  who  afterward  proved  to  be  Mr.  Martine, 
called  on  Dr.  Crane  and  said  that  Mr.  Bandouine  would  like  that  physi- 
cian to  call  on  his  said  daughter.  Dr.  Crane  did  call,  and  on  many  days, 
always  finding  in  the  room  Mr.  Bandouine,  who  received  the  doctor's 
instructions  and  acquiesced  in  his  suggestion  thatj-et  another  physician 
be  called  in.  This  was  Dr.  Crane's  story,  which  Mr.  Bandouine  contra- 
dicted in  material  regards ;  but  while  the  Appellate  Court  rested  their 
decision  on  the  ground  that,  in  the  conflict  of  testimony,  the  referee 
was  entitled  to  believe  the  defendant  and  find  accordingly,  they  also  in- 
timated strongly  that  the  facts  as  recited  by  the  doctor,  even  if  uncon- 
tradicted, did  not  give  rise  to  any  implied  contract  by  Mr.  Bandouine  to 
pay  for  medical  services  rendered  to  his  adult  married  daughter*  To 
the  same  purport  is  a  Pennsylvania  case,  where  it  was  held  that  a  father 
who  called  a  physician  to  attend  his  adult  son  in  the  father's  house  was 
not  liable.f  And  it  was  held  in  Alabama  that  an  obligation  to  pay  for 
medical  services  would  not  be  implied  necessarily  on  the  part  of  a  third 
person,  who  urged  a  physician  to  continue  attendance  which  the  latter 
had  begun  at  the  patient's  request  and  was  about  to  renounce.i:  So  also 
where  a  man  took  his  insane  brother  to  a  private  lunatic  asylum  for  care 
and  treatment,  the  court  said :  "  He  is  not  liable  unless  he  promised  to 
pay."§  But  wherever  it  is  clear  that  the  third  person  has  induced  the 
physician  to  render  services  upon  his  credit,  then,  undoubtedly,  he  is 
liable. | j  Thus  in  California  it  was  held  that  one  who  called  in  a  physi- 
cian to  attend  his  wife  was  estopped,  notwithstanding  the  incompleteness 
of  divorce  proceedings  instituted  by  the  lady  against  her  former  lord,  to 
deny  the  marital  relation  and  assert  one  as  tender  but  perhaps  less  legal. 
The  case  was  curious,  too,  in  this,  that  Dr.  Gerlaeh,  the  physician,  first 
sued  the  administrator  of  the  lady,  and  was  defeated  by  proof  that  she 
was  married  to  Mr.  Turner,  who  had  employed  the  doctor;  wherefore  her 
separate  estate  was  held  not  to  be  liable.  With  a  laudable  desire  to  col- 
lect his  fees  the  physician  then  sued  Mr.  Turner  himself,  and  again  was 
nonsuited  on  the  ground  that  decedent  was  but  a  fair  friend  of  defend- 
ant, and  had  contracted  to  pay  for  the  medical  services  out  of  her  own 
estate.  But  the  Appellate  Court  said  that,  while  such  a  sphinx-like 
result,  though  a  great  hardship,  might  be  legally  possible,  yet  in  this 
particular  case  the  facts  showed  that  Mr.  Turner  had  represented  himself 

*  Crane  vs.  Bandouine,  55  N.  Y.  256 ;  revg.  65  Barb.  260.  Where  A  and  wife  gave  a 
bond  to  support  C,  and  a  physician  who  attended  C  with  Mrs.  A's  knowledge,  but  with 
notice  that  A  would  not  be  responsible,  elected  to  credit  C's  estate ;  held  that  A  and 
wife  were  not  liable  for  his  services.     Shaw  vs.  (trans  8  Atl.  884;  79  Me.  166. 

t  Boyd  vs.  Sappington,  4  Watts,  247. 

t  Currey  vs.  Shelby,  90  Ala.  277. 

$  Smith  vs.  Watson,  14  Vt.  332. 

||   Hanford  vs.  Higgins,  1  Bosw.  441. 


G10  A   SYSTEM  OF  LEGAL  MEDICINE. 

as  the  lady's  husband,  which  was  quite  enough  to  make  him  liable.  So 
Dr.  Gerlach  got  his  fee  by  the  aid,  although  almost  in  spite  of  the  law;* 
for  under  the  general  principle  that  a  husband  must  furnish  his  wife 
with  necessaries  suitable  to  her  condition  in  life,  he  is  liable  for  medical 
services  rendered  to  her  unless  a  special  agreement  on  her  part  is  shown, f 
even  if  without  fault  on  her  part  she  be  living  away  from  his  domi- 
cile.$  But  she  may  contract  to  pay  out  of  her  separate  estate ;  and  if 
she  be  separated  from  her  husband  by  her  own  fault,  as  if  she  be  living 
in  adultery,  the  latter  will  not  be  liable  unless  he  authorizes  the  services.§ 
"Mesmeric  treatment,"  including  " dreams,  visions,  and  revelations,"  has 
been  held  to  be  a  "fancy  article"  and  not  necessary.|| 

A  father  should  supply  his  child  with  necessaries.  In  England  and 
in  some  of  our  States  this  duty  is  imposed  by  law  as  to  children  of  very 
tender  years ;  and  under  an  English  statute  to  this  effect,  one  of  the 
"Peculiar  People"  was  convicted  of  manslaughter  because  his  child  died 
for  lack  of  medical  attendance,  which  was  not  supplied,  in  obedience  to 
the  tenets  of  his  sect,  which  held  such  aid  to  be  contrary  to  the  teachings 
of  St.  James  V.  14,  15.|f  In  a  similar  case  in  New  York  the  child  of  an 
Episcopal  missionary  was  taken  from  the  father  by  a  humane  society  and 
put  under  surgical  care,  because  the  parent,  with  greater  faith  than  wis- 
dom, refused  to  do  more  for  the  infant's  broken  arm  than  adopt  this  same 
apostolic  but  surgically  ineffectual  treatment ;  the  bisliop  of  the  diocese,  it 
is  said,  very  properly  disapproved  of  the  missionary's  views.  Although  at 
common  law  it  is  considered  that  the  duty  of  employing  a  physician  for  a 
child  is  moral  only  and  not  legal,**  still  if  the  medical  services  can  be  said 
to  have  been  rendered  with  the  father's  assent  or  with  his  knowledge  and 
without  objection,  a  contract  will  be  implied ;  and  such  assent  may  be 
implied  even  though  the  child  have  left  the  parental  roof ;  ft  but  not  if 
the  parent  provide  for  the  child  and  does  not  assent  to  the  services.tj 
Inability  of  the  father  to  pay  does  not  make  the  child  liable.§§ 

Lord  Keiryon  was  of  opinion  that  a  master  was  liable  for  medical  ser- 
vices rendered  to  his  servant  ;||||  but  such  is  not  the  rule,^|^[  except  where 
a  contract  of  service  involves  that  obligation,  as  apprenticeship. 


■JpTf  W 


*  Gerlach  vs.  Turner,  89  Cala.  446  ;  26  Pac.  870. 

t  In  re  Shipman's  estate,  5  N.  Y.  Supl.  559 ;  22  Ab.  N.  C.  289.  Eevd.  in  part  on 
another  point :  53  Hun,  511 ;  23  Ab.  N.  C.  101 ;  6  Supl.  276. 

X  Harrison  vs.  Grady,  13  L.  T.  N.  S.  369  ;  Thorpe  vs.  Shapleigh,  67  Me.  235  ;  Webber  vs. 
Sjpannhalce,  2  Eeclf.  258. 

§  Cooper  vs.  Lloyd,  6  C.  B.  N.  S.  519.  As  to  separate  estate,  see  Moody  vs.  Osgood, 
50  Barb.  628. 

||    Wood  vs.  0>  Kelly,  62  Mass.  (8  Cush.)  406. 

1[  R.  vs.  Downs,  13  Cox.  C.  C.  Ill,  under  31  &  32  Vict.  e.  122,  s.  37.  Prior  to  the 
statute  there  had  been  an  acquittal  in  a  like  case  :  R.  vs.  Wagstaffe,  10  Cox.  C.  C  530. 

**  R.  vs.  Wagstaffe,  supra;  Kelh/  vs.  Davis,  49  N.  H.  187;  Gordon  vs.  Potter,  17  Vt. 
348. 

tt  Porter  vs.  Poicell,  44  N.  W.  295 ;  79  Iowa,  151  ;  Gilley  vs.  Gilley,  9  Atl.  623  (Me.) ; 
Deane  vs.  Ann  is,  14  Me.  236 ;  Swain  vs.  Tyler,  26  Vt.  1 ;  Ncilson  vs.  Gray,  17  N.  Y.  Supl. 
500  ;  Hunt  vs.  Thompson,  4  111.  179. 

\\  Rogers  vs.  Turner,  59  Mo.  116. 

§§  Hoyt  vs.  Casey,  114  Mass.  397.  An  infant  living  with  a  parent  or  guardian  who 
provides  for  it,  cannot  bind  its  estate  for  necessaries ;  but  a  stepfather  is  not  bound 
to  support  his  predecessor's  children:  Atchison  vs.  Bruff.  50  Barb.  381;  cf.  3  Barn.  & 
C.  484. 

Illl  Scarman  vs.  Castell,  1  Esp.  270.  Htf  Sellen  vs.  Norman,  4  C.  &  P.  80. 

***  R.  vs.  Smith,  8  C.  &  P.  153. 


LEGAL  EELATIOXS   OF  PHYSICIANS  AND  SUBGEOXS.  611 

Agents. — Neither  for  services  rendered  to  themselves  or  others  can 
servants,  not  authorized  to  do  so,  bind  principals  to  pay.  Thus,  if  the 
superintendent  of  a  corporation  send  for  a  physician  to  attend  a  man  in- 
jured in  its  employ,  no  contract  by  the  corporation  to  pay  for  the  medical 
service  can  be  implied  from  this  fact  alone ;  for  the  relation  of  employer 
and  employed  is  not  such  as  of  itself  to  create  the  obligation*  But  it 
is  otherwise  if  the  superintendent  have  authority  to  employ  a  doctor  in 
such  cases,  and  does,  in  fact,  employ  one.t  Dr.  Cooper  sued  the  New 
York  Central  and  Hudson  River  Railroad  Company  to  recover  fees  for 
attending-  on  and  amputating'  the  leg  of  one  Haley,  an  employee  of  the 
defendant.  It  appeared  that  the  engineer  of  defendant's  train,  Scanlon, 
had  thus  telegraphed  to  its  station-agent,  Martin :  "  June  6,  J.  Martin : 
Have  Mr.  Cooper  at  depot  on  arrival  of  No.  1 ;  man  hurt.  J.  Scanlon." 
Martin  sent  this  telegram  hy  a  hackman  to  the  physician,  who  also 
•offered  testimony,  which  was  held  irrelevant,  to  prove  previous  employ- 
ment by  defendant  in  other  cases.  The  doctor  was  nonsuited  upon  the 
ground  that  there  was  no  proof  that  the  engineer  and  station-agent  had 
power  to  bind  the  company  to  pay  for  medical  services.!  Where,  how- 
ever, a  railroad  conductor  employed  a  physician  under  somewhat  similar 
-circumstances,  and  notice  of  the  employment  was  conveyed  by  both  con- 
ductor and  physician  to  the  company's  superintendent  and  general  agent, 
and  the  employment  was  not  questioned  or  repudiated,  the  contract  was 
held  to  be  ratified,  and  a  cause  of  action  to  recover  fees  made  out.§  In 
England,  since  the  cases  cited  in  Cooper  vs.  Railroad,  the  employees' 
authority  has  been  implied.  ||  Where  ratification  is  needed  slight  acts 
will  be  so  construed.^} 

If  physicians  are  called  in  consultation  with  the  assent  of  the 
patient,  obviously  he  is  liable  to  them  for  their  fees ;  and  in  an  extreme 
•case  the  patient  was  held  thus  liable  to  a  consultant  called  in  by  the 

*  Meiseribach  vs.  Soutlieru  Cooperage  Co.,  45  Mo.  Ap.  232. 

t  McCarthy  vs.  E.  E.,  15  Mo.  Ap.  385. 

t  Cooper  vs.  .V.  Y.  C.  $  H.  E.  E.,  6  Him,  276  ;  citing  Stephenson  vs.  X.  Y.  <f  H.  E.  E., 
2  Duer.  341 ;  Cox.  vs.  Midland  Counties  Eailway,  3  Exch.  (Welsby  H.  &  G.)  268. 

§  Terre  Haute  eye.  E.  E.  Co.  vs.  Stockwell,  il8  Ind.  98;  20  N.  E.  650;  Mitchell,  J., 
•dissenting  so  far  as  the  opinion  seems  to  hold  that  the  conductor  could  employ  a  phy- 
sician without  express  authority  to  do  so. 

||    Walker  vs.  Great  Western  By.  Co.,  2  L.  E.  Ex.  228. 

51  Cairo  #c.  E.  E.  Co.  vs.  Mahoney,  82  111.  73.  The  modern  tendency  is  to  hold  a 
railroad  company  liable  for  medical  services  rendered  in  emergency  at  the  request  of 
an  employee  to  servants  of  the  company  or  passengers  injured  on  the  road.  Thus  in 
Toledo  tfc.  E.  E.  vs.  Bodrigues,  47  111.  188,  a  contract  by  a  station-master,  affirmed  by 
superintendent,  for  services  to  a  brakeman  was  sustained.  So  also  if  the  superin- 
tendent do  not  disaffirm  the  subordinate's  request  (  Toledo  $c.  B.  B.  vs.  Prince,  50  111. 
26;  Cairo  <$•  St.  L.  E.  E.  vs.  Mahoney,  82  111.  73).  The  power  of  a  railway  superin- 
tendent or  agent  to  contract  for  medical  services  to  injured  passengers  or  servants 
immediately  after  an  accident  is  implied  (Langan  vs.  C.  W.  By.,  30  L.  T.  N.  S.  173; 
Indianapolis  .V-  St.  I,.  E.  E.  vs.  Morris,  67  111.  295),  but  it  has  been  held  that  a  division 
superintendent  cannot  bind  the  road  to  pay  for  services  to  passengers  without  express 
authority,  although  he  may  do  so  as  to  employees  (U.  P.  E.  E.  vs.  Beatty,  35  Kan.  265; 
Brown  vs.  Mo.  A.  $  T.  E.  B.,  67  Mo.  122;  Terre  Haute  $  I.  It.  E.  Co.  vs.  McMurray,  98 
Ind.  358) ;  and  even  as  to  employees  it  is  held  in  Arkansas  that  except  in  emergency  a 
conductor  cannot  without  express  authority  bind  the  road  (St.  L.  A.  §•  I'.  E.  J!,  vs. 
Hoover,  53  Ark.  377).  As  to  nurses,  it  is  said  that  a  railroad  surgeon  has  no  power  to 
employ  them  (Bigham  vs.  Ch.  M.  #  St.  P.  It.  It..  7!»  Iowa,  534),  otherwise  of  a  "general 
manager"  (Louisville  E.  <V'  St.  L.  It.  It.  vs.  McVay,  98  Ind.  391 ;  and  see  Mayberry  vs.  Ch. 
E.  L  A  I'.  E.  E.,  75  Mo.  492;  and  Gin.,  Ind.,  St.  L.  #  Ch.  E.  E.  vs.  Davis,  126  Ind.  99). 


(512  -4   SYSTEM  OF  LEGAL  MEDLCINE. 

family  doctor  from  fear  of  neighborly  criticism,  although  when  the 
attending  physician  asked  for  a  consultant  the  patient  answered, 
"  You'll  do,"  and  only  assented  on  the  doctor's  promise  to  pay  the  con- 
sultant's fee.  The  grounds  of  the  decision  were,  of  course,  that  the 
patient  accepted  the  service,  and  that  the  consultant  did  not  know  that 
he  was  called  for  the  benefit  not  of  the  patient  but  of  the  doctor* 

Although  there  may  be  no  doubt  as  to  who,  if  any  one,  is  liable  un- 
der the  original  contract,  there  maybe  other  reasons  for  refusing  to  pay 
for  medical  attendance.  It  has  been  said  already  that  where  license  and 
registration  laws  exist  compliance  with  their  provisions  is  a  condition 
for  suing  to  recover  fees.  In  England  proof  of  qualification  must  lie 
made  as  part  of  the  plaintiff's  case  ;t  but  in  this  country,  unless  the 
contrary  appear,  it  will  generally  be  presumed  that  plaintiff's  practice 
was  lawful.|  In  a  New  York  case  under  the  old  statute,  which  only 
required  a  physician  to  file  a  copy  of  his  license  with  the  county  clerk 
under  penalty  of  twenty-five  dollars  for  failing  to  do  so,  but  did  not 
prohibit  those  not  complying  with  the  requirement  from  practicing,  it 
was  held  that  an  action  for  fees  could  be  maintained  by  one  who  had  not 
filed  his  license ;  the  forfeiture  being  the  sole  punishment  prescribed  for 
the  omission.§  But  where  practice  by  the  unlicensed  is  forbidden  a  con- 
tract to  pay  fees  is  void,  and  the  fees  cannot  be  recovered  by  the  prac- 
titioner even  though  he  subsequently  become  licensed  I  j  or  the  statute  be 
repealed.!]  Nor  can  an  illegal  practitioner  sue  on  notes  given  for  his  ser- 
vices.** But  even  where  the  statute  forbade  unlicensed  practitioners  to 
sue  for  fees,  it  was  held  that  a  licentiate  might  recover  compensation 
for  the  services  of  his  students  and  assistants.tt  And  in  England  it  was 
said  that  an  unregistered  assistant  might  sue  a  registered  practitioner 
for  salary,  although  an  unlicensed  practitioner  might  not  sue  a  regis- 
tered practitioner  for  services  rendered  to  the  latter's  patients  at  his 
request  ;f|  and  a  physician  may  sue  in  a  State  where  he  is  not  licensed 
for  services  lawfully  rendered  in  another  State.§§ 

*  Shelton  vs.  Johnson,  40  Iowa,  84;  ef.  Garreyxs.  Stadler,  67  Wis.  512. 

t  Morgan  vs.  Buddock,  1  H.  &  W.  505;  Sharpe  vs.  Wagstaffe,  3  M.  &  W.  521. 

$  Thompson  vs.  Sayre,  1  Den.  175;  McPherson  vs.  Cheadell,  24  Wend.  15;  City  of 
Chicago  vs.  Wood,  -24  111.  Ap.  40.  The  English  rule  seems  to  he  better  founded  since 
to  disprove  the  license  is  to  maintain  a  negative,  and  in  Adams  vs.  Stewart,  5  Harr. 
(Del.)  144,  it  was  followed. 

§  Finch  vs.  Grid-ley's  Excrs.,  25  Wend.  4G9. 

||  Puckett  vs.  Alexander,  102  N.  C.  95  ;  8  S.  E.  767  ;  Thompson  vs.  Hagcn,  25  Me.  104  ; 
Gardner  vs.  Tatum,  81  Cala.  370;  22  Pac.  880.  The  English  rule  seems  to  be  that  it 
is  enough  if  the  practitioner  be  registered  at  the  time  of  trial:  Turner  vs.  Beynall, 
8  L.  T.  R.  281.  But  he  must  be  qualified  when  the  service  is  rendered :  Leman  vs. 
Housely,  31  L.  T.  833. 

1f  Bailey  vs.  Mogg,  4  Den.  60;  Warren  vs.  Saxby,  12  Vt,  146.  But  if  the  statute 
does  not  forbid  the  practice,  but  only  forbids  collecting  fees  by  action,  one  may  sue 
after  its  repeal :  Heioitt  vs.  Wilcox,  42  Mass.  (1  Mete.)  154. 

**  Coylr  vs.  Campbell,  10  Ga.  570. 

tt  People  ex  rel  Waring  vs.  Monroe,  0.  P.  4  Wend.  200.  And  he  may  recover  for  his 
assistants:  Board  of  Commrs.  of  Jay  Co.  vs.  Brewington,  74  Ind.  7. 

tt  De  La  Bosa  vs.  Prieto,  10  L.  T.  757.  The  test  seems  to  be  that  the  services  of 
the  unregistered  assistant,  to  be  lawful,  must  be  given  under  the  supervision  of  the 
qualified  practitioner  and  not  independently.  See  Howarth  vs.  Brearly,  56  L.  T.  743  ; 
Dairies  vs.  Makuna,  53  L.  T.  314. 

§§  Downs  vs.  Minchew,  30  Ala.  86. 


LEGAL   RELATIONS   OF  PHYSICIANS  AND  SURGEONS.  G13 

The  contract  being,  as  we  have  seen,  to  furnish  ordinary  skill,  knowl- 
edge, and  diligence,  and  not  to  guarantee  a  cure,  and  no  presump- 
tion of  its  breach  arising  merely  from  a  mistake  in  diagnosis,*  it 
follows  that  death  or  any  other  bad  result  does  not  per  se  constitute 
a  defense  to  an  action  to  recover  compensation  for  services.  Thus, 
if  a  surgeon  operate  upon  a  married  woman  under  his  care,  without 
assent  of  the  husband  or  notice  to  him,  and  the  patient  die,  it  is 
not  necessary  in  suing  for  his  fees  that  the  surgeon  prove  that  the 
operation  was  well  done,  and  with  notice  to  the  husband.t  That  the 
treatment  or  operation  was  ill  done,  harmful,  or  unnecessary  is  an 
affirmative  defense  in  such  an  action,  and  the  burden  of  proof  is  on 
the  defendant.!  If  the  defense  be  negligence  of  nurses,  as  in  a  hos- 
pital, plaintiff  may  show  that  they  were  not  under  his  control.§  There 
is  a  comfortable  Georgia  case  wherein  the  patient  sought  to  evade  pay- 
ing his  doctor  on  the  ground  that  the  latter  tippled ;  but  this  was  held 
to  be  no  defense,  because  defendant  employed  the  doctor  with  knowledge 
of  his  habit.||  In  charging  fees  the  means  of  the  patient  may  properly 
be  considered.^]  But  an  East  Indian  case  holds  that  in  estimating  the 
remuneration  of  a  medical  officer  for  attending  the  family  of  a  public 
servant  the  patient's  prospects  cannot  be  considered ;  and  one  fifth  of 
the  patient's  monthly  income  was  said  to  be  a  fair  sum  for  the  years 
attendance.**  A  physician  may  show  his  own  high  standing  as  well  as 
the  difficulty  or  novelty  of  the  operation  as  bearing  on  the  value  of  his 
services.tt  In  the  absence  of  proof  altering  its  effect  a  receipt  in  full  for 
medical  services  will  be  the  measure  of  their  value.!!  Sometimes  the 
humble  name  of  wages  may  save  the  fees ;  as  where  a  physician's  com- 
pensation of  thirty  dollars  a  day  for  fifty-six  days'  attendance  on  city 
smallpox  patients  paid  in  one  sum  was  held  exempt  from  garnishment 
as  ''wages"  for  personal  services.  §§  A  physician  cannot  show  discover- 
ies, in  skin-grafting,  for  instance,  made  while  attending  a  case,  in  order 
to  enhance  the  value  of  his  services ;  nor  can  he  offer  evidence  as  to  the 
treatment  of  a  physician  subsequently  employed.  ||||  In  dealing  with 
municipal  organizations  the  physician  should  be  wary.  Where  a  statute 
permitted  trustees  of  a  town  to  pay  for  such  medical  relief  rendered  to 
the  poor  as  "  they  deemed  just  and  reasonable,"  their  opinion  as  to  the 
value  was  held  to  be  the  limit  of  recovery,  and  their  rejection  of  a  claim 
as  unjust  and  unreasonable,  to  be  final.flfl    It  was  held,  that  a  physician 

*  Ely  vs.  Wilbur,  49  N.  J.  L.  685;  10  Atl.  358  ;  Lawson  vs.  Conaway,  37  W.  Va.  159. 

t  State  vs. Housekeeper,  70  Md.  102;  McClallen  vs.  Adams,  36  Mass.  (19  Pick.)  333. 

X   Baird  vs.  Morford,  29  Iowa,  531.     See  under  malpractice,  infra. 

§  Baker  vs.  Wentworth,  155  Mass.  338;  29  N.  E.  589;  Perionowsky  vs.  Freeman,  4 
F.  &  F.  977.  But  he  is  liable  for  unskillful  acts  of  his  authorized  assistant:  Hancke 
vs.  Hopper,  7  C.  &  P.  81. 

||  McKleroy  vs.  Seicell,  73  Ga.  657. 

If  Czarnowski  vs.  Zeyer,  35  La.  An.  796.  And  also  unusual  services :  Succession  of 
Short.  (La.)  14  So.  184. 

tt  Lange  vs.  Kearney,  4  N.  Y.  Supl.  14;  45  Hun,  590;  127  N.  Y.  676. 

it  Datizigt  r  vs.  Hoyt,  40  Hun,  270  ;  afd.  120  N.  Y.  190.  And  the  amount  stated  in 
a  bill  rendered  is  not  binding  if  not  assented  to  by  the  patient :  Bronson  vs.  Hoffman, 
7  Hun,  674. 

§§  Sydnor  vs.  City  of  Galveston,  15  S.  W.  202. 

Illl    Gardner  vs.  Tatum,  81  Cala.  370;  22  Pac.  880. 

H1j  Trusters  of  Elizabeth  Township  vs.  White,  48  Ohio  St.  577. 


614  A   SYSTEM  OF  LEGAL   MEDICINE. 

summoned  to  make  an  autopsy  could  not  recover  a  fee  from  the  county 
in  the  absence  of  a  statute  authorizing-  the  expense.*  And  where  at  a 
coroner's  request  a  physician  made  the  autopsy  and  afterward  sued  for 
his  fees,  it  was  held  that  the  measure  of  value  was  what  his  services 
were  worth  in  the  particular  case  ;  and  the  amount  of  his  daily  earnings 
or  what  another  physician  would  charge  were  alike  immaterial. t  But 
under  the  Colorado  statute  providing  that,  if  the  jury  think  it  necessary, 
the  coroner  may  summon  a  physician  to  make  an  autopsy,  for  which 
the  county  shall  pay  a  reasonable  fee,  it  is  not  essential  in  an  action 
for  such  fee  that  the  plaintiff  should  prove  that  the  jury  thought  the 
autopsy  necessary ;  proof  of  the  summons  and  rendition  of  services  are 
sufficient.! 

Medical  services  rendered  in  emergency  to  a  poor  person  not  judi- 
cially declared  to  be  a  pauper  have  been  considered  not  to  be  a  county 
charge,  but  to  have  been  rendered,  presumably,  for  charity  ;§  a  different 
presumption  from  the  quaint  opinion  of  the  court  in  Rose's  case,  supra  : 
"  Therefore  let  the  distemper  be  what  it  will,  the  prescribing  and  advis- 
ing what  is  fit  for  it  is  the  business  of  the  physician,  though  without  a 
fee;  hut  that  rarely  happens."  \\ 

The  rule  as  to  the  fees  of  expert  witnesses  varies  with  the  jurisdic- 
tion. In  New  York,  although  under  the  general  subpoena  a  physician 
must  of  course  appear  in  court  and  testify  to  facts  of  the  case  within 
his  ordinary  observation,  he  will  not  be  compelled  to  give  his  opinion 
on  matters  of  skill  and  science.  And  therefore  it  is  proper  for  district 
attorneys  to  employ  medical  experts  on  behalf  of  the  people.  The  fact 
that  an  expert  has  received  a  large  fee  does  not  make  his  testimony  in- 
competent or  afford  ground  for  a  new  trial.fi  But  this  rule  of  compen- 
sation is  not  the  same,  however,  in  all  jurisdictions,  and  the  contrary  Was 
held  in  a  laboriously  argued  Alabama  case.**  Some  States  have  regulated 
the  matter  by  statute.  Thus,  in  Minnesota,  the  judge  is  authorized  to 
allow  an  expert  witness  "  such  fees  or  compensation  as  may  seem  just 
and  reasonable,"  and  it  might  seem,  therefore,  that  such  a  witness  might 
refuse  to  testif}r  until  he  received  at  least  the  promise  of  what  he  thought 
a  just  and  reasonable  fee.  But  the  Supreme  Court  held,  approving  the 
reasoning  of  ex  parte  Dement,**  that  this  provision  of  law  had  reference 
to  an  allowance  to  be  made  after  the  witness  had  been  dismissed,  not  be- 
fore.ff  In  Colorado,  if  the  expert  witness  testifies  under  subpoena  with- 
out making  an  agreement  in  advance  for  his  compensation,  he  is  only 
entitled  to  statutory  fees.J|  The  Indiana  Code  of  Civil  Procedure  pro- 
vides for  compelling  an  expert  witness  to  testify  without  extra  compen- 
sation^   But  prior  to  the  enactment  of  this  rule  in  1881,  the  courts  of 

*  Fears  vs. Nacogdoches  Co.,  71  Tex.  337;  9  S.  "W.  265. 

t  Marion  Count//  Commissioners  vs.  Chambers,  75  Lid.  409. 

X  Pueblo  Co.  vs.  Marshall,  11  Col.  84;  16  Pac.  837. 

§  Cantrell  vs.  Clark  Co.,  47  Ark.  239 ;  1  S.  W.  200 ;  ef .  Miller  vs.  Inhabitants  of  Som- 
erset, 14  Mass.  397. 

||  3  Salk.  17 ;  6  Mod.  44,  supra. 
^  IT  People  vs.  Montgomery,  13  Ab.  Pr.  (N.  S.)  207 ;  cf.in  re  Roelker,  1  Sprague  <;U.  S.), 
276 ;  semble,  that  in  ease  of  necessity  the  court  might  compel  testimony. 

**  Ex  parte  Dement,  53  Ala.  389. 

tt  State  vs.  Tiepner,  36  Minn.  535;  32  N.  W.  678. 

XX  Board  of  Commissioners  of  La  rimer  Count  1/  vs.  Lee,  32  Pac.  841. 

$§  Eev.  Sts.  Indiana,  §  504;  Code.  §  282. 


LEGAL   RELATIONS   OF  PHYSICIANS  AND  SURGEONS.  615 

that  State  had  laid  down  the  same  ride  as  in  New  York.*  The  Eng- 
lish rule  is  that  one  called  as  a  witness  to  give  his  opinion  on  a 
subject  with  which  he  is  peculiarly  conversant  from  his  employment 
in  life  is  not  bound  to  testify  unless  the  party  calling'  him  "  pay  for  his 
time."  t  And  in  a  comparatively  recent  case  an  auctioneer  was  said  to 
be  a  professional  witness  and  not  bound  to  testify  even  if  sworn,  until 
his  fee,  expenses,  or  compensation  for  time,  at  a  guinea  a  day,  were 
paid.| 

A  contract  whereunder  the  compensation  of  the  witness  is  contingent 
upon  the  success  of  the  side  for  which  he  is  called  is  void  as  against 
public  policy.§  Mr.  James  Summers,  of  Texas,  killed  Benito  Martinez, 
of  Nueces,  in  a  peculiarly  dastardly  fashion  while  the  latter  was  kneeling 
to  strike  a  match.  He  was  convicted  of  murder  in  the  second  degree, 
and  sentenced  to  imprisonment  for  ninety-nine  years.  On  the  trial  Dr. 
.Spolm,  who  attended  on  decedent  and  made  an  autopsy,  was  called  by 
the  prosecution,  but  refused  to  state  the  cause  of  death,  because,  in  the 
words  of  the  report,  "  what  he  knows  of  it  he  got  by  means  of  a  post- 
mortem examination  and  his  professional  skill  and  deduction  of  experi- 
ence, which  witness  considers  his  own  property,  and  for  which  the  county 
of  Nueces  persistently  refuses  to  pay."  The  Trial  Court  upheld  the  doc- 
tor in  this  position.  But  the  thrifty  prosecution,  instead  of  paying  the 
expert,  called  Mr.  Charles  Benson,  who,  although  he  "knew  nothing  of 
the  science  of  surgery  or  anatomy,"  had  served  at  the  inquest  and  testi- 
fied as  to  the  fractures  of  Benito's  skull  which  the  doctor  pointed  out  to 
him.  The  Appellate  Court  held  that  Dr.  Spolm  could  not  have  been  com- 
pelled to  make  a  gratuitous  autopsy  for  the  people ;  but  having  already 
made  one  for  his  own  enlightenment,  he  was  bound  to  testify  concern- 
ing it ;  and  the  court  said :  "  It  is  to  be  regretted  that  a  member  of  a 
profession  so  distinguished  for  liberal  culture  and  high  sense  of  honor 
and  duty  should  refuse  to  testify  in  a  cause  pending  before  the  courts 
of  his  country,  involving  the  life  or  liberty  of  a  fellow-being,  and  the 
rightful  administration  of  the  laws  of  a  common  country.  Dr.  Spolm 
has  doubtless  been  misled,  in  taking  the  position  he  did,  by  the  miscon- 
ceptions of  certain  writers  on  medical  jurisprudence."  This  saying  of  the 
court  prettily  illustrates  how  thankless  it  is  for  a  text-writer  to  angle  in 
the  chopping  sea  of  judicial  decisions  for  a  rule  of  general  utility.  How- 
ever, Mr.  Summers  did  not  escape  judgment,  for  the  Appellate  Court 
sagely  held  that,  although  the  Trial  Court  erred  in  not  compelling  Dr. 
Spolm  to  testify  gratuitously,  still  this  error  was  offset  by  the  error  of 
defendant's  counsel  in  not  themselves  calling  Dr.  Spolm  and  either  pay- 
ing him  or  taking  an  exception  if  he  was  permitted  to  refuse  to  testify. 
Errors  being-  thus  evenly  distributed  between  bench  and  bar,  not  to 
speak  of  text- writers,  honors  were  considered  easy,  and,  as  a  result,  so 
far  as  the  record  shows,  Mr.  Summers  is  now  serving  his  sentence,  which 

*  Buchanan  vs.  State,  59  Lid.  1. 

t   Webb  vs.  Page,  1  C.  &  K.  23. 

t  lie  "Workingmen's  Mutual  Soc,  L.  R.  21  Ch.  D.,  831 ;  but  scientific  experts  who  have 
made  experiments  for  the  trial  are  not  professional  men,  within  the  rule.  They  are 
entitled  to  seven  guineas  a  day  for  loss  of  time  in  reading  over  affidavits ;  but  the 
party  calling  them  must  pay  for  their  experiments.  See  Practice  Relating  to  Witnesses, 
Walter  S.  Sichel,  London,  1887. 

§   Pollock  vs.  Gregory,  9  Bos.  11G. 


616  J.   SYSTEM  OF  LEGAL  MEDICINE. 

will  not  expire  until  a.d.  1978,  and  the  county  of  Nueces  "  persistently 
refuses  to  pay  "  Dr.  Spolm  even  to  this  day.* 

Despite  every  precaution  it  sometimes  occurs  that  a  patient  dies- 
leaving-  his  doctor  unpaid  and  executors  who  refuse  to  pay  him ;  and 
then  where  the  plaintiff  is  forbidden,  as  in  New  York,t  to  testify  in  his 
own  behalf,  unless  the  executor  so  testify  in  behalf  of  the  estate,  proof 
of  the  services  must  be  made  otherwise  than  by  the  physician's  testi- 
mony, and  may  be  difficult. 

In  New  York  and  in  some  other  States,  if  a  physician  recover  a  judg- 
ment for  his  fees  even  by  default  in  appearance,  this  will  be  a  bar  to  an 
action  by  defendant  for  malpractice,  for  the  malpractice  is  a  defense 
to  the  former  action  ;f  but  in  other  States  this  rule  is  adopted  only  to 
the  extent  that  a  judgment  upon  the  merits  is  such  an  estoppel,  but  not 
one  taken  on  default  in  appearance.§ 

Professional  Confidences. — At  common  law,  communications  be- 
tween client  and  legal  adviser  necessary  to  the  fulfillment  of  their  rela- 
tion were  held  to  be  confidential  and  protected  from  disclosure.  But 
similar  communications  between  parishioners  and  clergy,  patients  and 
physicians,  were  not  so  privileged.  The  different  view  taken  of  these 
equally  sacred  confidences  by  the  "  eye  of  the  law,"  of  which  Mr.  Bumble 
spoke  so  feelingly,  has  been  said  to  be  due  not  to  any  especial  sanctity 
in  the  relation  of  counsel  and  client,  nor  to  any  privilege  allowed  to  the 
gentlemen  of  the  bar,  but  to  the  fact  that  owing  to  the  complexity  of 
the  laws  it  is  necessary  for  clients  to  consult  men  learned  therein,  in 
order  to  obtain  their  rights,  and  unless  this  consultation  be  untrammeled 
the  ends  of  justice  are  likely  to  be  defeated.  Therefore  the  privilege,, 
which  is  the  client's,  extends  only  to  communications  made  as  to  the  pre- 
cise matter  on  which  advice  is  sought  and  in  the  course  of  the  employ- 
ment :  it  is  also  perpetual,  and  can  only  be  waived  by  the  one  making 
the  confidence.  But  matters  confided  to  the  man  of  law,  or  discovered 
by  him,  apart  from  confidential  communications  in  the  course  of  his 
employment,  are  not  privileged,  even  though  he  might  never  have  known 
of  them  except  for  the  professional  relation.  Public  policy,  moreover, 
forbids  extending  this  privilege  to  either  communications  in  furtherance 
of  a  criminal  purpose  or  facts  showing  the  commission  of  crime  since 
the  employment  of  the  legal  adviser.|| 

In  England  the  question  whether  a  clergyman,  especially  a  Roman 
Catholic  priest,  may  be  compelled  to  disclose  confessions,  seems  to  be 
still  open.fl  But  in  the  Duchess  of  Kingston's  case,**  which  has  since 
been  followed  in  others,  it  was  held  that  a  surgeon  must  disclose  to  the 
court  professional  confidences  to  reveal  which  voluntarily  would  be,  said 

*  Summers  vs.  The  State,  5  Tex.  Ap.  365. 

t  Code  of  Civil  Procedure,  829 ;  Boss  vs.  Boss.  6  Hun,  182. 

i  Blair  vs.  Bartlett,  75  N.  Y.  150. 

iS  Goble  vs.  Dillon,  86  Ind.  327;  Lawson  vs.  Conaway,  37  W.  Va.  159;  and  see  the- 
treatises  of  Messrs.  Bigelow  and  Herman  on  estoppel. 

||  Greenleaf  on  Ev.,  ed.  of  1892,  ss.  237-24S.  Best's  Principles  of  Ei\,  §  581  -T 
Steph.  Dig.,  Art.  115. 

H  Steph.  Dig.,  Appendix,  note  xliv.  ;  Broad  vs.  Pitt,  3  C.  &  P.  518,  where  Best,  C.-J., 
said  that  such  communications  were  not  privileged,  but  that  he  would  not  compel  a 
clergyman  to  reveal  what  a  prisoner  had  told  him,  although  he  would  receive  it  if 
voluntarilv  offered  in  evidence. 

**  20  How.  St.  Tr.  355,  at  p.  573. 


LEGAL  RELATIONS   OF  PHYSICIANS  AND  SUBGEONS.  617 

Lord  Mansfield,  "  to  be  guilty  of  a  breach  of  honor  and  of  great  indis- 
cretion." This  rule  of  common  law  has  been  pronounced  by  Mr.  Best,, 
in  his  treatise  on  evidence,  to  be  "  harsh  in  itself,  of  questionable  policy, 
and  at  variance  with  the  practice  in  France  and  some  of  the  United 
States  of  America."*  Legislation  in  this  country  to  protect  confidences 
between  patient  and  physician  has  been  enacted  for  the  most  part  in 
those  States  where,  as  advocates  of  codification  think,  "common  sense" 
is  most  wont  to  assert  itself  against  outgrown  traditions  of  common 
law ;  in  New  York,  followed  by  Arkansas  (the  United  States  Court  in  the 
Indian  Territory  follows  Arkansas  Civil  Procedure),  California,  Colorado, 
North  and  South  Dakota,  Idaho,  Iowa,  Indiana,  Kansas,  Michigan,  Min- 
nesota, Missouri,  Montana,  Nebraska,  Nevada,  Ohio,  Oklahoma,  Oregon, 
Utah,  Washington,  Wisconsin,  and  Wyoming. 

The  extent  of  the  protection  thus  afforded  must  depend  in  every 
jurisdiction  upon  the  words  of  the  statute  and  the  construction  given 
to  them  by  the  courts.  But  the  general  statutory  rule  is  substantially 
that  enunciated  in  the  New  York  Code  of  Civil  Procedure,  Adz. :  "  A  per- 
son duly  authorized  to  practice  physic  or  surgery  shall  not  be  allowed 
to  disclose  any  information  which  he  acquired  in  attending  a  patient  in 
a  professional  capacity."  t  On  the  face  of  this  law  the  privilege  and 
duty  belong  only  to  those  duly  authorized  to  practice.  And.  a  com- 
munication to  an  illegal  practitioner,!  or  to  a  layman  sharing  a  physi- 
cian's office,§  is  not  within  the  statute.  At  the  same  time,  when  a  medi- 
cal practitioner  has  testified,  unless  his  disqualification  appear  he  will 
be  presumed  to  be  licensed.;]  It  is  not  all  the  knowledge  a  physician 
possesses  concerning  a  patient  that  he  is  forbidden  to  reveal,  but  only 
information  acquired  by  and  imparted  to  him  in  treating  the  case  and 
for  that  purpose.  Thus,  the  issues  being  testamentary  capacity  and 
undue  influence,  a  contestant  of  the  will  cannot  introduce  testimony  of 
the  decedent's  physician  as  to  knowledge  acquired  by  the  latter  in  his 
professional  relation.^]  But  it  is  otherwise  as  to  a  physician's  testimony 
regarding  matters  not  learned  professionally,  and  obvious  to  any  intelli- 
gence.** "  Therefore,  a  physician  who  has  seen  his  patient  often  socially 

*  Best,  Pr.  ofEv.,  582. 

t  N.  Y.  Code  Civ.  Pro.,  §  834.  Such  provisions  of  State  law  will  be  enforced  in  the 
Federal  Courts  in  civil  actions.  Conn.  Mut.  Lift  Ins.  Co.  vs.  Union  Trust  Co.,  112  U.  S. 
250  ;  but  not  in  criminal  actions  :  Logan  vs.  U.  S.,  144  U.  8.  26.3.  The  original  section 
of  the  N.  Y.  Rev.  Statutes  has  been  the  model  of  all  State  legislation  on  this  subject. 
But  the  phraseology  of  various  statutes  differs,  and  is  always  subject  to  change.  In  sev- 
eral States  the  privilege  only  exists  in  civil  cases.  Some  statutes  use  the  terms  "prac- 
ticing," "licensed,"  "authorized,"  "regular"  physicians.  Each  statute  must  be  con- 
sulted as  to  cases  arising  under  it.  But  the  decisions  of  the  New  York  Court  of  Appeals 
have  been  followed  as  authority  in  almost  every  decided  case  throughout  the  country. 

+    Wiel  vs.  Cowles,  45  Hun,  307, 

v^   Kendall  vs.  Grey,  2  Hilton,  300. 

||  Record  vs.  Village  of  Saratoga  Springs,  46  Hun,  448;  aid.  120  X.  Y.  646. 

H  Benihan  vs.  Dennin,  103  X.  Y.  57:;.  Matter  of  Coleman,  111  X.  Y.  220;  Van  Or- 
DKiii  vs.Van  Orman,  11  X.  Y.  Supl.  931,  and  cases  collected  in  note;  and  see  recent 
amendments  to  the  N.  Y.  Code  infra. 

**  Herrington  vs.  Winn,  14  X.'Y.  Supl.  612;  60  Hun,  235.  hire  Halsey's  Estate, 
9  X.  Y.  Supl.  441.  Whether  in  an  action  to  recover  damages  for  negligence  plaint- 
iff's physician  can  testily  to  statements  of  his  patient  as  to  how  the  accident  happened. 
has  been  decided  in  both  ways.  In  Brown  vs.  Borne,  W.  <V'  0.  1!.  /.'.  Co.,  45  Hun,  439, 
plaintiff's  physician  was  held  competent  to  testify  that  the  patient  said  he  heard  some 
one  halloo  and  wave  his  hat  as  the  train  which  injured  him  came  along.  But  in 
Penna.   Co.  vs.  Marion,  123  Ind.  415,  23  N.  E.  973,  the  contrary  was  held;  and  in 


618  ^   SYSTEM  OF  LEGAL  MEDLCINE. 

may  testify  as  to  his  opinion  of  her  mental  state,  from  knowledge  ac- 
quired outside  the  professional  relations,  if  he  can  exclude  from  his 
mind  in  answering  the  questions  all  information  acquired  in  the  course 
of  his  attendance*  How  far  such  separation  of  the  data  acquired  in 
the  diverse  social  and  professional  relations  can  he  effected  in  any  given 
case  must  necessarily  be  largely  determined  by  the  physician's  con- 
science ;  but  if  he  cannot  make  snch  separation  his  testimony  on  the 
point  must  be  excluded.!  Where  the  attorney  of  a  testatrix,  without 
her  consent,  called  in  to  examine  her  mental  condition  a  physician  who, 
without  prescribing  or  being  recognized  by  her  as  a  medical  attendant, 
subscribed  her  will  as  a  witness  at  her  request,  it  was  held  on  the  pro- 
bate that  the  physician's  testimony  as  to  her  mental  state  was  competent 
evidence.^  So  an  attending  physician  may  testify  both  as  to  his  patient's 
declarations  as  to  the  will  and  his  own  advice  concerning  it ;  §  and  also 
generally  as  to  the  value  of  the  services  of  a  nurse,  in  an  action  brought 
by  the  latter  to  recover  compensation  from  the  patient's  estate. || 

If  objection  is  made  to  a  physician's  testimony  that  it  relates  to 
knowledge  gained  in  his  professional  capacity,  the  burden  of  proving 
this  is  upon  the  objector.fi  The  limitations  of  the  privilege  under  the 
New  York  Code  have  been  exhaustively  discussed  by  the  Court  of  Ap- 
peals, notably  in  the  cases  of  Edington  and  Qrattan  vs.  The  Insurance 
Companies  ■**  aud  it  may  be  considered  as  settled  that  the  patient's  privi- 
lege extends  to  all  information  acquired  by  the  physician  in  his  profes- 
sional attendance,  whether  personally  observed  by  him  in  examining  the 
patient,  or  imparted  to  him  by  any  one  in  order  to  enable  him  to  act  in 
his  professional  capacity ;  and  that,  too,  although  it  might  not,  in  fact, 

Kling  vs.  City  of  Kansas,  27  Mo.  Ap.  231,  a  physician  was  not  allowed  to  testify  that  his 
patient  had  been  drinking;  while  in  Cooley  vs.  Foltz,  85  Mich.  47;  48  N.W.  E.  176,  the 
physician  was  allowed  to  say  that  the  patient  stated  that  she  would  sue  the  company  and 
wanted  him  as  a  witness;  and  that  plaintiffs  refusal  to  call  him  was  proper  subject  of 
comment  to  the  jury;  cf.  Gartside  vs.  Ins.  Co.,  76  Mo.  446  (see  note  also) ;  Linz  vs.  Ins. 
Co.,  8  Mo.  Ap.  363  ;  Streeter  vs.  City  of  Breckenridge,  23  Mo.  Ap.  244 ;  Norton  vs.  Moberly, 
18  Mo.  Ap.  457.  In  Collins  vs.  Mock,  31  Ark.  684,  the  physician  was  allowed  to  testify 
that  his  patient  admitted  that  she  had  never  been  engaged  to  marry  her  child's  father. 

*  Fisher  vs.  Fisher,  129  N.  Y.  654. 

t  In  re  Darragh's  Est.,  52  Hun,  591.  In  insurance  cases  it  has  been  held  that  an 
attending  physician  may  testify  to  the  fact  that  he  attended  decedent  at  certain  times 
and  places,  though  he  may  not  testify  as  to  what  he  learned  in  so  doing :  Numrich  vs. 
Swpr.  Lodge  K.  cf  L.  of  Honor,  3  N.  Y.  Supl.  552  ;  Patten  vs.  United  L.  <f  Ac.  Ins.  Ass'n, 
133  N.  Y.  450  ;  Breisenmeister  vs.  Knights  of  Pythias,  81  Mich.  525.  In  Missouri  it  is  held 
that  the  facts  showing  inability  to  separate  knowledge  acquired  professionally  from 
other  information  must  be  stated;  Gartside  vs.  Ins.  Co.,  8  Mo.  Ap.  593;  afd.  76  Mo. 
446,  supra;  and  also  that  the  witness's  incompetency  must  affirmatively  appear :  Boiclcs 
vs.  Kan.  City,  51  Mo.  Ap.  416. 

i  In  re  Freeman,  46  Hun,  458.  §  In  re  O'Neill's  Est,,  7  N.  Y.  Supl.  197. 

||  Pandjiris  vs.  McQueen,  13  N.  Y.  Supl.  705 ;  not  as  to  particulars  affecting  the 
patient:  Burlcy  vs.  Barrihard,  9  N.  Y.  St.  587. 

H  Stoioell  vs.  Amer.  Coop.  Pelf.  Ass'n,  5  N.Y.  Supl.  233.  As  to  when  the  objection  is 
to  be  made,  see  Feeny  vs.  L.  I.  P.  R.  Co.,  116  N.Y.  375;  cf.  Hoyt  vs.  Hoyt,  112  N.Y.  493. 

**  Edington  vs.  Mutual  Life  Ins.  Co.,  67  N.  Y.  185,  revg."  5  Hun,  1 ;  Edington  vs. 
Mtna  Lil\  Ins.  Co.,  77  N.  Y.  564,  revg.  13  Hun,  543;  Grattan  vs.  Met.  Life  Ins.  Co.,  80 
N.  Y.  281 ;  Peuihan  vs.  Dennin,  103  N.Y.  573  ;  Feeny  vs.  L.  I.  P.  P.  Co.,  116  N.  Y.  375  ;  in 
re  Darragh's  Est.,  52  Hun,  591 ;  Sloan  vs.  N.  T.  C.  P.  P.,  45  N.Y.  125  ;  and  cf.  Patten  vs. 
Piiited  L.  and  Ae.  lus.  Ass',,,  16  N.  Y.  Supl.  376 ;  revd.  133  N.  Y.  450 ;  Numrich  vs.  Sup. 
lodge  K.  $  L.  of  Honor,  3  N.  Y.  Supl.  552:  Briggs  vs.  Briggs,  20  Mich.  34;  Penna.  Co 
vs.  Marion,  123  Ind.  415  ;  23  N.  E.  973  ;  Kling  vs.  City  of  Kansas,  27  Mo.  Ap.  231  ;  Brown 
vs.  Pome,  W.  cf  O.  P.  P.,  45  Hun,  439. 


LEGAL   RELATIONS   OF  PHYSICIJXS  AXD   SURGEOXS.  619 

aid  him  to  prescribe ;  for  it  is  obvious  that  the  value  of  information  im- 
parted to  physicians  by  the  laity  cannot  be  known  until  the  communica- 
tions are  made.  Any  narrower  construction  of  the  statute  than  this 
would  defeat  its  purpose,  to  remedy  the  defect  of  the  common  law  by 
making  absolutely  confidential  all  communications  to  the  physician  in 
reference  to  the  patient's  case.  The  test,  therefore,  of  the  admissibility 
in  evidence  of  any  communication  to  a  physician  seems  to  be,  Was  it 
made  with  intent  to  assist  him  in  treating  the  case  '?*  A  learned  judge 
of  the  New  York  Court  of  Appeals  strenuously  argued  in  Edington  vs. 
JEtna  Life  Insurance  Co.J  that  the  statute  conferring  this  privilege,  be- 
ing a  departure  from  the  common  law  rule,  should  be  strictly  construed 
to  prohibit  the  disclosure  by  a  physician  only  of  information  of  a  confi- 
dential nature  obtained  from  the  patient  during  professional  attendance, 
but  not  to  exclude  testimony  as  to  matters  which  were  obvious  to  all ; 
as  in  the  case  of  a  maniac,  or  one  suffering  from  a  fractured  leg.  He 
again  urged  this  view  in  Grattan  vs.  Insurance  Co.,%  but  the  court  having 
elected  to  interpret  the  statute  liberally  as  a  remedial  act,  the  same  judge 
in  ReniJian  vs.  Denning  after  stating  his  own  previous  opposition  to  the 
establishment  of  the  ride,  declared  it  to  be  settled  that  the  statute  is  not 
confined  to  information  of  a  confidential  nature,  but  covers  all  informa- 
tion acquired  by  a  lawful  practitioner  while  attending  a  patient  profes- 
sionally, and  necessary  to  enable  him  to  act  in  the  professional  capacity ; 
and  also  that  the  privilege  extends  to  probate  proceedings  and  to  infor- 
mation acquired  by  a  physician  called  in  consultation. 

Where  the  privilege  is  held  to  exist  the  rule  is  rigorously  enforced. 
Thus,  where  a  physician  was  examined  as  a  debtor  in  supplemental  pro- 
ceedings, an  exhibition  of  his  account-books  containing  information  as  to 
his  patients'  maladies  was  not  permitted. ||  In  an  action  for  divorce  for 
adultery,  a  physician's  testimony  as  to  conversations  and  circumstances 
tending  to  establish  the  adultery  was  held  inadmissible.^  But  where  the 
prohibited  testimony  has  been  received  without  objection,  even  though  a 
motion  be  made  to  strike  it  out,  it  will  be  considered  on  appeal.** 

In  Indiana  a  physician  was  not  permitted  to  testify  as  to  what  he  had 
learned  of  the  condition  of  his  partner's  patient,  who  came  to  their  office 
for  treatment  ;tt  and  in  New  York,  on  an  application  for  a  committee  for 
an  habitual  drunkard,  an  affidavit  of  the  patient's  physician  in  support  of 
the  application  was  held  to  be  incompetent  evidence.JJ  It  is  not,  however, 
every  act  of  medical  attendance  that  creates  the  confidential  relation  and 
consequent  privilege.     Thus  it  seems  that  casual  advice  to  a  friend  is 

*  Matter  of  Darragh,  supra. 

t  77  N.  Y.  564;  ef.  Linz  vs.  Mass.  Mut.  Life  Ins.  Co.,  8  Mo.  Ap.  363;  disapproved 
iu  Kling  vs.  City  of  Kansas,  27  Mo.  Ap.  231 ;  Gartside  vs.  Ins.  Co.,  76  Mo.  446. 

i  80  N.  Y.  281. 

§  103  N.  Y.  573  ;  cf.  cases  cited  in  Breisenmeister  vs.  Knights  of  Pythias,  81  Mich.  525. 

||  Kelly  vs.  Levy,  8  N.  Y.  Supl.  849.  And  where  a  physician  sued  for  damages  for 
personal  injuries  an  examination  of  his  books  was  refused  to  defendant :  Mott  vs. 
Consumers'  Ice  Co.  2  Ab.  N.  C.  143 ;  52  How.  Pr.  148,  244. 

11  Hunn  vs.  Hunn,  1  Th.  &C.  499 ;  Briggs  vs.  Briggs,  20  Mich.  34 ;  Hanford  vs.  Han- 
ford,  3  Edw.  Ch.  468. 

**  Hoyt  vs.  Hoyt,  112  N.  Y.  493  ;  Johnson  vs.  Johnson,  14  Wend.  637,  revg.  4  Paige 
460  ;  but  see  note  *  p.  631. 

ft  Mtna  Ins.  Co.  vs.  Deming,  24  N.  E.  86,  375 ;  123  Ind.  384;  cf.  Raymond  vs.  B.  C. 
B.  4-  X.  Ry.  Co.,  65  Iowa,  152. 

U  In  re  Hoyt,  20  Ab.  N.  C.  162. 


(520  A  SYSTEM  OF  LEGAL  MEDICINE. 

not  professional  attendance  within  the  meaning  of  insurance  policies  * 
And  where  an  attending  physician,  solely  with  a  view  to  obtaining  or 
excluding  the  expert  testimony  of  a  surgeon,  asked  the  latter  to  examine 
the  c<  ►ndition  of  his  patient,  the  plaintiff,  the  surgeon,  was  held  to  be  a 
competent  witness  for  the  defense  as  to  the  true  condition  of  plaintiff ; 
this  upon  the  ground  that  the  surgeon  was  not  expected  to  and  did  not 
treat  or  prescribe  for  plaintiff  or  advise  as  to  Ms  treatment]  This  case  does 
not  seem  to  have  been  carried  up  to  the  Court  of  Appeals  or  ever  to  have 
been  cited  as  an  authority,  nor  does  the  opinion  of  the  General  Term  cite 
any  authority  in  support  of  the  position  that  an  examination  by  a  sur- 
geon with  a  view  to  informing  the  patient  of  his  condition  will  not  be 
considered  professional  attendance,  in  the  absence  of  proof  of  a  request 
or  expectation  that  the  surgeon  should  also  treat  the  case.  If  treatment 
or  the  expectation  thereof  be  the  test  of  the  privilege,  then  if  A,  desiring 
to  satisfy  himself  of  his  physical  condition,  either,  as  often  happens,  to 
verify  the  report  of  an  insurance  company's  examiner  or  for  any  other 
cause,  submit  himself  to  B  for  examination,  there  is  no  such  professional 
relation  between  A  and  B  as  the  statute  contemplates.  It  may  well  be 
doubted  if  this  construction  of  the  law  would  be  sustained  on  appeal ; 
nor  does  it  seem  to  be  in  harmony  with  the  rule  in  the  matter  of  Darragh, 
where  the  court  said :  "  It  is  so  difficult  to  draw  the  line  that  it  is  cer- 
tainly best  to  err  upon  the  side  of  safety,  and  shut  the  door  against  all 
disclosures  of  information  acquired  by  a  physician  in  attending  a  patient 
in  a  professional  capacity,  without  requiring  absolute  proof  that  such 
information  was  necessary  to  enable  him  to  act  in  that  capacity."  \ 
Moreover,  if  forming  a  professional  opinion  and  making  a  diagnosis  and 
report  is  not  "  acting  in  a  professional  capacity  "  quite  as  much  as  advis- 
ing the  patient  to  take  daily  exercise,  it  is  difficult  to  know  just  how  to 
characterize  such  action.  Would  the  court  forbid  a  pathologist  to  dis- 
close the  result  of  his  expert  examination  of  epithelial  tissue  with  refer- 
ence to  informing  the  attending  physician  of  the  true  nature  of  the 
disease  ?  Beyond  any  doubt  such  a  revelation  without  the  patient's  per- 
mission would  violate  the  spirit  of  the  statute  •,  and  yet  the  pathologist, 
not  being  expected  to  treat  the  case,  would  not  be,  under  the  test  applied 
in  Henry's  case,  in  "  professional  attendance  " ;  but  surely  he  should  not 
be  free  to  testify  that  the  patient's  disease  was  of  syphilitic  origin.  It  is 
very  certain  that  neither  in  Henry's  case  nor  the  case  just  supposed 
would  the  patient  have  submitted  his  condition  to  expert  examination 
except  in  the  belief  that  the  knowledge  so  acquired  by  the  medical  men 
would  be  privileged.  To  argue  otherwise  is  to  err  upon  the  side  of  dan- 
ger, and  to  defeat  the  benign  purpose  of  the  statute.  But  where  defend- 
ant sends  a  physician  to  examine  a  plaintiff  with  a  view  to  procuring 
information  as  to  his  condition,  the  former  may  testify  to  the  informa- 
tion so  acquired,  unless  the  contrary  has  been  stipulated  or  the  patient 
has  been  deceived  as  to  the  physician's  relation  to  him.§ 

*  Gibson  vs.  Am.  Mm.  Life  Ins.  Co.,  37  N.  Y.  580  ;  Ellington  vs.  Mutual  Life  Ins.  Co., 
5  Hun,  1  (reversed  on  another  point,  G7  N.  Y.  185) ;  qucere,  however,  if  a  confidential 
communication  to  such  a  one  is  not  privileged ;  it  certainly  should  be. 

t  Henry  vs.  N.  Y.  L.  E.  $  TV.  B.  B.,  57  Hun,  76;  10  N.  Y.  Supl.  508. 

t  57  Hun,  at  p.  593.  In  Renihan  vs.  Dennin,  103  N.  Y.  573,  it  is  held  that  the 
privilege  exists  as  to  a  consultant  called  in  by  an  attending  physician. 

§  Heath  vs.  Bwy.  $c.  B.  B.,  8  N.  Y.  Supl*  863.  Aliter  if  he  is  sent  at  plaintiff's 
request  to  act  as  physician.     Freel  vs.  Cable  By.  Co.,  97  Cala.  40 ;  31  Pac.  730. 


LEGAL  RELATIONS  OF  PHYSICIANS  AND   SURGEONS.  C21 

The  modern  tendency  is  to  apply  the  same  rules  of  evidence  to  criminal 
■as  to  civil  cases,  and  in  some  jurisdictions  there  are  special  enactments  to 
this  effect.*  Even  in  the  absence  of  such  legislation  the  privilege  of  pro- 
fessional confidences  has  been  held  to  exist  in  criminal  cases.  In  the  lead- 
ing case  of  People  vs.  Stout,]  the  defendant  was  in  jail  under  a  charge 
of  murder.  On  his  person  were  injuries  of  a  nature  to  be  sustained  in 
a  struggle.  Two  physicians  went  to  his  cell,  stating  that  they  had  been 
requested  by  the  coroner  to  examine  him.  They  felt  of  his  pulse,  looked 
at  his  tougue,  and  acted  as  physicians  are  wont  to  act.  But  they  did  not 
prescribe  or  intimate  that  they  would  do  so.  Being  asked  if  the  prisoner 
from  their  manner  had  reason  to  and  did  think  that  they  were  physicians 
examining  him  with  a  view  to  treatment,  one  of  them  answered  affirma- 
tively, assigning  as  his  reasons  for  this  opinion  their  manner,  the  "  entire 
submission,  willingness,  and  readiness  of  the  prisoner  to  do  what  was 
asked  of  him,"  and  his  inquiry,  when  they  went  away,  if  they  would  call 
on  the  morrow.  The  court,  in  a  carefully  reasoned  opinion,  held  that 
although  the  confidential  relation  of  physician  and  patient  did  not,  tech- 
nically, exist  upon  these  facts,  nevertheless  its  existence  is  not  indispen- 
sable where  there  is  "  a  state  of  circumstances  which  falls  short  of  consti- 
tuting this  technical  relation,  but  which  presents  a  very  proper  case  for 
the  application  of  the  statute."  They  were,  therefore,  "  of  opinion  that 
in  a  case  in  which  a  physician  has  attended  upon  a  person,  under  circum- 
stances calculated  to  induce  the  opinion  that  his  visit  was  of  a  professional 
nature,  and  the  visit  has  been  so  regarded  and  acted  upon  by  the  person, 
the  relation  of  physician  and  patient  contemplated  by  the  statute  may 
be  said  to  exist.  The  spirit  of  the  statute  is  thereby  respected,  and  no 
great  violence  is  done  to  its  literal  terms."  Accordingly,  the  testimony  of 
the  physicians  as  to  the  prisoner's  physical  condition  was  excluded. 

The  question  again  arose  upon  a  different  state  of  facts  in  People 
vs.  Murphy. \  Defendant  was  jointly  indicted  with  a  physician  for  pro- 
curing an  abortion.  The  district  attorney  sent  to  atteud  the  girl  upon 
whom  the  abortion  was  procured  a  physician  who,  first  having  told  her 
that  he  was  sent  by  the  public  prosecutor,  undertook  her  case  and  pre- 
scribed for  her.  Upon  the  trial  his  testimony  was  objected  to,  but  the 
Trial  Court  admitted  it,  being  of  opinion  that  the  district  attorney  hav- 
ing employed  the  witness  might  waive  the  privilege.  The  Court  of 
Appeals,  however,  reversed  the  judgment,  and  held  that  the  relation  of 
physician  and  patient  clearly  existed,  that  the  communications  of  the 
girl  to  the  physician  were  privileged,  and  "  that  the  exception  to  his  dis- 
closure of  what  he  learned  while  thus  in  professional  attendance  was 

*  N.  Y.  Code  of  Crim.  Pro.,  §  392. 

t  3  Park.  Cr.  R.  670.  Prior  to  this  ease  it  had  been  held,  in  Hewitt  vs.  Prime, 
21  Wend.  79,  an  action  by  a  father  against  his  daughter's  seducer  for  loss  of  the  girl's 
services,  that  the  seducer's  consultation  with  a  physician  with  a  view  to  have  an  abor- 
tion procured  was  not  privileged,  because  it  was,  to  say  the  least,  doubtful  if  the  re- 
lation of  physician  and  patient  existed,  and  also  because  the  information  imparted 
was  not  necessary  to  enable  the  physician  to  prescribe.  The  question  was  raised  in 
an  Iowa  breach  of  promise  case  whether  the  privilege  could  be  invoked  to  protect  a 
communication  made  with  criminal  intent,  and  a  physician  was  asked  if  plaintiff  had 
not  consulted  him  with  a  view  to  having  an  abortion  performed.  But  the  court  did 
not  decide  the  point,  holding  that  to  submit  to  an  abortion  might  be  not  criminal  but 
necessary,  and  woidd  be  presumed  iTinocent  in  the  absence  of  proof  of  criminal  pur- 
pose :   Guptill  vs.  Verback,  58  Iowa,  98. 

t  3  N.  Y.  Cr.  Rep.  338 ;  reversed  101  N.  Y.  126. 


(322  A    SYSTEM   OF  LEGAL   MEDICINE. 

well  taken."  Here  it  will  be  observed  that  the  question  of  privilege  was 
not  raised  by  the  patient,  who  was  not  on  trial,  but  by  one  who  was,  so 
to  speak,  a  co-conspirator  with  her  in  the  crime,  for  which  he  was  in- 
dieted.  The  court,  having  previously  held  in  the  Pierson  case,*  which 
will  be  discussed  presently,  that  the  statute  could  not  be  invoked  to  pro- 
tect  ;i  criminal,  now  distinguished  that  case  from  this  of  Murphy,  on  the 
ground  that  Piersohs  victim  was  dead,  and  therefore  unable  to  waive 
his  privilege  as  to  communications  to  the  physician  concerning  his  con- 
dition, in  which,  moreover,  there  was  nothing  discreditable;  and  conse- 
quently to  allow  one  charged  with  his  murder  to  exclude  by  objection 
statements  going  to  show  the  cause  of  death  would  be  to  apply  the  statute 
solely  to  shield  him  who  had  wronged  the  patient  and  not  at  all  to  protect 
the  patient  himself.  In  the  Murphy  case,  on  the  contrary,  the  girl  upon 
whom  the  abortion  was  performed  was  alive,  and,  if  she  saw  fit  to  do  so, 
capable  of  waiving  her  privilege,  which,  being  insisted  on,  served  to  pre- 
vent the  disclosure  of  a  very  discreditable  and  criminal  state  of  affairs 
on  her  part.  In  the  case  of  People  vs.  Kemmler]  two  physicians  were  sent 
by  the  prosecution  to  defendant's  cell  to  examine  him  with  reference  to 
his  sanity.  They  were  allowed  to  testify  to  their  conclusions  as  to  his 
mental  condition.  The  report,  unlike  that  in  People  vs.  Stout,  does  not 
show  very  satisf  actordy  the  nature  of  then-  intercourse  with  the  prisoner ; 
but  then-  testimony  was  said  to  be  "to  the  effect  that  there  was  noth- 
ing in  the  prisoner's  physical  make-up  upon  which  an  opinion  of  the 
prisoner's  unsoundness  of  mind  could  be  based.  They  expressed  the 
opinion  that  he  was  able  to  distinguish  between  right  and  wrong,  and 
that  his  conduct  on  the  fatal  morning,  and  subsequently,  displayed  a  con- 
sciousness of  the  nature  and  quality  of  his  act."  And  the  case  of  People 
vs.  Stout,  supra,  was  distinguished  on  the  ground  that  in  that  case  ''the 
visiting  physicians  attended  and  prescribed  for  the  injured  prisoner,  and 
they  were  allowed  to  describe  his  condition."  But  in  this  the  learned 
court  seems  to  have  fallen  into  error.  For  the  report  in  Stout's  case 
shows  that  although  Dr.  Langworthy,  the  jail  physician,  had  called  on 
the  prisoner  and  told  him  what  he  expected  to  prescribe,  prior  to  the 
visit  of  Drs.  Montgomery  and  Avery,  the  last  two  physicians  went  at  the 
request  of  the  coroner  to  examine  defendant  and  not  to  treat  him.  As 
to  then*  relation  to  the  prisoner  the  court  distinctly  said :  "  There  was  no 
prescription  made  and  no  conversation  about  any  being  made."  The 
gist  of  Stout's  case  is  in  these  words  of  the  opinion  :  "  If  the  prisoner's 
mind  had  been  carefully  disabused  at  the  outset  of  any  notion  of  the 
examination  being  solely  for  his  benefit,  and  he  had  been  carefully 
advised  that  its  sole  object  was  to  procure  evidences  of  his  guilt  of  the 
terrible  crime  of  which  he  was  suspected,  there  would  be  no  ground  or 
pretense  for  the  position  of  his  counsel.  But  so  many  things  combining 
to  satisfy  us  that  he  regarded  the  visit  very  differently,  and  had  occasion 
for  so  doing,  we  feel  bound  in  a  case  like  this,  involving  so  deeply  the 
dearest  eartldy  rights  of  a  man,  to  show  all  reasonable  indulgence,  both 
as  to  the  law  and  fact." 

The  same  point  was  considered  in  People  vs.  Sliney.%     In  rebuttal 

*  79  N.  Y.  424.  t  119  N.  Y.  580. 

X  137  N.  Y.  570.  Cf.  People  vs.  Glover,  71  Mich.  303,  where  the  prisoner  having 
been  told  that  the  physician  came  from  the  district  attorney,  and  having  voluntarily 
submitted  to  examination,  the  physician's  testimony  was  received. 


LEGAL  RELATIONS   OF  PHYSICIANS  AND  SUPGEONS.  623 

the  prosecution  called  a  physician  who,  having  been  sent  by  the  dis- 
trict attorney  to  see  the  prisoner,  Sliney,  testified,  as  summed  up  in  the 
report:  "That  he  entered  into  conversation  with  the  prisoner  for  the 
purpose  of  ascertaining  his  mental  condition ;  that  during  the  inter- 
view the  defendant  gave  him  a  long  account  of  how  he  and  deceased 
had  had  an  altercation  and  a  struggle,  in  which  he  struck  him  with  a 
cleaver,  but  did  not  know  that  he  had  killed  him."  This  is  all  that 
can  be  learned  from  the  report  of  the  circumstances  attending  the  in- 
terview between  the  witness  and  the  prisoner ;  and  of  the  objection  to 
the  testimony  the  court  said:  "The  objection  to  this  evidence  went  to 
its  competency7,  as  disclosing  a  communication  from  patient  to  physician, 
which  is  privileged  under  the  statute.  The  answer  is  that  no  such  rela- 
tion existed.  The  ph^ysician  was  sent  by  the  prosecuting  authority  to 
make  a  report  upon  the  sanity  of  the  prisoner.  He  acquired  no  infor- 
mation while  attending  a  patient,  and  was  not  acting  as  the  professional 
adviser  of  defendant."  It  appears,  therefore,  that  while  the  case  of 
People  vs.  Stout  has  never  been  reversed,  overruled,  disapproved,  nor  yet 
expressly  limited,  still  the  subsequent  cases  have  not  laid  down  the  rule 
so  broadly.  Thus,  in  People  vs.  Schuyler*  the  prosecution  called  as  an 
expert  witness  on  the  point  of  defendant's  mental  condition  the  physician 
of  the  jail,  who  testified  that  he  had  medical  charge  of  all  the  prisoners, 
had  examined  and  "  kept  his  eye  on "  defendant  at  the  request  of  both 
sides,  that  he  assumed  the  obligation  of  attending  the  prisoner,  and  "  saw 
to  the  defendant  as  he  did  to  the  others,  when  he  needed  it."  He  further 
testified  that,  in  answering  the  prosecution's  hypothetical  question  five 
pages  in  length,  it  was  practically  impossible  to  divest  his  mind  of  the 
knowledge  he  had  obtained  of  the  prisoner  while  in  jail ;  and  asked, 
therefore,  that  his  answer  might  be  withdrawn.  But  the  majority  of 
the  Appellate  Court  held  that  the  proof  did  not  show  that  the  relation 
of  physician  and  patient  existed,  that  the  burden  of  establishing  the  exist- 
ence of  that  relation  and  the  fact  that  the  information  of  the  witness  was 
acquired  in  professional  attendance  was  upon  the  defendant,  who  had 
failed  to  show  that  the  prisoner  was  ever  ill  or  prescribed  for.  The 
court  said  that  the  mere  facts  of  witness  being  the  jail  physician  and 
defendant  a  prisoner  did  not  constitute  the  relation,  and  even  if  the 
witness's  answer  to  the  hypothetical  question  had  been  influenced  by  his 
knowledge  acquired  by  seeing  defendant  in  the  jail,  it  was  not  for  that 
reason  incompetent.t  The  modern  rule  as  to  examining,  medically,  a 
prisoner  in  behalf  of  the  prosecution,  seems,  therefore,  to  be  that  in 
order  to  exclude  the  testimony  of  a  physician  or  surgeon  who  lias  made 
such  examination  it  must  appear  affirmatively  and  clearly  that  the  wit- 
ness's knowledge  has  been  acquired  either  in  the  actual  medical  treat- 
ment of  the  patient,  or  under  circumstances  leading  the  prisoner  to 
believe  that  the  object  of  the  examination  or  treatment  was  to  acquire 
information  for  the  purpose  of  giving  him  snch  treatment. 

It  has  been  seen  in  Murphy's  case  (supra)  that  a  third  person  may  in- 
voke the  prohibition  of  the  statute  to  shield  himself  against  a  criminal 

*  106  N.  Y.  298. 

t  Rapallo  and  Andrew,  J.J.,  dissented,  the  former  reading  a  very  cogent  opinion 
in  favor  of  reversal.  These  recent  cases  come  perilously  near  to  making  the  accused 
testify  against  himself.  But  where  such  an  examination  was  procured  by  threats,  the 
act  was  held  to  be  unconstitutional :  People  vs.  McCoy,  45  How.  Pr.  217. 


624  A   SYSTEM  OF  LEGAL  MEDICLNE. 

charge,  and  it  is  important  to  ascertain  within  what  limits  this  may  be 
done.  In  two  cases  of  murder  by  poison,*  the  latter  very  recent,  the 
testimony  of  physicians  was  admitted  not  only  as  to  the  causes  of  death 
and  the  condition  in  which  they  found  decedents,  but  also  as  to  state- 
ments both  of  the  patients  and  attendants,  and,  in  the  Pierson  case,  of 
the  defendant  as  well.  Pierson,  who  was  charged  with  poisoning  one 
Wither,  had  called  Dr.  Coe  to  see  the  decedent  before  his  death.  The 
physician  examined  and  prescribed  for  the  sick  man,  and  on  the  trial 
was  allowed  to  state  decedent's  symptoms  and  condition  as  he  found 
them  by  examination  and  as  he  learned  them  from  defendant  and  Mrs. 
Withey,  who  was  jointly  indicted  with  Pierson  for  the  murder.  Under 
the  letter  of  the  statute  such  evidence  was  clearly  incompetent.  But 
the  Appellate  Courts  held  that  the  enactment  must  be  construed  with  a 
view  to  its  sole  purpose,  namely,  the  protection  and  welfare  of  the  patient 
by  making  eonfideutial  all  communications  to  his  physician,  made  with 
a  view  to  benefit  him.  And  because  the  court  were  of  the  opinion  that 
the  exclusion  of  such  testimony  as  Dr.  Coe's  would  make  convictions  of 
poisoners  well-nigh  impossible,  and  so  be  clearly  contrary  to  the  spirit 
and  intent  of  the  legislature,  it  was  said  by  Earl,  J.,  adopting  the  words 
of  Talcott,  J.,  below :  "  That  in  such  a  case  the  statute  is  not  to  be  so 
construed  as  to  be  used  as  a  weapon  of  defense  to  the  party  so  charged, 
instead  of  a  protection  to  his  victim."  The  court,  however,  did  not  think 
it  expedient  to  lay  down  a  general  rule  limiting  the  scope  of  the  statute, 
but  confined  their  opinion  to  construing  the  law  in  its  application  to  the 
facts  of  the  case  at  bar,  upon  which  it  was  considered  that  "  there  was 
nothing  of  a  confidential  nature  in  anything  that  he  [Dr.  Coe]  learned  or 
that  was  disclosed  to  him."  Suppose  there  had  been  a  confidential  dis- 
closure by  the  prisoner ;  suppose  in  a  moment  of  evil  impulse  he  had 
given  the  poison,  and  then,  overcome  by  fear  or  remorse,  had  called  in 
medical  aid  with  bond  fide  intent  to  save  his  victim,  and  confessed  the 
method  employed  in  his  crime  in  order  that  an  antidote  might  be  sup- 
plied :  would  there  be  here  a  locus  penitent  m,  and  would  this  confession, 
made  in  order  to  enable  the  physician  to  act  professionally,  be  privileged  ? 
The  Pierson  case  was  decided  by  the  Court  of  Appeals  in  the  year  1880. 
In  1889  it  was  considered  by  a  General  Term  of  the  Supreme  Court  on 
an  appeal  from  a  judgment  of  conviction  of  manslaughter  in  the  first 
degree,  in  a  case  wherein  the  only  evidence  to  sustain  the  conviction 
was  that  of  the  physician  attending  decedent  in  her  last  moments.  He 
testified,  under  objection,  that  he  was  called  to  visit  the  woman  by  de- 
fendant, who,  at  the  same  time,  in  order  to  aid  the  physician's  diagnosis 
and  treatment,  confessed  that  he  had  attempted  to  procure  upon  her  an 
abortion  by  an  operation,  the  details  of  which  he  described.  The  Gen- 
eral Term  held  that  these  facts  differed  widely  from  those  of  the  Pierson 
case,  since  here  defendant  felt  that  the  physician  ought  to  know,  as  in 
fact  it  was  necessary  for  him  to  know,  the  probable  causes  of  the  patient's 
prostration.  And  without  dissent  it  was  said :  "  In  this  critical  moment, 
with  the  sole  purpose  of  saving  the  woman's  life,  he  disclosed  the  secret 
to  the  physician  to  enable  him  to  act  rightly.  To  have  withheld  the 
disclosure  would  have  made  the  defendant  a  consenting  party  to  the 

*  Pierson  vs.  People,  79  N.  Y.  424,  affirming  18  Hun,  239 ;  supra,  p.  22 ;  People  vs. 
Carlyle  Harris,  136  N.  Y.  423. 


LEGAL  RELATIONS   OF  PHYSICIANS  AND  SURGEONS.  625 

-woman's  death.  We  have  no  doubt  that  the  statute,  both  in  letter  and 
spirit,  protects  the  confidence  thus  reposed  in  the  physician  and  forbids 
him  to  betray  it."*  In  1893  came  the  decision  of  the  Court  of  Appeals 
in  the  case  of  Carlyle  Harris,  convicted  of  murder  in  the  first  degree  by 
poisoning  his  wife.  The  record  showed  that  the  Trial  Court  received  as 
relevant  to  the  establishment  of  motive,  testimony  of  decedent's  uncle, 
Dr.  Treverton,  to  the  effect  that  he  had  operated  upon  his  niece  some  six 
months  prior  to  her  death,  and  removed  a  five  months'  foetus.  At  that  time 
defendant,  a  medical  student,  appeared  on  the  scene  pursuant  to  a  message 
from  witness,  and  then  said  that  he  had  previously  performed  two  opera- 
tions upon  the  girl  and  thought  everything  was  removed.  On  appeal  it 
was  argued  that  this  testimony  was  incompetent,  first,  because  it  was 
the  revelation  by  a  physician  of  a  privileged  communication,  upon  which 
point  the  Brower  case  was  cited ;  and  second,  because  it  was  proof  of  a 
separate  crime  from  that  charged.  The  Court  of  Appeals,  affirming  the 
judgment  below,  said :  "  The  first  ground  of  objection  is  untenable  for 
several  reasons.  In  the  first  place,  the  witness  was  not  employed  by  the 
■defendant.  In  the  second  place,  he  acquired  no  important  information 
from  the  defendant,  or  any  which  he  was  not  already  possessed  of,  or 
which  was  necessary  for  him  to  act  in  a  professional  capacity.  Lastly, 
the  statutory  privilege  was  not  conferred  to  shield  a  person  charged 
with  the  murder  of  a  patient ;  as  was  held  in  Pierson  vs.  People,  79  N.  Y. 
424.  I  should  never  be  willing  to  assent  to  a  construction  or  to  beHeve 
in  a  legislative  intent  which  would  operate  to  convert  a  statutory  provi- 
sion protecting  a  patient  from  a  damaging  or  objectionable  disclosure 
into  a  protection  for  a  person  on  trial  for  the  murder  of  a  patient."  The 
last  ground  for  refusing  to  consider  the  communication  as  privileged 
seems  to  make  the  first  two  unnecessary,  and,  logically,  to  imply  that 
even  if  defendant  had  employed  the  witness,  and  had  imparted  to  him 
•confidential  information  necessary  to  enable  him  to  act  professionally, 
still  the  court  would  not  construe  the  statute  to  shelter  the  pris<  >ner. 
On  the  other  hand,  if  Harris  had  employed  his  wife's  uncle,  and  had  im- 
parted to  him  confidential  and  necessary  professional  information,  and 
if  these  facts  would  have  been  sufficient  to  exclude  the  uncle's  testimony, 
as  the  court's  assignment  of  the  first  two  reasons  might  imply,  then  on 
this  point  the  Harris  case  would  have  been  on  all-fours  with  People  vs. 
Brower,  and  the  decision  in  the  latter  case  is  good  law ;  and,  if  it  be 
good  law,  then  only  the  spirit  of  prophecy  can  determine  how  the  courts 
will  decide  if  ever  there  shall  be  presented  to  them  our  hypothetical 
case  of  a  repentant  poisoner  turning  away  from  his  wickedness  and  try- 
ing to  undo  his  crime.  If,  however,  that  supposititious  penitent  be  con- 
versant with  medicine  and  the  law  reports,  he  will,  unless  his  conscience 
is  very  active,  decline  to  make  perilous  confidences  and  seek  rather  to 
procure  a  certificate  of  peritonitic  death. 

The  purpose  of  conferring  this  privilege  is  clearly  set  out  in  the  Note 
of  the  Revisers  of  the  New  York  statutes  (3  R.  S.,  2d  Ed.,  737),  who  were 
the  originators  of  the  rule  throughout  the  land.  It  was  to  enable  a 
patient  frankly  to  disclose  his  physical  condition  and  history  to  his 
medical  adviser  so  as  to  benefit  by  his  advice  without  fear  of  publicity. 
'The  privilege  is  solely  for  the  patient's  protection.     It  is  not  intended  to 

*  People  vs.  Brower,  53  Hun.  217;  G  X.  Y.  Supl.  730. 


(J2G  A   SYSTEM   OF  LEGAL  MEDICINE. 

keep  secret  anything  that  he  wished  to  be  public.  An  over-literal 
construction  of  the  law  begets  such  reductiones  ad  dbsurdum  as  that  sug- 
gested in  Depoister's  case:*  that  if  the  body  of  a  child  non  sui  juris. 
and  therefore  incapable  of  waiving  its  right,  be  violated,  the  offending 
brute  may  invoke  its  privilege  to  exclude  the  testimony  of  the  examin- 
ing physician.  It  is  a  fair  presumption  that  in  criminal  cases  every 
person 'wronged  desires  the  punishment  of  the  one  who  has  injured  him. 
In  theory  public  safety  demands  such  punishment.  Every  one  who 
does  not' thereby  incriminate  himself  must  testify  against  the  criminal. 
Therefore,  if  the  patient  be  dead,  it  is  fair  to  presume  that,  if  living,  he 
would  waive  his  privilege  and  permit  his  physician  to  reveal  matters  not 
disgraceful  to  his  memory,  as  in  Pierson's  case,  or  even  to  corroborate 
disgraceful  matter  already  revealed,  as  in  Harris's  case.  If  the  patient 
be  living,  and  the  physician's  testimony  would  add  a  new  evil  to  that 
already  suffered  by  him,  as  in  Murphy's  case,  it  seems  logical  that  the 
privilege  should  subsist  if  not  expressly  waived.  In  the  cases  of  which 
Brower's  is  a  type,  the  arguments  seem  closely  balanced.  Yet,  applying 
the  test  of  the  patient's  wish,  no  one  can  doubt  but  what  if  the  decedent 
in  that  case  could  have  spoken,  she  would  have  sheltered  under  her 
privilege  the  defendant  who  made,  a  perilous  confession  in  order  to  save 
her  life,  who,  although  his  victim,  was  also  his  willing  accomplice  in  the 
sorrowful  crime.  It  is  more  doubtful  whether  such  presumption  could 
arise  as  to  an  abortionist  for  hire.t  Doubtless.it  was  a  perception  of  the 
difficulties  of  applying  such  a  statute  in  criminal  cases  that  has  led  cer- 
tain States  to  allow  this  privilege  only  in  civil  actions. 

The  appbeation  of  the  rule  in  "accident"'  and  "insurance"  cases, 
also  obviously  too  often  serves  only  to  cloak  fraud.  It  needs  no  argu- 
ment to  show  the  unfairness,  if  not  dishonesty,  as  a  general  rule,  of 
those  who  bring  actions  to  recover  damages  for  their  physical  injuries, 
yet  will  not  permit  the  best  evidence  of  the  nature  and  extent  of  those 
injuries  to  be  put  before  the  jury.  The  remedy  for  this  evil  is  to  be 
sought  in  amendment  of  the  statutes ;  yet  even  now  it  is  not  so  great  as 
it  may  seem.  For  to  any  intelligent  jury  the  fact  that  one  party  to  the 
action  is  suppressing  the  truth  as  to  the  issue  must  be  as  convincing  of 
the  weakness  of  his  cause  as  direct  testimony,  and  more  prejudicial ;  and 
it  is  in  the  power  of  the  adverse  party  by  calling  the  physician  and 
proving  his  attendance  on  patient,  to  demonstrate  that  if  his  adversary 
does  not  then  offer  the  physician's  testimony,  it  is  because  he  dare  not 
have  the  whole  truth  known. 

Waiver. — It  is  a  principle  of  law  that  any  one  may  waive  his  own 
rights  and  privileges,  expressly  or  by  implication.  The  prohibition  to 
reveal  the  secrets  of  the  sick-room  was  early  decided  to  be  the  privilege 
of  the  patient,  not  of  the  physician,!  and  therefore  after  the  patient's 
death  neither  his  executor  nor  any  one  else  can  waive  it,  a  mere  succes- 
sion in  property  interest  not  being  sufficient  to  authorize  such  waiver  ;§ 

*  State  vs.  Depoistcr,  25  Pac.  1000. 

t  As  this  book  goes  to  press  the  point  is  "before  the  General  Term  of  the  Supreme 
Court  of  New  York  in  People  vs.  Chase. 

X  Johnson  vs.  Johnson,  14  Wend.  637  ;  therefore,  if  the  patient  waive  the  privilege, 
the  court  will  compel  the  physician  to  answer.  Valensin  vs.  Valensin,  14  Pac.  397 ; 
Penn.  Mut.  Life  Ins.  Co.  vs.  Wiler,  100  Ind.  92.  But  the  physician  cannot  waive  it : 
Harris  vs.  Rupel,  14  Ind.  209. 

$    Westover  vs.  JEtna  Life  Ins.  Co.,  99  N.  Y.  56;  Loder  vs.Whelpley,  111  N.  Y.  239; 


LEGAL  RELATIONS   OF  PHYSICIANS  AND  SURGEONS.  627 

consequently,  in  an  action  against  a  life  insurance  company  on  a  policy, 
the  defendant  cannot  prove  by  an  attending  physician  the  condition  of 
health  of  decedent  or  members  of  his  family  prior  to  his  application,* 
nor  in  an  action  by  an  executor  against  the  company  where  the  defense 
is  the  insured's  suicide  can  the  plaintiff  show  by  decedent's  physician 
that  the  insured  was  insane.t  A  waiver  need  not  be  in  writing  or  made 
in  any  particular  form  or  maimer.  The  circumstances  may  show  an  ex- 
press intent  to  make  it ;  as  if  a  testator  ask  his  physician  or  attorney  to 
subscribe  his  will  as  a  witness ;  where  the  request  necessarily  implies 
that  the  witnesses  are  at  liberty  to  testify  as  to  the  circumstances  sur- 
rounding the  execution  of  the  will  and  the  testator's  mental  condition ; 
or  there  may  be  an  agreement  before  death,  as  in  an  insurance  policy,  that 
the  physicians  attending  the  insured  at  his  decease  may  testify  as  to  the 
cause  of  death  4  But  where  there  is  no  such  contract,  is  a  certificate  of 
the  attending  physician,  filed  with  the  proofs  of  death  as  to  the  cause 
of  the  insured's  demise,  competent  evidence  ?  It  has  been  said  already 
that  the  physician's  direct  testimony  on  that  point  is  not  admissible ; 
but  his  certificate  may  be  admitted  upon  grounds  that  commend  them- 
selves more  to  the  legal  than  to  the  lay  mind.  To  illustrate,  A,  who  is 
insured  under  a  policy  avoided  by  drunkenness,  dies.  B,  the  bene- 
ficiary, gets  from  the  company  a  blank  form  of  proof  of  death,  includ- 
ing a  request  for  a  statement  of  the  cause  of  death,  to  which  informa- 
tion the  company  is  not  entitled.  A's  physician  violates  professional 
confidence  and  gives  a  certificate  erroneousby  stating  that  A  died  of  de- 
lirium tremens.  B  offers  proof  of  some  more  respectable  illness.  The 
certificate  is  admissible  in  evidence  not  as  original  proof  of  the  cause  of 
death,  but  as  an  admission  by  the  plaintiff  against  his  interest.  But  if 
the  beneficiary  of  the  policy  be  an  infant  ward,  such  an  admission  by  his 
guardian  does  not  bind  him,  and  is  therefore  incompetent  evidence^ 

During  the  lifetime  of  a  plaintiff,  his  attorney,  on  the  trial  of  his  ac- 
tion to  recover  damages  for  injuries,  may  waive  his  privilege  and  call  his 
physicians  to  testify  to  his  physical  condition,  notwithstanding  defend- 
ant's objection.||  It  has  been  said  that  the  mere  bringing  of  an  action 
to  recover  damages  for  personal  injury  does  not  constitute  a  waiver  of 
the  plaintiff's  privilege  that  will  allow  defendant  to  call  the  latter's  phy- 
sicians to  testify  as  to  his  condition/]    Nor  does  a  plaintiff  by  suing  for 

Venn.  Mut.  Life  Ins.  Co.  vs.  Wiler,  100  Ind.  92.  Iu  Indiana  it  would  seem  that  a 
•decedent's  physician  may  not  testify  against  his  patient's  competency  to  make  a 
will :  Heuston  vs.  Simpson,  115  Ind.  62.  But  he  may  be  called  by  decedent's  executor 
-or  other  successor  in  interest  to  uphold  the  will  even  although  the  widow  object  and 
invoke  decedent's  privilege:  Morris  vs.  Morris,  119  Ind.  341;  cf.  Masonic  Ass'n  vs. 
Reck,  77  Ind.  203.  The  rule  in  Missouri  is  similar :  Thompson  vs.  Isli,  99  Mo.  160 ; 
.and  so  in  Michigan  :  Eraser  vs.  Jennison,  42  Mich.  206,  where  Judge  Cooley  said  what 
the  patient  "may  do  in  his  lifetime,  those  who  represent  him  after  his  death  may  do 
for  the  protection  of  the  interests  they  claim  under  him."  But  see  Dreicrvs.  Conti- 
nental Life  Ins.  Co..  24  Fed.  670. 

*  Grattam  vs.  Metropolitan  Life  Ins.  Co.,  80  N.  Y.  281;  Breisenmeister  vs.  Supr. 
Lodge  Knights  of  Pythias,  81  Mich.  525.  But  he  may  testify  to  having  attended  dece- 
dent or  his  family :  Breisenmeister  vs.  K.  of  P.;  Numricli  vs.  Lodqe  eje,  3  N.Y.  Supl.  552. 

t    Westover  vs.'  Mtna  Life  Ins.  Co..  99  N.  Y.  56. 

t  Matter  of  Coleman,  ill  N.  Y.  220 ;  AlberU  vs.  X  Y.  L.  E.  cf  TV.  R.  R.  Co..  118  N.  Y. 
77;  Andreveno  vs.  Mutual  Reserve  ,\<:  Ass'n,  34  Fed.  870. 

§  RuffaJo  Loon  ,(V.  (  o.  vs.  I\ni<ihts  Templars  .|V.  Ass'n,  126  N.Y.  450  ;  27  N.  E.  942  ;  cf. 
Dreier  vs.  Continental  Lit)'  Ins.  Co..  24  Fed.  670  ;  Hehoig  vs.  Mnt.  L.  Ins.  Co.  132  X.Y.  331. 

||   Mlwrti  vs.  N.   Y.  L.  K.  $  If.  R.  /.'.  Co..  US  X.  Y.  77. 

H  Jones  vs.  Brooklyn  B.  <f  W.  E.  R.  II.  Co..  3  X.  Y.  Supl.  253;  afd.  121  N.  Y.  683. 


(328  A    SYSTEM  OF  LEGAL  MEDLCINE. 

• 

injuries  resulting  from  miscarriage  waive  her  privilege  so  as  to  admit 
testimony  of  physicians  who  attended  her  some  months  before  her  acci- 
dent but  not  after  it*  In  New  York,  Missouri,  and  Michigan  it  is  held 
that  if  plaintiff  call  one  of  several  physicians  to  testify  to  his  bodily  con- 
dition resulting  from  injuries,  he  does  not  waive  the  privilege  as  to  the 
others.t  And  in  Iowa,  where  a  plaintiff  testified  in  her  own  behalf  that 
her  health  had  always  been  good  prior  to  the  accident  whereby  she  sus- 
tained the  damages  which  she  sued  for,  this  was  held  to  be  no  such  waiver 
as  would  permit  the  defense  to  call  physicians  who  had  attended  her  to 
contradict  her  testimony .|  So  in  Indiana,  it  was  held  that  plaintiff's 
testimony  that  a  certain  physician  had  treated  her  injuries  was  not  a 
waiver  permitting  him  to  be  called.§  In  a  comparatively  recent  case  a 
plaintiff,  having  testified  that  he  had  called  several  times  on  a  physician 
wlio  asked  him  no  questions,  gave  him  no  advice,  but  merely  examined 
his  eye  and  told  him,  on  the  third  visit,  "to  get  examined  by  a  doctor," 
it  was  held  that  although  these  facts  constituted  the  relation  of  physician 
and  patient,  nevertheless  the  plaintiff's  testimony  waived  his  privilege 
and  made  it  error  to  exclude  the  physician's  testimony.  The  court  said : 
"  Can  it  be  that  a  patient  can  distort  the  features  of  a  consultation  with 
his  physician  so  as  to  do  the  physician  the  greatest  of  injury,  and  the 
physician  be  prohibited  from  defending  himself?  Clearly  not.  The 
patient  may  keep  the  door  of  the  consultation-room  closed,  but  he  can- 
not be  permitted  to  open  it  so  as  to  give  an  imperfect  and  erroneous  view 
of  what  has  taken  place  there,  and  then  close  the  door  when  the  actual 
facts  are  about  to  be  disclosed.  This  would  be  allowing  a  plaintiff  to- 
manufacture  evidence  for  himself  in  cases  of  this  description,  and  pre- 
vent the  defendant  from  resorting  to  the  only  means  to  elicit  the  truth."  jj 
And  in  a  still  more  recent  case  in  the  New  York  Common  Pleas,  where  a 
plaintiff  testified  fully  as  to  her  injuries,  the  General  Term  of  that  court, 
adopting  the  language  above  quoted,  held  her  testimony  to  be  a  waiver 
making  her  physician  a  competent  witness  against  her.fl  It  may  be  noted 
that  in  both  of  these  cases  the  physician  was  called  not  to  testify  to 
the  existence  of  any  aibnent  of  the  patient,  but,  on  the  contraiy,  to  the 
patient's  freedom  from  the  specific  injury  or  disease  in  issue.  And  it 
had  been  suggested  previously  by  the  Court  of  Appeals  that  the  object 
of  the  statute  being  to  prevent  the  disclosure  of  the  patient's  ailments,  it 
was  questionable  whether  testimony  that  the  patient  was  in  good  health 
could  be  regarded  as  prohibited.**  In  the  former  of  these  two  cases,  that 
of  Marx,  it  may  be  said  that  plaintiff  having  testified  to  certain  conduct 
of  a  physician,  it  was  competent  to  call  the  latter,  because  the  patient 
had  opened  the  door  for  his  entrance  into  the  case ;  but  it  is  hard  to  see- 

*  Butler  vs.  Man.  By.  Co.,  23  N.  Y.  Supl.  163;  30  Ab.  N.  C.  78,  see  note. 

t  Hopexs.  Troy  $  L.  B.  B.,  40  Htm,  438;  110  N.  Y.  643;  followed  in  Mellor  vs. 
Missouri  Pac.  Ey.  <  '<>.,  105  Mo.  455 ;  16  S.  W.  866  ;  Dotton  vs.  Village  of  Albion,  57  Mich. 
575  ;  24  N.  W.  786. 

\  McConnell  vs.  City  of  Osage,  80  Iowa,  293 ;  45  N.  W.  550 ;  semlle  if  she  testified  to 
a  statement  made  to  the  physician  he  might  contradict  her  as  to  that. 

§    Williams  vs.  Johnson,  13  N.  E.  872. 

||  Marx  vs.  Man.  By.  Co.,  56  Him,  575  (May,  1890).  This  is  consonant  with  the 
common  law  ride  that  if  a  client  testify  against  an  attorney,  the  latter  may  protect 
himself  by  testifying  to  a  privileged  communication. 

H  Treanor  vs.  Man.  Ey.  Co.,  16  N. Y.  Supl.  536  ;  28  Ab.  N.  C.  47 ;  cf.  Freel  vs.  Market 
St.  Cable  Ry.  Co.,  31  Pac' 730. 

**  People  vs.  Schuyler,  106  N.  Y.  298. 


LEGAL  RELATIONS   OF  PHYSICIANS  AND  SUBGEONS.  629 

how,  even  by  most  subtle  reasoning,  the  Treanor  case  can  be  brought 
into  accord  with  Record  vs.  Village  of  Saratoga  Springs*  and  Hope  vs. 
Railroad.]  Marx,  by  testifying  that  a  physician  examined  him  thrice 
and  told  him  nothing,  except  to  go  to  another  physician  for  examination, 
and  Treanor,  by  testimony  as  to  the  injury  of  her  head,  are  held  to  have 
waived  the  privilege  so  as  to  permit  their  physicians  to  contradict  them 
and  show  that  they  Lad  little  or  nothing  the  matter.  While  Hope  and 
Record  each  testified  in  detail  as  to  their  respective  injuries,  and  each 
called  one  of  the  attending  physicians  in  corroboration,  and  yet  neither 
was  held  to  have  waived  by  this  testimony  the  privilege  as  to  other 
attending  physicians.  The  question,  although  substantially  the  same  in 
all  actions  to  recover  damages  for  negligence,  has  always  seemed  clearer 
when  the  action  grows  out  of  alleged  medical  malpractice;  for  here  the 
nature  of  disease  or  injury  and  all  circumstances  necessary  to  judge  of 
the  skill  and  wisdom  of  defendant's  treatment  are  the  main  issues,  and 
the  plaintiff  waives  the  privilege  both  as  to  the  attending  physician  and 
his  consultants.! 

But  when  it  is  the  question  whether  if  a  party  to  an  action  offers 
upon  one  trial  medical  testimony  as  to  his  physical  condition  this  is 
such  a  waiver  of  privilege  as  will  permit  the  other  party  on  a  new 
trial  to  offer  the  same  testimony,  we  again  find  doubt  and  conflicting 
decisions.  The  Xew  York  Court  of  Appeals  have  decided  this  point 
upon  reasoning  that,  at  least,  as  the  phrase  is,  "squints  both  ways."  In 
Grattan's  case,§  upon  a  second  trial  the  defense  called  a  physician  who 
attended  the  insured  in  his  last  illness.  The  witness  had  testified  on  the 
former  trial,  but  it  did  not  appear  by  whom  he  was  then  called.  He  was 
asked  if  he  had  not  then  testified  in  reply  to  plaintiff's  counsel  that  the 
insured  died  of  consumption.  This  was  held  to  be  improper :  first,  be- 
cause what  he  testified  at  the  former  trial  was  admissible  only  to  refresh 
his  memory  or  discredit  him,  and  the  occasion  for  doing  either  did  not 
exist;  second,  because  the  court  did  not  agree  that  the  plaintiff's  inquiry 
on  the  former  trial  precluded  his  objection  on  the  latter  one.  "It  was 
an  incident  in  the  mode  of  trial.  It  waived  for  that  occasion  and  under 
then  existing  circumstances  an  objection  which  might  have  been  relied 
on.  It  was  in  no  sense  an  admission  of  the  party,  but  proof  by  a  wit- 
ness. The  party  was  not  even  then  bound  by  the  fact,  but  might  dis- 
prove it."  If  this  language  could  be  understood  as  a  ride  that  a  waiver 
on  one  trial  is  not  a  waiver  for  all  time — and  the  Michigan  Supreme 
Court  has  so  understood  it  j  | — then  the  case  is  distinctly  overruled  by 
that  of  McKinney,^]  where  it  is  argued  that  after  the  patient  had  once 
admitted  his  confidence  to  be  published,  the  purpose  of  the  statute,  viz., 

*  46  Hun,  448;  afd.  120  N.Y.  G4G ;  of.  McConnell  vs.  City  of  Osage,  SO  Iowa,  293. 

t  40  Hun,  438  ;  cf.  with  this  and  the  Treanor  case,  the  opinion  in  Johcs  vs.  Brooklyn 
]!.  .V  W.  E.  /.'.  R.  Co.,  3  X.  Y.  Supl.  253;  afd.  121  N.  Y.  6S3. 

i  Lane  vs.  Boicourt,  27  X.  E.  1111  Ind. 

v^  Grattan  vs.  Metropolitan  Life  Ins.  Co.,  92  X.  Y.  275. 

||  Breisenmeister  vs.  Knights  of  Pythias,  SI  Mich.  525. 

i[  McKinney  vs.  Grand  St.  ,\ '■<■.  By.  Co.,  104  X.  Y.  352.  The  reasoning  of  this  ease 
has  been  cited  lately  in  a  Nevada  case.  State  vs.  Depoister,  25  Pac.  1000.  where  an 
objection  by  defendant,  charged  with  rape  on  a  child  of  seven  years,  to  admitting 
testimony  of  the  infant's  physician,  was  held  to  be  untenable  on  the  ground  that  the 
child's  parents,  by  testifying  as  to  the  facts,  had  both  impliedly  waived  the  privilege 
and,  by  giving  publicity  to  the  matter,  removed  the  ground  of  the  privilege. 


G30  ^   SYSTEM  OF  LEGAL   MEDICINE. 

to  protect  him,  was  defeated,  and  upon  the  principle,  "  Cessante  rat  tone 
legis  cessat  ipsa  Mr,"  the  privilege  could  never  again  be  claimed.  With 
this  argument  the  Michigan  Supreme  Court  does  not  agree,  but  holds 
in  the  Breisenmeister  case  that  the  object  of  the  statute  being  to  enable 
the  patient  to  control  the  evidence,  as  well  as  to  suppress  the  informa- 
tion, a  waiver  on  one  trial  is  not  a  waiver  thereafter,  thereby  following 
what  they  assume  to  be  the  rule  in  Grattan's  case  (supra)  ;  but  there  is, 
however,  this  vital  point  in  Grattan's  case  clearly  differentiating  it  from 
McKinney's,  namely,  that  in  the  former  the  privilege  was  that  of  the  in- 
sured ;  and  he  being  dead,  no  one  under  the  rule  in  Westover's  case 
(supra)  could  waive  it* 

It  is  unnecessary  further  to  discnss  the  cases.  Ever  since  the  com- 
mon law  rule  was  abrogated  by  statutes,  two  conflicting  tendencies 
have  been  at  work  in  construing  the  law:  the  one  to  confine  privilege 
to  the  narrowest  limits  within  which  its  assumed  purpose  could  be 
effectuated,  as  though  the  statute  were  in  derogation  of  a  common 
right  ;f  the  other  to  construe  the  law  liberally  according  to  its  plain  lan- 
guage as  a  remedial  statute,  leaving  it  for  the  legislature  to  modify  its 
terms  if  necessary.:}:  And  whether  or  not  invariable  adherence  to  the 
latter  principle  would  have  worked  greater  injustice  in  individual  cases, 
it  would  have  effected  probably  greater  certainty  in  the  law,  which  is 
no  small  boon.  The  statute  is  plain  in  its  terms.  If  it  works  injustice 
in  testamentary,  insurance,  negligence,  or  criminal  cases  "  the  remedy  is 
with  the  legislature,  and  not  with  the  courts." §  And  this  remedy  has 
already  been  essayed  in  New  York,  where  the  privilege  originated  and 
has  been  most  stoutly  fought  over.  (See  note  at  the  close  of  this  title.) 
It  is  to  be  remarked  also  that  in  general  the  statutes  creating  this  privi- 
lege only  provide  that  the  physician  "  shall  not  be  allowed  to  disclose  " 
this  privileged  information.  But  under  the  decisions  and  the  practice 
this  prohibition  is  in  many  instances  mere  brutum  fulmen — "  sound  and 
fury,  signifying  nothing."  Who  is  it  that  is  not  to  allow  this  gross  breach 
of  faith "?  Apparently  not  the  court ;  for  it  is  said  that  the  rule  does  not 
go  "  further  than  to  stamp  such  communications  as  confidential,  and  to 
protect  them  from  disclosure,  when  objected  to;  unless  the  privilege  has 
been  competently  waived.  The  rule  does  not  prohibit  the  examination 
of  such  classes  of  witness ;  but  it  prohibits  the  evidence  of  the  character 
described  from  being  given  in  the  face  of  an  objection."  \\  This  word  "ob- 
jection "  being  injected  into  the  statute,  it  would  seem  that,  notwith- 
standing the  so-called  privilege  of  the  dead,  still  if  in  a  probate  conten- 
tion a  greedy  crowd  on  both  sides  are  scrambling  for  decedent's  gold, 
all  willing  to  bemire  his  name  for  gain,  and  none  having  an  interest  to 
protect  his  memory,  the  court  is  to  sit  quietly  in  the  absence  of  objec- 
tion, and  allow  a  physician  to  betray  the  trust  reposed  in  him.  "  If," 
said  the  court  in  a  case  cited  heretofore,  "  a  physician,  disregarding  the 
plain  obligations  of  his  situation,  should,  in  conversation,  disclose  the 

*  99  N.  Y.  56. 

t  Edington  vs.  Mtna  Life  Ins.  Co.,  77  N.  Y.  564. 

t  Edington  vs.  Mutual  Life  Lis.  Co.,  67  N.  Y.  185. 

vN  Renihan  vs.  Dennin,  103  N.  Y.  573.  In  Missouri  a  defendant  devisee  may  waive 
decedent's  privilege  and  call  his  physician  :  Thompson  vs.  Ish,  99  Mo.  160.  So  in  In- 
diana, if  the  testator's  legal  representative  call  decedent's  phvsician,  the  latter  may 
testify  to  decedent's  sanitv:  Morris  vs.  Morris,  21  N.  E.  918;  119  Ind.  341. 

II   Hoyt  vs.  Hoyt,  112  N.  Y.  at  p.  515. 


LEGAL  BELATIOXS   OF  PHTSICIAXS  AND  SUBGEOXs.  G31 

secrets  of  his  patient,  lie  would,  so  far  as  we  know,  violate  no  statute, 
however  reprehensible  his  conduct  would  be,"*  and  therefore  such  reve- 
lations, though  incompetent  as  original  evidence  if  objected  to,  may  be  re- 
ceived indirectly,  if  repeated  by  a  party  as  his  admissions  if  adverse  to 
his  interest.  And  thus  it  happens  that  the  mantle  which  the  law  in- 
tended to  throw  over  the  confidences  of  physician  and  patient  is  constantly 
torn  away  by  the  hand  of  vulgar  greed,  because  instead  of  absolutely 
prohibiting  the  disclosure  or  its  repetition,  some  unspecified  power, 
ostensibly  the  court,  but,  as  it  would  seem,  the  court  only  as  the  medium 
of  an  objector,  is  commanded  not  to  allow  it.t  But  in  tins  maze  of 
argument  there  is  nothing  to  puzzle  the  physician  or  surgeon.  As  to 
him,  the  rule  is  clear  and  his  duty  plain.  He  is  to  regard  all  knowledge 
concerning  his  patients'  affairs  as  sacred,  and  to  refuse  to  testify  con- 
cerning it  except  at  the  request  of  the  patient  or  under  the  direct  order 
of  the  court ;  and  even  when  commanded  to  testify  from  the  bench,  he 
should  feel  his  way  cautiously  and  not  meet  the  examiner  with  indecent 
haste.  For  the  guidance  of  the  lawyer  the  rule  seems  to  be  that  all  in- 
formation accpiired  by  a  physician  through  any  of  his  senses  in  his  pro- 
fessional relation  with  a  patient,  or  one  having  valid  reason  to  believe 
himself  a  patient,  is  privileged  if  it  in  any  way  conduces  or  was  intended 
to  conduce  to  his  knowledge,  or  aid  his  treatment  of  the  case ;  whether 

*  Buffalo  Loan  $•  T.  Co.  vs.  Knights  T.  <$-e.  Ass'n,  126  N.  Y.  at  p.  455 ;  cf.  Suitings  vs. 
Shakespeare,  46  Mich.  408;  41  Am.  K.  166.  Such  a  breach  of  confidence,  however, 
is  clearly  a  wrong,  and  is  analogous  to  the  betrayal  of  confidence  by  a  physician  who 
takes  a  layman  unnecessarily  to  a  case  of  labor,  for  which  wrong  substantial  damages 
have  been  recovered.  (See  end  of  this  title.)  Nor  is  judicial  authority  lacking  to 
maintain  that  a  judge,  or  even  a  commissioner,  who  is  but  a  machine  to  take 
depositions,  should  exclude  such  testimony.  Thus  in  Storrs  vs.  Scougale,  48  Mich. 
387,  a  physician  having  testified  before  a  commissioner  that  his  patient  had  an  offen- 
sive disease,  Mr.  Justice  Cooley  said  :  "This  evidence  ought  not  to  be  passed  over 
without  remark.  .  .  .  The  physician  had  no  business  to  give  it.  ...  If  a  physician  is 
found  disposed  to  violate  both  the  law  of  the  land  and  the  precepts  of  professional 
ethics  by  making  such  a  disclosure,  and  if  counsel  invite  him  to  do  so  by  their  ques- 
tions, the  commissioner,  in  the  case  of  so  plain  a  disregard  of  the  law  to  the  prejudice 
of  a  third  party,  may  well  decline  to  be  an  instrument  of  the  wrong ;  at  least  until  he 
can  take  the  opinion  of  the  circuit  judge  on  the  subject.  .  .  .  It  is  to  be  regretted  that 
the  circuit  judge  did  not  have  his  attention  directed  to  this  evidence,  for  he  would 
probably  have  ordered  it  stricken  out  at  the  cost  of  the  party  taking  it.  He  would 
have  needed  to  wait  for  no  motion  for  that  order."  In  matter  of  Hannah,  11 
V.  F.  Sf.  B.  807,  the  court  said  the  physician's  testimony  should  never  have  been 
received,  and  the  privilege  should  have  been  asserted.  Cf.  Linz  vs.  Mass.  Mitt.  Ins. 
Co.,  8  Mo.  Ap.  363. 

t  Since  the  decisions  were  rendered  in  these  cases  of  Ho>/t  vs.  Hoi/t  and  Trust  Co. 
vs.  Knights  Templars,  the  New  York  Code  has  been  amended  in  1877,  1891,  1892,  and 
1893,  so  that  as  this  book  goes  to  press  the  sections  relating  to  this  privilege  read  as 
follows : 

"  $  834.  A  person  duly  authorized  to  practice  physic  or  surgery  shall  not  be  al- 
lowed to  disclose  any  information  which  lie  acquired  in  attending  a  patient  in  a  pro- 
fessional capacity,  and  which  was  necessary  to  enable  him  to  act  in  that  capacity. 

"  $  836.  The  last  three  sections  apply  to  any  examination  of  a  person  as  a  witness 
unless  the  provisions  thereof  are  expressly  waived  upon  the  trial  or  examination  by 
the  person  confessing,  the  patient  or  the  client.  But  a  physician  or  surgeon  may 
upon  a  trial  or  examination  disclose  any  information  as  to  the  mental  or  physical  con- 
dition of  a  patient  who  is  diseased,  which  he  acquired  in  attending  such  patients 
professionally,  except  confidential  communications  and  such  facts  as  would  tend  to 
disgrace  the  memory  of  the  patient,  when  the  provisions  of  §  834  have  been  expressly 
waived  on  such  trial  or  examination  by  the  personal  representatives  of  the  deceased 
patient,  or  if  the  validity  of  the  last  will  and  testament  of  such  deceased  patient  is  in 


632  -4   SYSTEM  OF  LEGAL  MEDICLNE. 

it  be  the  result  of  his  own  observation  or  be  imparted  to  him  because  of 
his  professional  relation  to  the  patient.  Only  the  patient  can  waive  the 
privilege,  which  is  perpetual,  unless  the  statute  expressly  or  by  judicial 
construction  provide  otherwise,  but  nevertheless  to  insure  the  exclusion 
of  the  disclosure  an  objection  is  necessary;  and  if  in  default  of  such 
objection  such  a  disclosure  be  made,  it  will  be  considered  on  appeal. 
Nevertheless,  as  "the  evidence  is  in  itself  objectionable,"*  it  would  seem 
to  be  the  clear  duty  of  the  court,  certainly  in  all  cases  where  a  question 
calls  for  the  disclosure  of  a  privileged  communication  made  by  one  not  a 
party  to  the  litigation,  to  effect  the  purpose  of  the  statute  by  protecting 
those  who  are  dead,  or  for  any  reason  not  present  or  competent  to  protect 
themselves  or  their  memory  from  reproach. 

Sanctity  of  the  Person. — Analogous  to  the  duty  of  guarding  pro- 
fessional confidences  is  that  of  protecting  the  sanctity  of  the  patient's- 
person.  A  patient  cannot  be  made  a  subject  of  clinical  study  or  imper- 
tinent curiosity  against  his  will.  And  the  pudicity  of  a  woman  is  par- 
ticularly to  be  regarded.  A  country  physician  took  an  unmarried  lay- 
man to  carry  his  lantern  and  umbrella  to  a  confinement  case.  There 
was  but  one  room  in  the  woman's  house,  and  there  the  doctor  took  his 
friend.  There  being  no  real  need  of  the  layman's  presence  to  assist  in 
the  case,  this  action  was  considered  to  be  in  the  nature  of  trespass,  ren- 
dering both  the  physician  and  his  friend  liable  in  substantial  damages  to 
the  woman  and  her  husband  for  this  wanton  invasion  of  their  privacy. t 

Although  it  is  said  that  there  is  no  property  in  a  dead  body,|  so  that 
a  man  cannot  dispose  of  his  remains  by  will,§  or  enforce  a  contract  for 
the  sale  of  a  corpse, ||  or  replevin  his  amputated  leg  if  the  surgeon  walks 
off  with  it,  nevertheless  the  desecration  of  the  graves  and  bodies  of  the 
dead  is  an  offense  to  public  decency,  punishable  at  common  law  as  a 

question,  by  the  executor  or  executors  named  in  said  will,  or  the  surviving  husband, 
widow,  or  any  heir-at-law,  or  any  of  the  next  of  kin  of  such  deceased,  or  any  other 
party  in  interest.  But  nothing  herein  contained  shall  be  construed  to  disqualify  an 
attorney  in  the  probate  of  a  will  heretofore  executed  or  offered  for  probate,  or  here- 
after to'  be  executed  or  offered  for  probate,  from  becoming  a  witness  as  to  its  prepara- 
tion and  execution  in  case  such  attorney  is  one  of  the  subscribing  witnesses  thereto. 
In  an  action  for  the  recovery  of  damages  for  a  personal  injury  the  testimony  of  a 
physician  or  surgeon  attached  to  any  hospital,  dispensary,  or  other  charitable  institu- 
tion as  to  information  which  he  acquired  in  attending  a  patient  in  a  professional 
capacity,  at  such  hospital,  dispensary,  or  other  charitable  institution,  shall  be  taken 
before  a  referee  appointed  by  a  judge  of  the  court  in  which  such  action  is  pending; 
provided,  however,  that  any  judge  of  such  court  at  any  time  in  his  discretion  may, 
notwithstanding  such  deposition,  order  that  a  subpoena  issue  for  the  attendance  and 
examination  of  such  physician  or  surgeon,  upon  the  trial  of  the  action.  In  such  a 
case  a  copy  of  the  order  shall  be  served,  together  with  the  subpoena. 

"Sections  872,  873,  874,  875,  876,  879,  880,  884,  and  886  of  this  code  apply  to  the 
examination  of  a  physician  or  surgeon  as  prescribed  in  this  section."  The  word 
"diseased  "  in  Section  836  is  an  inadvertence.  The  word  has  been  deceased  until  the 
passage  of  c.  295,  Laws  of  1893,  when  the  mistake  was  made.  By  these  amendments  the 
power  of  waiver  has  been  enlarged.  What  their  effect  will  be  the  learned  Dr.  Abbott 
has  essayed  to  outline  (see  notes  to  Abbott's  New  <  'ases,  vol.  xxviii.  at  p.  55.  and  vol.  xxx. 
at  p.  84,  also  Columbia  Lair  Times,  April,  1892);  but  who  shall  blithely  assume  to 
prophesy  the  result  of  legal  hermeneutics  when  applied  by  different  courts? 

*   Westerner  vs.  Mtna  Co.,  99  N.  Y.  at  p.  60. 

t  L)c  May  vs.  Roberts,  46  Mich.  160;  41  Am.  R.  154. 

i  Blackstone  Com.  2,  429  ;  Corven's  case,  12  Co.  105  ;  Haynes's  case,  ib.  113  ;  3  Inst, 
202;  B.  vs.  Lynn,  2  T.  R.  733. 

§  Williams  vs.  Williams,  L.  R.  20  Ch.  D.  659.  He  may  under  special  statutes ;  §  305* 
Penal  Code  of  New  York  so  provides.  ||  Am.  Law  Times,  July,  1871. 


LEGAL  RELATIONS   OF  PHYSICIANS  AND   SURGEONS.  G33 

misdemeanor  ;*  a  civil  action  will  also  lie  for  the  trespass  on  the  soil,  and 
the  circumstances  of  the  act  may  be  shown  to  enhance  damages.t  When 
the  body  is  once  buried,  it  cannot  be  removed  without  the  consent  of  the 
owner  of  the  grave,  or  permission  of  the  proper  ecclesiastical,  municipal, 
or  judicial  authority.!  This  topic,  which  is  more  curious  than  practical, 
is  more  fully  discussed  in  Wilcock's  Medical  Profession,^  and  the  treatise 
of  Mr.  Rogers.||  Its  practical  bearing  is  upon  the  method  of  procuring 
material  for  the  dissecting-room.  By  an  early  statute  "  to  prevent  the 
odious  practice  of  digging  up  and  removing,  for  the  purpose  of  dissec- 
tion, dead  bodies  interred  in  cemeteries  or  burial  places,"  fl  the  New  York 
legislature  provided  that  in  the  exercise  of  their  discretion  the  judges  of 
the  Supreme  Court,  oyer  and  terminer  or  goal  delivery,  might  make  it 
part  of  the  sentence  of  one  convicted  of  murder,  arson,  burglary,  or  any 
capital  crime,  that  his  body  should  be  delivered  to  a  surgeon  for  dissec- 
tion ;  and  since  this  act  was  passed  provision  has  been  made  by  law,  in 
New  York  and  elsewhere,  both  to  furnish  to  the  hospitals  and  schools 
the  bodies  of  convicts  and  other  unclaimed  dead  for  dissecting-material, 
and  also  to  punish  body-stealing,  grave-desecration,  and  unlawful  dissec- 
tion.** In  a  very  extraordinary  case  of  late  years,  a  woman,  at  whose 
request  a  coroner  had  exhumed  the  remains  of  one  deceased,  was  con- 
victed of  bod}r-stealing,  but  the  judgment  was  reversed  on  appeal.tt  And 
a  father  who  exhumed  his  child's  body  to  get  its  thigh-bone  as  an  exhibit 
in  an  action  for  malpractice  was  held  not  to  have  violated  the  statute.Jf 

Duty  as  to  Contagious  Diseases. — A  duty  is  devolved  upon  practic- 
ing physicians  in  most  jurisdictions  of  reporting  to  the  municipal  author- 
ities the  existence  of  diseases  classified  as  contagious,  an  omission  to 
perform  which  subjects  the  delinquent  to  a  penalty.  Such  sanitary  regu- 
lations are  different  in  different  States,  are  subject  to  constant  change 
by  amendment,  and  must  be  sought  not  only  in  the  statute  books  but 
in  the  sanitary  codes  issued  by  Boards  of  Health.  The  duty  to  report  a 
case  of  contagious  disease  is  of  course  directly  in  conflict  with  the  phy- 
sician's duty  to  guard  the  secrets  of  the  sick-room ;  but  it  grows  out  of 
the  fundamental  principle,  Salus  populi  suprema  lex.  At  the  same  time 
it  may  well  be  questioned  how  far  a  statute  imposing  this  duty  could  be 
effectually  enforced,  if,  with  a  view  to  quarantining  them,  the  classifica- 
tion of  contagious  diseases  should  be  enlarged  to  include,  as  is  now  sug- 
gested, consumption  and  tuberculous  maladies. 

It  is,  of  course,  the  physician's  duty  to  use  every  precaution  when 
attending  a  contagious  disease  to  avoid  becoming  himself  a  medium  of 

*  7?.  vs.  Lynn,  2  T.  E.  733. 

t  Meagher  vs.  Driscoll,  99  Mass.  281. 

t   Held  vs.  Walker,  130  Mass.  422  ;  cf .  R.  vs.  Sharpe,  7  Cox  C.  C,  where  defendant  was 
convicted  of  misdemeanor  in  removing  his  mother's  body  to  bury  it  by  his  father's ; 
Wynkoop  vs.  Wynkoop,  42  Penn.  St.  293;  Guthrie  vs.  Weaver,  1  Mo.  Ap.  136;  contra, 
Boqert  vs.  Indianapolis,  13  Ind.  131. 
'§  London,  1830. 

||   The  Law  and  Medical  Men,  by  E.  Vashon  Eogers,  Jr.,  Toronto,  1884. 

II  Laws  of  1789,  c.  3. 

**  Penal  Code  of  New  York,  $S  305  to  314  inclusive;  ch.  123,  Laws  of  1854  as- 
amended  by  Laws  of  1887;  Eev.  Statutes,  8th  ed.,  vol.  ii,  p.  1219  &  Part  IV.  ch.  3; 
Art  IV.,  §§  132,  133,  vol.  iv..  p.  2821.     (See  the  statute  books  of  other  States.) 

ft  People  vs.  Fitzgerald,  105  N.  Y.  146.  In  New  York  the  district  attorney  may 
exhume  a  body  for  examination  :  Penal  Code,  §  308. 

U  Rhodes  vs.  Brandt,  21  Hun,  1. 


£34  ^   STSTEM  OF  LEGAL  MEDICINE. 

infection ;  and  where  a  physician,  contrary  to  his  promise  to  one  patient, 
attended  another  one  sick  with  smallpox,  and  communicated  the  latter's 
disease  to  the  former,  it  was  held  that  he  was  liable  for  the  results  of  his 
negligence,  and  that  they  might  be  shown  in  reduction  of  his  charges  * 
If  it  be  necessary,  a  physician  may  order,  under  the  Maine  law,  proper 
disinfecting  process  even  to  the  extent  of  destroying  property ;  for  in- 
stance, causing  the  removal  of  wall-paper  of  an  infected  room;f  and  it 
was  held  to  be  an  indictable  offense  unlawfully  to  inoculate  children 
with  smallpox,^  or  while  they  were  sick  expose  them  in  the  public  high- 
way^ Under  a  Michigan  statute  requiring  plrysicians  to  report  immedi- 
ately contagious  diseases,  it  was  held  a  question  for  the  jury  whether  a 
physician,  who  had  reported  cases  of  diphtheria  in  children  a  week  or 
ten  days  after  his  diagnosis,  had  acted  within  a  reasonable  time ;  and  it 
was  decided  that  diphtheria,  being  a  virulent  and  rapid  disease,  eight 
days  was  not  a  reasonable  time,  and  also  that  verbal  mention  to  the 
health  officer  of  the  existence  of  the  cases  was  not  such  a  report  as  the 
statute  required. 1 1  The  question  of  the  liability  of  a  physician  to  a 
patient  for  reporting  him  as  sick  of  a  contagious  disease  was  considered 
a  few  years  ago  in  a  New  York  case  that  aroused  much  interest  at  the 
time.  Dr.  Purdy,  a  physician  of  excellent  professional  standing,  who 
had  been  elected  president  of  the  medical  society  of  that  county,  was 
called  in  by  a  Miss  Brown,  a  florist,  to  attend  her.  The  testimony  was 
conflicting.  The  patient  at  the  time  of  her  illness  was  suffering  from  a 
cutaneous  affection,  and  expert  testimony  differed  as  to  whether  it  was 
a  light  attack  of  smallpox  or  only  an  eczema.  However  that  matter  be, 
the  physician  considered  the  case  one  of  smallpox,  and  called  in  a  health 
inspector,  who  agreed  with  that  diagnosis  and  ordered  the  removal  of 
the  patient  to  the  smallpox  hospital,  whence  she  was  soon  after  discharged. 
In  an  action  against  Dr.  Purdy,  Miss  Brown  recovered  a  verdict  of  five 
thousand  dollars ;  but  upon  appeal  this  judgment  was  reversed  upon  the 
ground  that  her  removal  was  an  independent  act  of  the  inspector  upon 
his  own  diagnosis ;  that  Dr.  Purdy  was  only  performing  his  duty  in  mak- 
ing his  report,  whether  he  was  mistaken  or  not,  and  that  the  complaint 
should  have  been  dismissed.^]  The  principle  of  the  Purdy  case  is  equally 
applicable  in  cases  of  "  Commitment  of  the  Insane,"  although  no  duty 
of  reporting  the  condition  of  an  insane  patient  to  the  public  authorities 
is  pi-escribed,  as  in  the  case  of  contagious  diseases.  Whether  such  a 
report  should  not  be  required  in  all  cases  where  the  patient's  mania  is 
of  homicidal  tendency  is  worth  serious  consideration.  The  liability  of 
physicians  upon  whose  reports  persons  are  committed  as  insane  has  been 
carefully  considered.**  And  it  has  been  held  that  while  the  judge  who 
signs  the  report  possesses  judicial  immunity,  the  physicians  who  make 

*  Piper  vs.  Menifee,  12  B.  Monroe  (Ky.)  465. 

t  Seavyvs.  Preble,  64  Me.  120;  cf.  Raymond  vs.  Fish,  51  Conn.  80;  a  case  of  de- 
stroying oyster  beds  in  purifying  a  river. 

t  B.  vs.  Burnett,  4  M.  &  S.  272. 

§  R.  vs.  Vantandillo,  4  M.  &  S.  73. 

II  People  vs.  Brady,  90  Mich.  459 ;  51  N.  W.  537. 

IT  Brairn  vs.  Purdy,  54  Super.  Ct,  (N.Y.)  109  ;  8  N.Y.  St.  R.  143,  cf.  Pemiell  vs.  Cum- 
mings,  75  Me.  163.  If  patients  are  carelessly  removed  the  authorities  are  liable  :  Aaron 
vs.  Broiles  ct  al,  64  Tex.  316. 

*  Ayers  vs.  Russell,  50  Hun,  282 ;  Pennell  vs.  Cummings,  75  Me.  163 ;  Hall  vs.  Semple, 
3  F.  &  F.  337. 


LEGAL  RELATIONS   OF  PHYSICIANS  AND   SURGEONS.  635 

it  act  as  medical  experts,  not  as  judicial  officers,  and  are  liable,  as  in 
other  cases  of  malpractice,  for  their  failure  to  have  and  exercise  due 
care,  skill,  and  knowledge.  They  must  make  careful  examination  of  the 
facts  in  the  case.  There  are  few  graver  wrongs  than  the  careless  com- 
mitment of  a  sane  person  to  a  lunatic  asylum.  And  where  an  eminent 
alienist  directed  a  commitment  upon  hearsay  alone  this  was  admitted 
by  counsel  of  both  parties  to  be  assault,  and  a  verdict  of  five  hundred 
pounds  was  rendered  against  the  physician*  A  somewhat  analogous  case 
of  wrong-doing  by  the  erroneous  report  of  a  physician  occurred  in  New 
York,  where  a  verdict  for  plaintiff  was  sustained  in  an  action  for  deceit 
growing  out  of  the  fact  that  defendant,  the  surgeon  of  the  Seventh  Regiment 
of  New  York,  had  made  a  maliciously  false  report  of  plaintiff's  physical 
condition,  thereby  causing  the  latter  to  be  discharged  from  the  regiment.! 
Partnership. — The  ordinary  mercantile  partnership  is  an  association 
of  two  or  more  persons  to  cany  on  a  particular  business  and  share  its 
profits  and  losses.  And  within  the  scope  of  this  business  they  are  liable 
one  for  the  act  of  the  other.  In  an  early  New  York  case  partners  in  the 
practice  of  plrysic  were  said  to  be,  within  the  law  merchant,  i  And  in 
Tennessee  the  note  of  one  of  two  physicians  in  partnership  was  said  to 
be  binding  on  both  if  "  executed  for  anything  for  which  a  firm  of  phy- 
sicians had  use  " ;  e.g.,  drugs  or  instruments,  even  though  the  proceeds 
were  appropriated  to  his  own  use  by  the  drawer.  "  But,"  continued  the 
court,  "  money  is  not  an  article  for  which  such  a  firm  has  use  directly, 
though  it  may  indirectly."  And  therefore,  the  drawing  of  notes  not 
being  within  the  scope  of  the  partnership,  the  firm  is  not  bound.§  The 
"good- will"  of  a  medical  practice  may  be  sold,  and  it  is  a  valid  agree- 
ment if  the  seller  contract  not  to  practice  in  a  certain  locality. ||  Mr. 
Glenn  says  that  a  medical  man  is  liable  for  wrongful  acts  of  his  partner 
in  practice,^  and  there  are  two  American  cases  that  so  hold.**  In  Hyme 
vs.  Erwin  it  appeared  that  a  father  and  son  practiced  medicine  as  part- 
ners, and  both  were  charged  with  negligence  in  practice.  Plaintiff 
recovered  a  verdict.  The  court  said  that  in  such  an  association  each 
partner  "  guarantees  that  within  the  scope  of  the  common  business  rea- 
sonable care,  diligence,  and  skill  shall  be  displayed  by  the  one  in  charge," 
or  at  least  the  failure  of  one  to  exercise  such  skill  and  care  is  the  failure 
of  all.  In  Whittaker  vs.  Collins  it  appeared  that  plaintiff  had  employed 
the  firm  of  Graff  &  Collins  to  set  his  leg,  which  was  broken.  Graff 
attended  him  part  of  the  time  skillfully,  so  plaintiff  considered,  but 
Collins  attended  him  the  rest  of  the  time,  and  made  a  mess  of  it.  So 
Whittaker,  holding  Graff  blameless,  considerately  sued  Gollins,  alone ; 
but  the  defendant  ungraciously  demurred  to  the  complaint  on  the  ground 
of  defect  of  parties ;  and  the  court  considering  the  action  to  be  in  contract, 
sustained  the  demurrer  because  the  innocent  Graff  was  not  sued.     This 

*  Anderson  vs.  Burrows,  4  C.  &  P.  210. 

t  Dederick  vs.  Morris,  14  Week.  Dig.  232. 

t  Allen  vs.  Blanchard,  9  Cow.  631. 

§  Crosthwaite  vs.  Ross,  1  Humph.  23  ;  cf.  Thompson  vs.  Howard,  2  Ind.  245. 

||  Hoyt  vs.  Holly,  39  Conn.  326;  Dtoight  vs.  Hamilton,  113  Mass.  175;  Warfield  vs. 
Booth,  33  Md.  63  ;  and  see  May  vs.  Thompson,  L.  E.  20  Ch.  D.  705  ;  Christie  Administra- 
trix vs.  Clark,  16  Upper  Canada  C.  P.  544. 

51  Manual  of  the  Laws  Affecting  Medical  Men  (London,  1871),  at  p.  340. 

**  Hyme  vs.  Erwin,  23  S.  C.  226  ;  55  Am.  R.  15  ;  Whittaker  vs.  Collins,  34  Minn.  299  ; 
25  N.  W.  632. 


636  ^   SYSTEM  OF  LEGAL  MEDICINE. 

shows  the  danger  of  partnerships,  and  recalls  the  occasion  when  Chang, 
the  Siamese  twin,  having  been  made  president  of  a  total  abstinence  society 
and  chosen  to  lead  its  parade,  Eng  fuddled  himself,  and  the  two  stoned  the 
procession  to  the  lasting  disgrace  of  Chang,  who  never  used  stimulants. 

A  n  unlicensed  person  may  form  a  partnership  with  a  qualified  practi- 
tioner, and  share  the  profits  of  the  practice,  although  he  cannot  himself 
treat  the  patients  of  the  firm.*  And  whatever  the  conditions  of  the 
relationship  may  be,  its  liabilities  are  dependent  on  its  scope  and  the 
application  to  it  of  the  general  principles  of  partnership. 

'Grateful  Patients,  as  is  well  known,  often  send  gifts  to  their  doctors. 
Sometimes  the  gift  is  in  lieu  of  payment  of  the  bill,  but  often  it  is  given 
by  way  of  bequest,  and  is  of  considerable  value.  If  it  be  a  large  part  of 
decedent's  estate,  the  question  of  undue  influence  might  be  raised.  It 
is  enough  to  say  on  this  point  that  while  a  medical  man  may  make  a 
contract  with  or  be  the  legatee  of  his  patient,  still  if  the  donor  or  tes- 
tator be  a  person  of  weak  mind  the  relation  is  such  as  to  make  the  court 
view  the  transaction  with  suspicion.  Nor  should  a  physician  who  has 
reason  to  believe  that  he  may  be  a  legatee  sign  a  will  as  witness,  lest 
being  called  on  to  prove  the  document  he  lose  his  legacy.  The  cases  on 
undue  influence  are,  as  Mr.  Redfield  says,  "almost  infinite  in  number 
.and  variety,"  and  it  is  impossible  in  a  limited  space  to  do  more  than  refer 
to  a  few  in  which  the  relation  of  physician  and  patient  has  played  part.t 

Who  Owns  the  Prescription  ?  is  a  question  frequently  asked  by  phy- 
sicians, but  not  as  yet  answered  by  the  courts.  In  his  treatise  on  medi- 
cal jurisprudence  Ordronaux  has  devoted  some  pages  to  its  discussion; 
but  the  matter  is  one  of  academic  rather  than  of  practical  interest.  The 
patient  pays  for  advice.  He  receives  a  prescription  orally  or  in  writing. 
It  is  his.  He  can  take  it  as  often  as  he  wishes  at  his  own  risk,  or  give 
it  to  his  friends.  No  one  has  ever  pretended  that  a  lawyer  can  forbid  a 
client  repeating  the  legal  advice  given  to  him.  Perhaps  a  contract  might 
be  made  with  the  patient  not  to  "repeat  the  prescription";  but  then  if 
he  break  the  agreement,  what  is  the  physician's  measure  of  damages? 
If  indeed  the  patient  put  up  the  prescription  as  a  patent  medicine  and 
advertise  it  under  the  physician's  name,  this  might  be  a  libel  ;|  but  the 
gist  of  that  offense  would  be  not  selling  the  prescription,  but  imputing 
unprofessional  conduct.  There  is  no  practical  method  of  preventing  a 
patient  from  repeatedly  swallowing  a  prescription  intended  for  a  single 
•occasion,  except  to  give  him  the  actual  remedy,  after  the  old  fashion, 
now  again  coming  into  vogue,  or  else  to  make  the  dose  so  disagreeable 
that  to  take  it  will  be  a  pain  rather  than  a  pleasure. 

Criminal  Offenses. — It  has  been  seen  that  the  practice  of  medicine 
in  some  jurisdictions  is  entirely  free ;  in  others  it  is  prohibited  to  the 
unlicensed  under  penalties  collectable  in  civil  suits  ;  in  yet  others  unlaw- 
ful practice  is  declared  to  be  a  misdemeanor.  In  any  criminal  prosecu- 
tion or  suit  for  penalty  against  an  unlicensed  practitioner,  the  plaintiff's 

*  Turner  vs.  Beijnall,  14  C.  B.  N.  S.  328  ;  8  L.  T.  281. 

t  Crispell  vs.  Dubois.  4  Barb.  393  ;  Dent  vs.  Bennett,  4  Mvl.  &  C.  269  ;  Gibson  vs.  Rus- 
sell, 2  Y.  &  Coll.  C.  C.  104 ;  Popham  vs.  Brooke,  5  Russ.  8 ;  Gremlle  vs.  Ti/lee,  7  Moo.  P. 
C.  320;  Calhoun  vs.  Jones,  2  Redf.  34;  Peck  vs.  Belden,  6  Dem.  289;  of.  Newhouse  vs. 
Godwin.  17  Barb.  236,  where  an  attorney  was  legatee.  The  English  cases  are  col- 
lected in  Glenn's  Manual,  p.  312  seq. 

J  Clark  vs.  Freeman,  11  Beav.  112. 


LEGAL  RELATIONS   OF  PHYSICIANS  AND   SURGEONS.  G37 

prima  facie  case  is  made  out  as  soon  as  defendant's  practice  is  shown  * 
The  burden  of  proving  authority  then  shifts  to  defendants  Nor  is  this 
making  the  accused  prove  his  innocence,  as  some  have  fancied.  The 
forbidden  act  is  the  practice,  and  the  defense  is  a  license,  which  must 
be  estabhshed  affirmatively  like  the  defenses  of  autrefois  acquit  and 
former  jeopardy.  Were  this  not  the  rule,  it  would  be  obviously  impos- 
sible to  convict  unlicensed  practitioners  in  jurisdictions  where  any  med- 
ical diploma  is  a  license ;  for  the  prosecution  would  have  to  prove  a 
negative  as  wide  as  the  world. 

Proof  of  Diploma. — In  order  to  establish  his  defense,  the  defendant 
must  show  the  qualifications  required  by  the  statute ;  and  if  one  of  them 
be  the  possession  of  a  diploma  conferred  lw  a  foreign  corporation,  it  is 
not  enough  to  produce  the  parchment,  but  under  the  strict  rule  he  should 
prove  also  the  charter  of  the  college,  its  existence  at  the  date  of  the  di- 
ploma, the  genuineness  of  the  seal,  and  that  it  was  affixed  by  the  proper 
officer  ;|  but  in  practice  the  rigor  of  the  rule  is  relaxed.  It  would  seem, 
too,  that  compliance  with  the  requirements  preliminary  to  conferring  the 
■degree  should  also  be  shown.§ 

It  scarcely  needs  a  statute  to  emphasize  the  inadvisability  of  under- 
taking an}-  duty  with  "  a  drappie  in  our  ee  " ;  but  it  has  seemed  good  to 
legislative  wisdom  in  several  States  ||  to  declare  the  performance  by  an 
intoxicated  physician  or  surgeon  of  any  act  endangering  the  patient's 
life,  or  seriously  affecting  his  health,  a  misdemeanor,  or  if  death  result, 
manslaughter.^  And  under  the  common  law  Baron  Garrow,  in  Long's 
case,**  said :  "  Suppose  the  person  comes  drunk,  and  gives  me  a  tum- 
blerful of  laudanum,  and  sends  me  into  the  other  world,  is  it  not  man- 
slaughter?" Bayley  considered,  however,  that  so  rash  an  act  would 
be  homicide,  whether  the  prescriber  were  tipsy  or  sober  ;tt  but  in  the 
Georgia  case  referred  to  (supra)  it  was  held  no  good  plea  in  defense 
to  Dr,  Sewell's  suit  against  Mr.  McKleroy  for  fees,  that  plaintiff  went  to 
defendant's  house  in  a  state  of  intoxication,  and  administered  four  cups 
■of  ipecac  at  a  dose,  which  caused  him  to  vomit  so  violently  that  he  was 

*  As  to  what  constitutes  practice,  see  ante. 

+  Apothecaries  Co.  vs.  Bentley,  1  C.  &  P.  538 ;  People  vs.  Nyce,  34  Hun,  298  ;  People  vs. 
Fulda,  52  Hun,  65  ;  People  vs.  Rontey,  4  N.Y.  Supl.  235  ;  117  N.Y.  (324  ;  Raynor  vs.  State, 
■62  Wis.  289 ;  22  N.  W.  430  ;  Wharton  on  Criminal  Evidence,  §§  333-341 ;  Lawson's  Pre- 
sumption of  Evidence,  p.  20. 

X  Hill  vs.  Boddie,  2  Stew.  &  Porter  (Ala,),  56 ;  Hunter  vs.  Blount,  27  Ga.  76 ;  Moises 
vs.  Thornton,  8  T.  R.  303  ;  but  see  Finch  vs.Gridley's  Excrs.,  25  Wend.  469  ;  and  Walmis- 
ley  vs.  Abbott,  1  C.  &  P.  309. 

§  Andrews  vs.  Styrap,  26  L.  T.  R.  704;  Chadwick  vs.  Running,  2  C.  &  P.  106; 
and  Collins  vs.  Carnegie,  1  A.  &  E.  695. 

||  N.  Y.  Penal  Code,  §  357;  Rev.  Stat,  Ohio,  §  6813;  Gen.  Stats.  Mich.,  $  9319;  and 
see  statute  books  of  other  States.  There  seems  to  be  no  need  for  such  a  statutory 
regulation  of  the  drinking  habits  of  lawyers  ;  whether  on  account  of  their  capacity  or 
their  good  habits  may  be  surmised. 

H  Penal  Code,  §  200. 

**  Rex  vs.  St.  John  Long,  4  C.  &  P.  378. 

tt  Rex  vs.  St.  John  Long,  4  C.  &  P.  423.  Whether  causing  the  death  of  a  patient  by 
erroneous  medical  treatment  would  be  manslaughter  on  the  part  of  the  unlicensed 
physician,  although  only  actionable  malpractice  on  the  part  of  a  legally  qualified  prac- 
titioner, is  more  appropriately  discussed  under  Malpractice.  It  is  sufficient  here  to 
say  that  whether  a  practitioner  be  licensed  or  not,  if  by  his  gross  ignorance  or  neg- 
ligence he  causes  the  patient's  death,  he  may  be  guilty  of  manslaughter.  (See  the 
opinion  of  Judge  Oliver  Wendell  Holmes.  Jr.,  in  the  recent  case  (1884)  of  Pierce  vs. 
Commonwealth,  138  Mass.  165,  52  Am.  R,  264.)     It  is  a  principle  of  common  law,  how- 


638  A   SYSTEM    OF  LEGAL   MEDICINE. 

seriously  injured,  and  was  damaged  to  the  extent  of  two  hundred  dollars. 
For  the  court  held  that  "  tort  cannot  be  set  off  against  contract,"  and 
added :  "  The  idea  that  an  overdose  of  ipecac  endangered  a  man's  life 
two  hundred  dollars,  without  stating  in  the  plea  wherein  and  how,  is 
hardly  plainly  and  distinctly  setting  out  a  defense."  * 

Abortion. — The  unlawful  attempt  to  kill  a  child  en  ventre  de  sa  men 
has  been  said  to  be  only  a  misdemeanor  at  common  law ;  but  if  the  death 
of  an  unborn  child,  or  of  the  mother,  result  from  the  attempt,  this  will 
render  the  defendant  guilty  of  homicide.  The  degree  of  the  crime  is 
now  established  by  statute  in  nearly  every  civilized  jurisdiction ;  the  ill- 
founded  distinction  between  the  condition  of  the  child  before  and  after 
quickening  being  generally  maintained.  Of  course  to  save  the  mother's 
life  procuring  an  abortion  is  lawful,  but  the  burden  of  proving  the 
necessity  of  the  operation  is  upon  the  defendants  The  full  discussion 
of  this  topic  also  is  referable  to  the  article  on  Malpractice. 

To  have  carnal  knowledge  of  a  patient  under  pretense  of  medical 
treatment,^  or  to  unnecessarily  make  her  disrobe  under  pretext  of  ex- 
amination^ have  been  held  to  be  assaults.  In  Begina  vs.  Case,  it 
appeared  that  defendant,  a  surgeon,  under  pretense  of  treating  a  girl 
fourteen  years  old  for  suppressed  menstruation  had  had  carnal  inter- 
course with  her,  she  consenting  in  the  belief  that  it  was  good  treatment. 
And  Wilde,  C.-J.,  discussing  the  evidence  in  the  case,  said :  "  The  defend- 
ant, for  aught  that  appears  to  the  contrary,  may  have  adopted  the 
course  he  took  bona  fide  with  a  view  to  her  cure.  The  court  cannot  say 
that  it  might  not  have  been  beneficial  in  a  medical  point  of  view."  But 
in  the  end  the  entire  court  agreed  that  such  a  system  of  practice  should 
be  discouraged,  and  affirmed  the  conviction. 

Excise  Laws  are  not  to  be  disregarded  by  the  medical  practitioner, 
who  must  be  wary  in  prescribing  spiritus  frumenti,  especially  if  the 
patient  is  a  chronic  sufferer  and  given  to  repeating  the  prescription.  In 
Alabama,  where  a  physician  may  lawfully  administer  the  prohibited 
liquor  in  cases  of  necessity,  he  cannot  prescribe  a  quart  of  whiskey  and 
give  the  patient  an  order  for  it  upon  a  drug  shop  in  which  he  is  inter- 
ested.! |  And  if  a  country  doctor  prescribe  and  furnish  whiskey  at  the 
usual  price  he  is  a  retailer,  and  violates  Section  3242  of  the  Revised 
Statutes  of  the  United  States,  unless  he  pay  the  special  tax.^J  In  Iowa  a 
doctor  cannot  without  a  permit  put  up  prescriptions  containing  intoxi- 

ever,  that  if  one,  while  committing  a  misdemeanor,  cause  death,  he  is  guilty  of  man- 
slaughter ;  and,  as  we  have  pointed  out,  illegal  practice  of  medicine  in  England  is  a 
prohibited  offense  punishable  only  by  a  civil  penalty,  and  not  an  indictable  mis- 
demeanor. This  was  true  in  the  time  of  Hale,  whose'  opinion  (Pleas  of  the  Crown, 
429)  the  American  cases  have  followed.  And  it  is  to  be  noted  that  those  cases  have 
been  decided  in  jurisdictions  where  the  medical  law  was  similar  to  the  English. 
But  it  was  early  said  that  such  a  killing  would  be  manslaughter  in  New  York,  where 
illegal  medical  practice  is  a  misdemeanor.     (March  vs.  Davison,  9  Paige,  584.) 

*  McKleroy  vs.  Sewell,  73  Ga.  657. 

t  People  vs.  McGoneqaJ,  136  N.  Y.  62. 

X  R.  vs.  Stanton,  1  Car.  &  Kir.  415 ;  E.  vs.  Case,  19  L.  J.  M.  C.  174. 

§  R.  vs.  Rosinski,  1  Moo.  C.  C.  19.  It  was  said  in  R.  vs.  Case  that  the  evidence  in 
Rosinski's  case  showed  that  the  removal  of  the  clothing  was  not  an  entirely  voluntary 
act  of  the  patient,  but  that  defendant  used  some  force  ;  therefore  the  conviction  of  as- 
sault was  maintainable.     But  the  case  is  always  cited  to  the  effect  stated  in  the  text. 

||  Brinson  vs.  State,  8  So.  527. 

If   U.  S.  vs.  Smith,  45  Fed.  115. 


LEGAL  RELATIONS  OF  PHYSICIANS  AND   SURGEONS.  G:J9 

eating  liquor.*  In  Kentucky  physicians,  who  are  the  only  persons 
allowed  to  keep  and  prescribe  liquor  as  a  medicine  within  three  miles  of 
Newcastle  Court-house,  violate  the  law  if  they  fail  to  record  the  sale  in 
a  book,  and  the  statute  so  providing  has  been  held  to  be  constitutional^ 
In  the  same  State  Dr.  Greene  being  indicted  for  "  prescribing  whiskey 
improperly,''  the  court  held  this  to  be  bad  pleading;  for  prescription  of 
whiskey  is  entirely  consistent  with  propriety,  and  facts  showing  bad 
faith  should  be  alleged.^  In  Oregon  a  physician  selling  any  of  the  drugs 
enumerated  in  the  act  relating  to  poisons  must  show  that  he  also  pre- 
scribed it  and  kept  the  record  required  by  law.§ 

Medical  Societies  have  been  incorporated  very  generally,  for  the 
purpose  of  increasing  knowledge  of  medical  science,  fostering  personal 
relations,  and  regulating  professional  conduct.  New  York,  which  in 
1760  enacted  her  first  statute  forbidding  unlicensed  medical  practice,|| 
created  in  1806  by  a  general  act  of  incorporation  a  system  of  State 
and  county  medical  societies,^  "for  the  diffusion  of  true  science,  and 
particularly  the  knowledge  of  the  healing  art."  Since  that  timt  kindred 
societies  have  grown  up  all  over  this  country  of  a  national,  State,  and 
county  jurisdiction.  In  the  beginning  of  the  century  quackery  of  every 
kind  was  rampant,  as  Carlyle  has  forcibly  pointed  out  in  his  essay  of 
Cagliostro  ;  but  the  medical  profession  was  comparatively  homogeneous. 
There  were  individual  pretenders,  such  as  Thompson,  whose  disciples 
have  been  repeatedly  indicted  for  manslaughter  by  ill-advised  prescrip- 
tions of  his  specifics,  "ram-cats"  and  " well-my-gristle," **  and  who  him- 
self founded  what  was  called  the  "  botanic  system,"  and  Perkins,  who 
established  treatment  by  metallic  tractors.  But  these  men  had  no  legal 
status  as  physicians  belonging  to  incorporated  societies.  Reputable  prac- 
titioners were  not  divided  among  themselves;  and  it  was  feasible  to 
enact,  as  was  done,  that  every  practicing  physician  should  upon  notice 
join  a  county  society  under  penalty  of  forfeiting  his  license  in  case  of 
contumacy.tt  This  law  is  still  in  force  in  New  York ;  but  the  incorpora- 
tion of  Homoeopathic  and  Eclectic  county  societies  has  made  it  prac- 
tically a  dead  letter;  since  in  order  to  enforce  it  cooperation  would  be 
needed  among  the  three  societies.  Therefore  many  legal  practitioners 
do  not  belong,  as  the  law  contemplates  they  should  do,  to  any  county 
societ}\  .  These  organizations  have,  of  course,  all  the  powers  specified 
in  their  charters  and  necessary  to  effect  their  purpose,  preserve  their 
being,  and  enforce  their  lawful  discipline.^!  And  it  was  early  held  that 
such  a  society  could  demand  an  initiation  fee,§§  expel  a  member  for  gross 
ignorance  or  immorality,  even  though  he  had  been  tried  and  acquitted 
on  the  charges,||||  and  also  that  it  would  not  be  directed  by  the  writ  of 
mandamus  to  admit  to  membership  one  whom  it  would  have  to  expel 

*  State  vs.  Bcnadouc,  79  Iowa,  90  ;  44  N.  W.  218. 

t  Sarris  vs.  Commonwealth,  83  Kentucky,  327. 

X  Commonwealth  vs.  Green,  80  Kentucky,  178. 

§  State  vs.  Jones,  18  Or.  256;  22  Pac.  840. 

||  Ch.  198,  Laws  of  1760 ;  Livingston  &  Smith,  p.  188. 

H  Ch.  138,  Laws  of  1806. 

**  Lobelia  inflata  of  Linnaeus. 

tt  Rev.  St.  of  N.  Y.,  Part  I.,  ch.  xiv..  title  vii.,  §§  1  and  2. 

It  People  ex  rel  Bartlett  vs.  Med.  Soc.  of  Erie,  32  N.  Y.  187. 

H  People  ex  rel  Bunnell  vs.  Med.  Soc.  of  N.  Y.,  3  Wend.  426. 

|||i  Ex  parte  Smith,  10  Wend.  449. 


C40  A   SYSTEM  OF  LEGAL   MEDICINE. 

immediately,  e.g.,  a  homoeopath  with  an  avowed  intent  to  adhere  to  his 
belief  in  the  doctrine  of  si  mil  id,  psora,  and  the  high  potencies.*  But 
where  one  who  had  in  the  past  acted  contrary  to  the  medical  code 
by  advertising,  being  otherwise  qualified  and  ready  to  abandon  his 
misdoing,  was  refused  admission  to  such  a  society,  a  mandamus  was 
granted  commanding  his  election,  although  it  was  conceded  that  if  he 
should  advertise  after  becoming  a  member,  he  would  be  liable  to  ex- 
pulsion; the  point  being  that  advertising  is  not  of  itself  immoral, 
and  that  the  obligation  of  the  code  and  by-laws  does  not  exist  until 
they  are  subscribed  to;t  but  the  same  society  was  not  permitted  to 
expel  a  member  who  attended  the  county  poor  in  violation  of  a  rule 
establishing  a-  tariff  of  charges,  for  the  rule  itself  was  considered  con- 
trary to  public  policy.J  Dr.  Fawcett  was  elected  to  the  Alleghany 
County  Medical  Society  in  1831,  as  a  physician  and  surgeon,  on  produc- 
ing his  diploma  from  the  Royal  College  of  Surgeons  of  Edinburgh. 
"  This  document,"  says  the  report,  "  was  in  Latin,  and  it  appeared  that 
although  the  credential  was  handed  about  and  inspected  by  the  members 
of  the  society,  the  greater  part  of  them  could  not  translate  it.  It  was, 
however,  translated  on  the  trial,  and  found  to  be  only  a  diploma,  author- 
izing the  practice  of  surgery."  Dr.  Charles,  getting  wind  of  this  wicked 
deception,  offered  the  following  resolution:  "Whereas,  Henry  Fawcett, 
hy  false  pretensions,  became  a  member  of  the  Alleghany  County  Medi- 
cal Society :  therefore  resolved,  that  we  reconsider  the  vote  taken  at  the 
last  meeting  in  February,  1831,  making  Henry  Fawcett  a  member  of 
this  society,  and  that  he  be  no  longer  considered  a  member  of  the  Alle- 
ghany County  Society,  until  he  qualifies  himself  to  practice  physic,  etc., 
.according  to  the  laws  of  this  State."  This  sounded  so  well  that  not  only 
did  the  society  adopt  it,  and  as  they  supposed,  expel  Fawcett,  but  the 
Angelica  Republican,  with  a  kindly  spirit  of  "newspaper  enterprise,"  also 
pul  >lished  the  proceedings.  Whereupon  Fawcett  sued  Charles  for  libel 
and  recovered  a  verdict  of  one  hundred  and  fifty  dollars,  which  the  Ap- 
pellate Court  sustained,  saying  that  plaintiff's  performance  in  palming 
off  his  Latin  for  more  than  it  was  worth  was  no  ground  for  expulsion. 
"It  was  not  breach  of  his  oath,  for  he  had  taken  none,  nor  of  his  official 
duty,  for  he  was  not  yet  a  member,"  wherefore  the  court  held  that 
Fawcett,  like  Sandy's  shilling  in  the  box,  "being  once  in  was  always  in," 
and  added,  for  the  benefit  of  the  society,  and  doubtless  with  unconscious 
humor,  that  "their  proceedings  were  coram  non  jiidice." 

Slander  and  Libel,  therefore,  are  actions  that  will  lie  for  wrongfully 
assailing  a  physician's  professional  reputation.  It  would  be  inadvisable 
to  enumerate  here  the  cases  of  this  nature  which  have  grown  out  of  the 
careless  speeches  concerning  medical  practitioners,  many  of  them  being 
grotesque  to  a  degree.  Nevertheless,  as  a  finger-post  of  warning  to  the 
impetuous  and  irascible,  it  may  be  worth  while  to  cite  a  few  instances, 
more  or  less  modern,  in  which  utterances  concerning  the  practitioner  of 
medicine  have  been  held  to  be  slanderous  or  libelous.  Libel  and  slander 
are  both  malicious  defamation  of  character.  But  the  latter  is  by  word 
of  mouth ;  the  former,  by  the  more  deliberate  and  enduring  expressions 

*  Ex  parte  Paine,  1  Hill  (N.  Y.),  665. 

t  People  ex  rel  Bartlett  vs.  Med.  Soc.  of  Eric.  32  N.Y.  187 ;  see  opinion  of  Davis,  P.  J., 
at  General  Term,  25  How.  333  ;  this  case  led  to  the  enactment  of  Laws  of  1S66,  ch.  445. 
t  People  ex  rel  Gray  vs.  Med.  Soc.  of  Eric,  24  Barb.  570. 


LEGAL  RELATIONS   UE  rHYSICIANS  AND   SURGEONS.  641 

that  are  apprehended  by  the  eye — printed  or  written  words,  signs,  pict- 
ures, or  effigy.*  But  because  verba  dicta  pereunt,  litera  scripta  manent, 
and  also  because  the  deliberation  of  writing  aud  perhaps  revising  the 
proof  of  a  defamatory  saying  or  joke  shows  greater  depravity  than  does 
the  sudden  impulse  of  a  speech,  words  that  if  spoken  would  be,  in 
the  mild  eye  of  the  law,  innocent,  become  libels  if  printed  or  written. 
Slanderous  words  must  defame  a  man  with  respect  to  his  occupation  in 
life  or  character;  it  is  even  said  that  they  must  impute  crime  or  such  ig- 
nominy as  would  exclude  him  from  society ;  while  to  constitute  libel  it 
is  sufficient  if  he  be  made  ridiculous. 

Thus  words  charging  a  physician  with  gross  ignorance  and  unskill- 
fulness  or  neglect  in  his  profession  may  constitute  either  slander  or  libel, 
.according  as  they  are  spoken  or  written.!  To  say  of  an  unlicensed  phy- 
sician that  he  is  a  quack  is  not  actionable,  as  we  have  already  seen.i: 
But  it  is  otherwise  if  the  person  defamed  have  complied  with  the  law 
although  he  adopt  a  "system"  disapproved  by  the  defamer.  xVnd  if  the 
imputation  of  quackery  be  made  maliciously  it  will  not  be  privileged, 
because  it  was  made  on  the  witness-stand.  Doctors  White  and  Carroll 
practiced  medicine  in  Amsterdam,  N.  Y.  White,  though  a  graduate 
of  a  regular  medical  college,  adopted  and  practiced  homoeopathy.  Both 
attended  Jay  Phillips.  Nevertheless  Jay  died,  and  his  will  being  con- 
tested after*  the  fashion  of  the  time,  both  physicians  were  called  before 
the  surrogate  to  testify  as  to  decedent's  mental  capacity.  Dr.  Carroll 
being  asked  if  any  other  physician  than  he  attended  Mr.  Phillips,  an- 
swered, "Not  as  I  know  of."  *  He  was  then  asked,  "Did  not  any  physi- 
cian attend  him  at  the  time  he  was  at  Mrs.  Moore's,  when  you  did  not  ? " 
and  he  replied :  "  Not  as  I  know  of.  I  understand  he  had  a  quack ;  I 
would  not  call  him  a  physician.  I  understood  that  Dr.  White,  as  he  is 
called,  had  been  there."  The  jury  thought  that  Dr.  White  was  damaged 
to  the  extent  of  one  hundred  dollars  by  this  aspersion. §  So  to  say  of  a 
physician,  "  He  is  no  doctor ;  he  bought  his  diploma  for  fifty  dollars,"  ||  is 
actionable.  Where  adultery  is  a  crime,  it  is  of  course  slanderous  aud 
libelous  falsely  to  impute  the  guilt  of  it  to  any  man  or  woman  ;  but  in 
the  absence  of  statute  making  that  offense  criminal,  it  was  held  at  com- 
mon law  that  merely  to  impute  it  to  a  physician  was  not  slander,  because 
a  man  may  be  a  good  physician,  or  rather  an  able  man  in  his  profession, 
and  yet  play  havoc  with  the  seventh  commandment  ;||  but  if  the  charge 

*  A  learned  text-writer  (Townshend  on  Libel  and  Slander,  eh.  1,  p.  3,  4th  ed.)  is  of 
•opinion  that  "effigy"  includes  "gestures";  but  the  adjudicated  cases  do  not  seem  to 
have  determined  the  point.  Gesture  appeals  to  the  eye,  it  is  true,  and  not  to  the 
ear,  but  it  is  less  premeditated  and  more  transitory  even  than  words.  It  would  make 
a  great  difference  in  the  case  of  the  Sacristan  cited  by  Ingoldsby.  whether  his  subtle 
aspersion  of  character  by  gesture  were  slander  or  libel. 

"An  uncle— so  'tis  whisper'd  now  throughout  the  sacred  fane. 
And  a  niece— whose  father's  far  away  upon  the  Spanish  main. 
The  Sacristan  he  says  no  word  that  indicates  his  doubt. 
But  he  puts  his  thumb  unto  his  nose,  and  spreads  his  fingers  out. 

t  Carroll  vs.  White,  33  Barb.  615  ;  Gauvreau  vs.  Superior  Publishing  Co.,  62  Wis.  403 : 
Southee  vs.  Denny,  1  Exch.  196;  Secor  vs.  Harris.  18  Barb.  425. 

i  Hargan  vs.  Purdy,  20  S.  W.  432  (Ken.  Ct,  Ap.  1892) ;  March  vs.  Davison,  9  Paige, 
580 ;  Skirving  vs.  Boss,  31  Up.  Can.  C.  P.  423. 

«    White  vs.  Carroll,  42  N.  Y.  161. 

II  Bergoldvs,  Putcha,  2  Th.  C.  (X.  Y.)  532.  To  impute  to  a  practicing  physician 
general  ignorance  of  medical  science  and  lack  of  professional  skill  is  actionable,  with- 


642  ^   SYSTEM  OF  LEGAL  MEDICINE. 

be  of  adultery  with  a  patient,  this  involves  professional  character,  and 
for  such  an  imputation  a  physician  of  prominence  recovered  a  verdict  of 
twenty  thousand  dollars  against  the  Detroit  Evening  News*  The  Roches- 
ter Democrat  and  Chronicle,  under  the  headline  "  A  Narrow  Escape  From 
Being  Buried  Alive,"  narrated  that  farmer  Hammell  had  been  found 
frozen  stiff  in  the  highway,  that  coroner  Purdy  promptly  sat  on  the  body 
and  was  investigating  the  cause  of  death  with  his  jury,  when  Dr.  Lester 
insisted,  despite  the  laughter  aroused  by  his  statement,  that  the  farmer 
still  lived,  as  indeed  proved  to  be  the  case.  It  chanced  that  the  coroner 
was  also  a  physician,  although  the  Democrat  said  nothing  of  the  fact,  and 
he  brought  Ins  action  in  libel  to  recover  damages.  And  let  this  case 
show  how  futile  it  would  be  to  try  to  give  to  our  definition  a  point  like 
that  of  Ithuriel's  lance,  able  to  detect  libel  the  moment  the  loathsome 
thing  appears.  The  trial  judge,  being  of  opinion  that  the  words  were 
not  libelous  per  se,  directed  a  verdict  for  defendant.  But  verdicts  by 
judges  or  juries  are  elusive.  The  General  Term  with  one  accord  were  of 
opinion  that  the  words  were  libelous  per  se.  For  they  said,  with  some 
appearance  of  argument,  "Was  it  not  calculated  to  bring  disgrace  or 
ridicule  upon  a  physician  to  say  of  him  in  substance  that  he  did  not 
know  on  inspection  that  a  man  was  alive  or  dead?"  So  they  reversed 
the  judgment  below  and  ordered  a  new  trial.  But  the  Court  of  Appeals 
still  remained,  and  thither  the  parties  trudged  in  quest  of  justice.  That 
court — also  with  one  accord — reversed  the  General  Term,  for,  said  they : 
"  It  appears  from  the  complaint  and  evidence  that  the  plaintiff  was  by 
profession  a  physician  and  by  office  a  coroner.  In  the  article  complained 
of  he  is  referred  to  in  the  latter  capacity  only,  and  nowhere  can  be 
found  a  word  or  suggestion  from  which  the  most  astute  inquirer  could 
infer  that  he  had  any  other  than  that  public  occupation.  As  the  lan- 
guage used  did  not  relate  to  his  profession  in  any  way,  so  as  to  his  office 
of  coroner,  it  exhibits  on  his  part  a  prompt  and  efficient  performance  of 
its  duties ;  and  it  is  impossible  to  see  how  any  person  reading  it  could 
ascribe  to  the  words  a  defamatory  meaning,  or  without  the  innuendoes 
apply  them  to  the  plaintiff  in  his  professional  capacity,  and  there  is  no 
evidence  that  such  application  was  intended."!  As  the  procedure  allowed 
no  further  appeal,  and  the  defendant  had  won  the  best  two  out  of  the 
three  legal  bouts,  the  coroner  got  no  damages. 

The  audacity  of  those  who  do  business  by  advertising  presents  an- 
other phase  of  this  subject  of  libel.  Dr.  Clark  applied  to  the  courts  for 
an  injunction  to  prevent  the  use  of  his  name  by  one  Freeman,  a  manu- 
facturer of  "  consumption  pills,"  which  were  put  in  boxes  and  labeled 
with  Dr.  Clark's  name.  The  injunction  was  refused  on  the  ground 
that  Freeman's  act  was  libelous  and  therefore  damages  were  recoverable 
at  law;  and  when  this  is  so  equity  refuses  to  interfere  by  injunction.^ 

out  proof  of  special  damage.  Cruiksliarik  vs.  Gordon,  48  Hun,  308  ;  afd.  118  N.  Y.  178. 
See  Lynde  vs.  Johnson,  39  Hun,  12  ;  Carroll  vs.  White,  33  Barb.  615 ;  Collins  vs.  Carnegie, 
1  A.  &  E.  695 ;  Long  vs.  Chubb,  5  C.  &  P.  55. 

*  Maclean  vs.  Scripps,  52  Mich.  214. 

t  Purdy  vs.  Rochester  Printing  Co.,  26  Hun,  206;  reversed,  96  N.  Y.  372. 

X  Clark  vs.  Freeman,  11  Beav.  112.  A  droll  action  for  libel  was  that  of  Sidlings  vs. 
Shakespeare,  46  Mich.  408 ;  41  Amer.  166.  Plaintiff  wrote  a  puff  of  himself  which  de- 
fendant, publisher  of  the  Kalamazoo  Gazette,  misprinted,  so  that  it  read  that  Sidlings 
had  removed  a  "  patty  tuber  "  from  the  "  hypogastrium  "  of  A.  B.  Smith.  Verdict  for 
defendant. 


LEGAL  RELATIONS   OF  PHYSICIANS  AND  SURGEONS.  643 

But  in  a  very  recent  case*  the  court  at  special  term  granted  an  in- 
junction to  Sir  Morrell  McKenzie  restraining  the  use  of  his  name 
by  a  manufacturing  company  to  advertise  certain  salts  of  Carlsbad. 
The  case  never  reached  the  Appellate  Court.  The  use  of  his  photo- 
graph as  an  advertisement  is  something  that  the  public  man  may  expect. 
He  may  approve  of  it  or  he  may  not.  That  makes  little  difference  to 
the  advertiser.  An  eminent  English  actor,  whose  face  a  great  pilL- 
maker  has  used  as  an  advertisement,  fled  not  long  ago  for  rest  and 
privacy  to  a  little  country  town  where  he  thought  he  would  be  un- 
known. He  met  two  pretty  children  in  his  walks,  who  smiled  in  recog- 
nition as  they  passed.     He  turned  and  said :  "  My  dear,  do  you  know 

me  ? "     "  Oh  yes/'  they  said,   "  you're 's  pills."     And  the  player's 

dream  of  fame  was  realized.  But  when  an  abuse  becomes  intolerable, 
the  courts  find  a  remedy  even  if  they  shatter  a  tradition  to  do  so.  The 
use  of  a  private  person's  likeness  without  his  permission  will  be  en- 
joined.t  The  relatives  of  a  decedent  have  been  able  to  procure  an 
injunction  f  to  prevent  the  erection  of  a  statue  identifying  their  dead 
with  a  movement  of  a  public  nature,  and  there  is  reason  to  hope  that 
the  right  of  privacy  and  public  decency  will  be  more  and  not  less  en- 
forced in  the  future. 

DENTISTRY. 

If  Celsus  said  truly  that  all  parts  of  medicine  were  so  interwoven  as 
not  to  be  separable,  argument  is  unnecessary  to  show  that  dentists  belong 
to  the  class  of  medical  men.  It  is  common  knowledge  that  the  clergy 
were  well-nigh  the  only  practitioners  of  physic  and  surgery  prior  to 
a.d.  1163,  when  the  Council  of  Tours,  perceiving  that  the  success  achieved 
by  the  faithful  was  but  a  snare  of  the  arch-enemy  to  divert  pious  souls 
from  holy  things  to  things  temporal,  issued  the  decree  restricting  excur- 
sions from  the  cloister  and  the  absorbing  practice  of  healing  arts  by 
priest  or  monk.  Thereafter  surgery  fell  into  the  hands  of  smiths  and 
barbers ;  in  oblivious  commemoration  whereof  the  barber  erects  his  pole 
to  this  day.  The  greater  surgical  operations  soon  fell  naturally  into  the 
better  educated  and  more  skillful  hands,  and  surgeons  formed  into 
colleges ;  but  "  tooth-pulling,"  which  by  some  is  even  yet  understood  to 
•constitute  dentistry,  remained  until  comparatively  recently,  together  with 
cupping  and  leeching,  part  of  the  barber's  business.  And  if  it  be  true 
that  the  world  takes  us  at  our  own  estimate  of  ourselves,  it  is  in  no 
.small  degree  the  fault  of  dentists  themselves  that  they  continued  so  long 
to  occupy  a  less  dignified  plane  of  usefulness  than  their  medical  brethren, 
the  physicians  and  surgeons.  Their  advertisements  by  hideous  displays 
of  artificial  teeth  and  instruments,  their  lack  of  organization,  ethical 
rules,  and  esprit  du  corps,  possibly  even  the  similarity  of  the  dental  chair 
to  that  of  the  barber,  all  tended  to  preserve  the  old  tradition,  especially 
when  joined  with  a  steady  flow  of  conversation  not  far  removed  in  sub- 
ject and  quality  from  that  of  the  gentlemen  of  the  pole.  "  Attaqui, 
calommnie',  ridiculisS  comme  le  chirurgien  ou  le  mtdecin  au  temps  de  Moliere, 
le  dentiste  a  eu pendant  une  bonne  partie  de  le  siMe  tin  sort  peu  enviable" 

*  McKenzie  vs.  Soden  Mineral  Springs  Co.,  27  Ab.  N.  C.  402,  18  N.  Y.  Supl.  240. 
t  Pollard  vs.  PJwtographic  Co.,  40  Ch.  D.  345;  Marks  vs.  Taffa,  2G  N.  Y.  Supl.  908. 
t  Schuyler  vs.  Curtis,  27  Ab.  N.  C.  387;  24  N.  Y.  S.  509. 


(j44  A  SYSTEM  OF  LEGAL  MEDICLNE. 

{Code  du  Chirurgien-Dentiste,  par  MM.  Roger  et  Godon,  Paris,  1893.) 
But  all  this  has  been  changed.  The  organization  of  societies  and  col- 
leges, the  enactment  of  registration  and  license  laws,  the  extraordinary 
progress  of  dental  art  and  science,  and  the  high  character  of  then-  lead- 
ing exponents,  have  been  such  as  to  elicit  admiration,  and  some  enthusi- 
asts have  gone  so  far  as  to  consider  dentistry  a  separate  profession, 
which  it  is  undesirable  to  "hitch  on  to  the  tail  of  the  medical  kite  to 
give  it  ballast  for  a  higher  flight"* — a  proposition  not  to  be  rashly 
accepted. 

However  this  may  be,  the  practice  of  dentistry,  and  the  relations  of 
the  dentist  to  his  patient  so  far  as  the  law  is  concerned,  are  governed  by 
the  same  rules  already  laid  down  in  the  preceding  pages.  The  question 
has  indeed  been  raised  in  the  courts  as  to  whether  a  dentist  was  a  trades- 
man, an  artisan,  or  a  professional  man.  Tims  a  dentist  who  made  at  her 
request  two  sets  of  teeth  for  a  lady,  who  died  before  she  could  try  them 
in,  was  held  in  a  suit  against  her  executor  incapable  of  recovering  their 
value  upon  the  ground  that  the  action  was  not  for  services  but  for  goods 
sold,  and  as  such  not  maintainable  under  Section  17  of  the  Statute  of 
Frauds.t  In  a  Mississippi  case,  decided  in  1856,  the  question  at  issue 
being  whether  dental  instruments  were  exempt  from  levy  under  execu- 
tion, as  mechanical  tools,  the  court  held  that  they  were  not,  because  den- 
tistry is  not  a  trade.f  In  a  similar  case,  however,  in  18G8,  Chief -Justice 
Cooley  held  that  such  instruments  were  exempt  from  levy  under  attach- 
ments. The  learned  jurist  did  not  hold  a  dentist  to  be  "  a  mechanic,"  as 
Mr.  Rogers  suggests,§  nor  do  his  words  quoted  by  that  excellent  writer 
fairly  bear  such  an  interpretation.  His  decision  went  no  further  than 
to  hold  that  the  vocation  is  of  a  duplex  nature ;  that  dental  operations 
are  for  the  most  part  mechanical,  "  and  so  far  as  tools  are  employed  they 
are  purely  so  ;  "  but  is  not  this  so  of  the  surgeon's  saw  ?  The  court  said : 
"  Indeed,  dentistry  was  formerly  purely  mechanical,  and  instruction  in  it 
scarcely  went  beyond  manual  dexterity  in  the  use  of  tools  ;  and  a  knowl- 
edge of  the  human  system  generally,  and  of  the  diseases  which  might 
affect  the  teeth  and  render  an  operation  important,  was  by  no  means 
considered  necessary.  Of  late,  however,  as  the  physiology  of  the  human 
system  has  become  better  understood,  and  the  relations  of  the  various 
parts  and  their  mutual  dependence  become  more  clearly  recognized, 
dentistry  has  made  great  progress  as  a  science,  and  its  practitioners 
claim,  with  much  justice,  to  be  classed  among  the  learned  professions."  || 
The  most  recent  expression  of  judicial  opinion  that  dentistry  is  a  medical 
specialty  is  in  Fliekinger's  case,fl  wherein  the  Missouri  statute  exempting 
"a  medical  practitioner"  from  jury  service  was  held  to  apply  to  one 
lawfully  practicing  dentistry.  The  court  said:  "  While  dentistry  as  an 
independent  calling  may  have  had  a  humble  and  comparatively  recent 
origin,  it  has  now  become  a  very  important  branch  of  medical  science, 

*  Dentistry  n<>f  a  Specialty  of  Medicine,  by  N.  W.  Kingsley,  D.B.S.,  Medical  Record, 
November  20,  1886.  Is  Dentistry  a  Specialty  of  Medicine  .'  by  the  writer,  Medical  Bee- 
ord,  December  4,  1886. 

t  Lee  vs.  Griffin,  30  L.  J.  Q.  B.  252  ;  ef.  Oilman  vs.  Andrus,  28  Vt.  241,  where  a  hus- 
band was  held  liable  to  pay  for  his  wife's  teeth. 

X   Whitcomb  vs.  Beid,  31  Miss.  567. 

vS  Rogers,  The  I. air  and  Medical  Men,  p.  170. 

||  Maxon  vs.  Perrott,  17  Mich.  332. 

If  State  ex  rel.  FUcJcinger  vs.  Fisher,  21  S.  W.  446,  593. 


LEGAL  RELATIONS   OF  PHYSICIANS  AND  SURGEONS.  (j45 

[Address  of  N.  S.  Davis,  M.D.,  president  of  the  American  Medical  Asso- 
ciation.] The  fact  that  this  branch  of  the  medical  profession  has  grown 
to  such  proportions  as  to  have  its  own  independent  colleges  and  to  con- 
fer its  own  degrees,  and  that  it  has  become  necessary  that  its  practice 
should  be  regulated  by  statute,  indicate  the  importance  of  the  exercise 
of  its  functions  to  the  public  welfare.  The  fact  that  it  is  regulated  in  a 
separate  article,  and  as  an  independent  calling  from  that  of  an  M.D., 
does  not  in  any  manner  affect  the  character  of  those  functions." 

The  Dental  Act  of  1878*  regulates  the  practice  of  dentistry  in  the 
United  Kingdom,  and  places  it,  like  medical  practice,  under  the  super- 
vision of  the  General  Council  of  Medical  Education  and  Registration, 
whose  functions  in  dental  as  in  medical  matters  are  discretion ary  and 
not  controllable  by  mandamus.f 

In  France  the  practice  is  regulated  by  the  recent  law  of  November  30, 
1892.  Germany,  Austria,  Switzerland,  Belgium,  Spain,  Italy,  Norway, 
Sweden,  Finland,  Denmark,  and  Russia,  all  prescribe  rides  of  licenser 

In  this  country  Alabama  seems  to  have,  been  the  first  State  to  enact 
a  dental  law.  At  present  such  laws  are  in  force  in  Arkansas,  Connecti- 
cut, District  of  Columbia,  Georgia,  Indiana,  Kentucky,  Maine,  Massa- 
chusetts, Michigan,  Minnesota,  Missouri,  Mississippi,  New  Hampshire, 
New  York,  North  Dakota,  Ohio,  Oregon,  Rhode  Island,  South  Carolina, 
Vermont,  Virginia,  Wisconsin.  The  Dental  Act  of  41  &  42  Vict,  is  very 
similar  to  the  Medical  Act  in  its  provisions,  and  up  to  the  present  year 
the  diplomas  of  Harvard  and  Ann  Arbor  have  been  recognized  as  en- 
titling their  holders  to  registration  thereunder.  But  it  was  decided  by 
the  General  Council  lately  (in  1893)  to  discriminate  no  longer  as  between 
American  diplomas,  none  of  which  now  entitle  their  holders  to  register 
as  dentists.  The  French  law  has  so  recently  become  operative  that  its 
results  cannot  be  criticised.  The  statute  confines  practice  of  dentistry 
to  doctors  of  medicine  or  surgeon  dentists,  the  diploma  of  the  latter 
class  to  be  conferred  by  the  government,  after  a  course  of  study  to  be 
promulgated  by  the  higher  council  of  public  instruction  and  examina- 
tions. Illegal  practice  is  punishable  by  a  fine  of  from  fifty  to  one  hun- 
dred francs  for  the  first,  and  from  one  hundred  to  five  hundred  francs 
for  the  second  offense. 

To  make  a  synopsis  of  the  statutes  of  our  States  is  hardly  worth  while 
in  this  place,  for  the  same  reasons  that  have  caused  an  omission  of  a  like 
synopsis  of  the  medical  laws.  In  this  transition  and  formative  period  the 
statutes  are  subject  to  change  by  every  legislature  ;  and  the  only  safe  prac- 
tical guide  for  one  desiring  to  begin  the  practice  of  dentistry  in  any  State  is 
to  consult  its  most  recent  statute  book.  A  summary  of  the  law  made  to-day 
might  prove  to-morrow  a  mere  Jack-o'-lantern  misleading  the  inquirer.  It 
may  be  said  generally,  however,  that  the  prevalent  requirement  of  license 
is  that  the  candidate  shall  appear  before  a  board  of  dental  examiners 
appointed  by  the  State  or  State  Dental  Society,  and  either  satisfy  them 
that  he  holds  a  diploma  from  a  college  in  good  standing,  or  submit  to 
their  examination.  And  we  have  already  seen  that  the  courts  will  not 
allow  a  State  Board  to  delegate  its  powers  to  a  national  association^ 

*  41  &  42  Vict.  e.  33. 

t  Partridge  vs.  Geril  Council  Med.  Ed.  <f  Beg.;  L.  I,'.,  25  Q.  B.  90. 

X  Code  du  Chirurgien-Dentiste,  supra. 

§  Illinois  State  Board  Dental  Exrs.  vs.  People,  123  111.  227. 


64G  ^   SYSTEM  OF  LEGAL   MEDICINE. 

The  contract  of  the  dentist  is  governed  by  the  same  rule  as  to  the 
standard  of  skill  and  knowledge  which  applies  to  the  physician.  A 
dentist  must  have  and  exercise  the  reasonable  and  ordinary  knowledge, 
skill,  and  care  of  his  profession*  In  a  New  York  case  it  was  said  that  a 
dentist  owed  the  highest  degree  of  skill  and  care  to  a  patient  under  the 
influence  of  an  anaesthetic,  and  that  the  fact  that  the  operator  instead 
of  extracting  the  tooth  of  the  unconscious  man  let  it  slip  down  his 
throat,  was  sufficient  proof  of  negligence  to  carry  the  case  to  the  jury.t 
In  administering  chloroform,  however,  it  was  said  in  a  Pennsylvania 
case  that  a  dentist  was  only  bound  to  look  to  the  natural  and  probable 
effects  of  the  anaesthetic! 

It  has  been  seen  above  that  the  confidential  relations  between  physi- 
cian and  patient  render  extraordinary  agreements  by  the  latter  in  the 
former's  favor  suspicious ;  and  in  a  grotesque  case  where  a  dentist  took 
from  a  pensioner  of  Greenwich  Hospital  a  bill  of  exchange  for  £262  10s. 
upon  an  alleged  agreement  to  keep  the  old  gentleman  supplied  with 
teeth  for  the  rest  of  his  life,  the  court  held  the  agreement  to  be  a  gross 
fraud.§ 

Partnerships,  signs,  and  such  matters  are,  of  course,  regulated  by 
the  ordinary  rules  of  law  in  such  cases  provided.  And  so  far  as  signs 
and  advertising  are  concerned,  there  is  no  call  to  cite  authorities  in  a 
book  intended  for  professional  men. 


PHARMACISTS. 

Reference  has  been  already  made  to  the  manner  in  which  the  apothe- 
cary became  in  England  a  general  practitioner  of  medicine,  being  suc- 
ceeded in  his  ancient  and  narrower  function  by  the  pharmacist  and 
chemist.  In  the  practical  administration  of  medical  laws,  constant  com- 
plaint is  heard  against  "  counter-prescribers,"  so  called,  who  are  the  true 
successors  of  apothecary  Rose,  who  made  the  great  fight  against  the 
College  of  Physicians  and  Surgeons.  It  is  chiefly  in  sparsely  settled 
districts  and  the  poorer  quarters  of  great  cities  that  the  druggist  as- 
sumes to  act  as  a  physician.  The  test  of  whether  he  violates  the  law 
in  any  instance  must  be  determined  by  the  particular  facts  of  each  case, 
for,  as  was  said  by  Mr.  Justice  Hawkins  in  a  case  already  cited,  "  It  is 
idle  to  lay  down  a  golden  rule  upon  the  subject."  ||  It  becomes  always  a 
question  of  fact  whether  under  the  proven  circumstances  the  druggist 
merely  sold  an  article,  as  he  is  entitled  to  do,  or  prescribed  it  after  the 
manner  of  a  physician. 

A  druggist  is  responsible  for  all  injury  due  to  his  lack  of  reasonable 
knowledge,  skill,  and  care.  He  is  bound  to  know  the  properties  of  med- 
icines and  to  employ  competent  assistants,  for  whose  acts  in  the  course 
of  his  business  he  is  also  liable.  In  the  leading  case  of  Thomas  vs.  Win- 
chester]] the  defendant  was  held  liable  for  injuries  resulting  from  a  mis- 

*  Simonds  vs.  Henry,  39  Me.  155. 

t  Keih)  vs.  Colton,  1  City  Court  (N.  Y.),  439. 

t  Bogle  vs.  Winslmv,  5  Phila.  136. 

§  Allen  vs.  Davis,  4  De.  G.  &  S.  133. 

||  Apothecaries  Co.  vs.  Jones  (1893),  5  R.  101 :  1  Q.  B.  89 :  67  L.  T.  677. 

1T  6  N.  Y.  397. 


LEGAL   RELATIONS   OF  PHYSICIANS  AND   SURGEONS.  647 

take  of  his  assistant  in  labeling  a  jar  of  belladonna  as  dandelion,  which 
jar  was  first  sold  to  one  Aspinwall,  by  him  to  Ford,  and  by  Ford  to 
the  plaintiff.  In  two  Kentucky  cases*  druggists  were  held  liable,  the 
one  for  selling  cantharides  on  a  prescription  calling  for  snake-root 
and  pernvian  bark,  the  other  for  selling  croton  oil  instead  of  linseed ; 
and  in  Michigan  t  a  defendant  was  held  liable  for  his  clerk's  error  in 
dispensing  sulphate  of  zinc  for  Epsom  salts.  But  although  a  drug- 
gist sells  a  poisonous  drug  without  labeling  it,  he  is  not  responsible 
for  its  reckless  use  by  one  whom  he  has  warned  of  its  properties,^  and 
he  is  entitled  to  have  the  competency  of  his  clerk  submitted  to  a  jury, 
together  with  the  cpiestion  whether  there  was  actual  negligence  in  the 
case.§ 

Although  one  who  manages  a  pharmacy  is  recpiired  to  have  a  certifi- 
cate of  competency  under  the  statutes  of  many  of  the  States,  neverthe- 
less one  who  is  not  entitled  to  such  certificate  may  invest  his  money  in 
a  pharmacy  and  employ  a  duly  certified  agent  to  carry  it  on  jj|  but  he 
cannot  take  part  in  the  conduct  of  the  pharmacy  himself  .fl 

A  pharmacist  entitled  to  register,  and  who  has  applied  so  to  do  and 
paid  his  fee,  has  been  held  not  liable  under  the  statute  of  Illinois  if  the 
Board  of  Pharmacy  failed  to  register  him.** 

The  sale  of  poisons  and  intoxicants  being  now  almost  universally 
regulated  by  law,  it  behooves  both  physicians  and  druggists  to  know  the 
statutory  regulations  of  their  domiciles  in  this  regard.  The  fact  that  in- 
toxicants or  poisons  are  sold  under  a  physician's  prescription  is  no  de- 
fense if  the  vendor  has  no  license.tt 

Under  the  British  Pharmacy  Act,Jf  forbidding  the  sale  by  unregis- 
tered persons  of  certain  poisons,  but  exempting  patent  medicines,  the 
exemption  is  held  not  to  embrace  all  proprietary  remedies,  but  only 
those  covered  by  letters  patent.§§  But  a  sale  of  poison  under  the  act  is 
not  established  by  proving  the  sale  of  a  compound  containing  an  infini- 
tesimally  small  quantity  of  a  poison  defined  by  the  act.|||| 

An  unregistered  assistant,  who  in  his  master's  absence  sells  a  poison, 
is  liable  to  the  penalty  under  this  statute.^ 

There  is  a  joyous  opinion  in  a  Georgia  case  of  interest  to  physicians, 
druggists,  and  laymen  alike,  for  it  holds  that  whiskey  is  not  a  drug. 
The  term  drug,  said  the  learned  and  experienced  court,  "  carries  along 
with  it  an  idea  inseparable  from  it,  of  something  repulsive,  nauseous — 
at  which  the  gorge  heaves.  Whiskey,  on  the  contrary,  is  inviting,  ex- 
hilarating." And  the  court  also  argued  with  profundity  that  a  drug 
is  so  hard  to  sell  that  merchandise  difficult  to  dispose  of  is  commonly 

*  Fleet  et  al  vs.  Hollenkemp,  13  B.  Mon.  219 ;  Hansford's  Admx.  vs.  Payne  $•  Co., 
11  Bush.  380. 

t  Brown  vs.  Marshall,  47  Mich.  576. 

X   Wohlfahrt  vs.  Becker t,  92  N.  Y.  490. 

$  Beckwith  vs.  Oatman,  43  Hun,  265 ;  afd.  132  N.  Y.  94. 

||   Commonwealth  vs.  Johnson,  144  Pa.  St.  377;  22  Atl.  703. 

If  State  vs.  Norton,  67  Iowa,  641. 

**  Carberry  vs.  People,  39  111.  Ap.  506. 

tt  Druggists  eases,  85  Tenn.  449.  Liquor  cases,  37  Am.  E.  284.  Compare  with 
English  eases  below,  as  to  what  is  a  sale  of  liquor  or  poison. 

XX  31  &  32  Vict.  c.  121. 

U  Pharmaceutical  Socy,  vs.  Piper  (1893)  5  R.  296;  1  Q.  B.  686;  68  L.  T.  490. 

Illl  Pharmaceutical  Socy,  vs.  Delve,  L.  R.  1894,  1  Q.  B.  71. 

1111  Pharmaceutical  Socy,  vs.  Wheeldon,  24  Q.  B.  Div.  683. 


(>4S  ^   SYSTEM  OF  LEGAL  MEDICINE. 

so  called ;  whence  it  would  seem  to  follow  that  to  call  whiskey,  the  sale  of 
which  is  proverbially  easy,  a  drug,*  would  be  a  "palpable  misnomer." 
But  where  the  question  is  one  of  selling  on  Sunday,  it  would  seem  that 
over  the  border  such  toothsome  delicacies  as  peppermint  lozenges  will  be- 
held prim  a  facie  to  be  a  drug  or  medicine.t 

*  Gault  vs.  State,  34  Ga.  533. 

t  Beg.  vs.  Howarth,  33  U.  C.  Q.  B.  537. 


INDECENT  ASSAULT  UPON  CHILDREN. 

BY 

W.  TRAVIS  GIBB,  B.S.,  M.D. 


Definition. — According  to  the  English  and  American  Criminal  Codes, 
indecent  assault  is  ordinarily  denned  as  the  mere  touching,  by  a  man, 
of  the  genital  organs,  breasts,  or  legs  of  any  female  not  his  wife,  with- 
out her  consent,  even  though  the  parts  are  covered  with  clothes.  In 
the  French  and  most  of  the  German  codes  the  offense  is  designated  as 
"  unchaste  conduct."  Should  the  female  be  under  the  age  of  legal  con- 
sent, the  act,  even  with  her  consent,  would  constitute  the  crime  of  in- 
decent assault  upon  a  child. 

Legal  Aspect. — There  is  little  or  nothing  in  the  medico-legal  litera- 
ture pertaining  directly  to  the  crime  of  indecent  assault  upon  children, 
except  as  embraced  under  the  heading  of  ordinary  indecent  assault 
upon  a  female.  Reese,  in  his  Medical  Jurisprudence,  states  that  as  this 
crime  is  usually  committed  in  secret  and  without  witnesses,  the  law  re- 
ceives the  evidence  of  a  single  person,  the  complainant  or  prosecutrix, 
as  sufficient  to  establish  the  charge.  In  the  State  of  New  York  a  law 
has  been  recently  passed  which  permits  the  testimony  of  a  child,  even 
though  she  is  too  young  to  understand  the  nature  of  an  oath,  to  lie 
submitted  to  the  jury  for  what  such  an  appearance  is  worth  without  the 
formality  of  administering  the  oath.  As  false  accusations  are  exceed- 
ingly common,  medical  evidence  becomes  of  the  greatest  importance  ;is 
corroborative  proof,  and  it  is  therefore  exceedingly  important  that  the 
physician  examining  the  child  should  be  particularly  careful  in  making 
his  examination  and  framing  his  report,  for  it  is  frequently  upon  his 
testimony  that  the  prosecution  depends,  especially  if  there  have  been  no 
witnesses  to  the  assault,  and  the  victim  is  too  young  to  give  competent 
testimony. 

According  to  most  penal  codes,  the  consent  of  a  child,  even  though 
she  is  under  the  legal  age  for  consent  to  sexual  intercourse,  to  the  com- 
mission of  an  act  of  indecent  assault  is  considered  a  sufficient  defense 
to  the  charge;  but  in  the  State  of  New  York  the  accused  man  may  be 
prosecuted,  even  though  the  child  has  given  her  consent,  under  Section 
289  of  the  Penal  Code,  which  states  that : 

"  A  person  who 

"  1.  Willfully  causes  or  permits  the  life  or  limb  of  any  child  actually 

a  id 


(550  ^   SYSTEM  OF  LEGAL  MEDICINE. 

or  apparently  under  the  age  of  sixteen  years  to  be  endangered,  or  its 
health  to  be  injured,  or  its  morals  to  become  depraved ; 

"  2.  Willfully  causes  or  permits  a  child  to  be  placed  in  such  a  situation 
or  engage  in  such  an  occupation  that  its  life  or  limb  is  endangered,  or 
its  health  is  likely  to  be  impaired,  is  guilty  of  a  misdemeanor." 

While  the  term  "  indecent  assault  upon  a  child  "  usually  implies  the 
indecent  act  of  an  adult  male  toward  a  female  under  the  age  of  consent, 
it  is  equally  applicable  to  the  indecent  assault  of  an  adult  female  upon 
a  male  child,  or  of  an  adult  female  upon  a  female  child,  or  of  an  adult 
male  upon  a  male  child.  These  latter  varieties  of  indecent  assault  are 
not  as  common  as  the  first,  but  it  is  undeniably  true  that  they  occur 
much  more  frequently  than  is  generally  supposed,  although  but  few  of 
the  cases  are  brought  to  public  notice,  owing  to  the  difficulty  of  proving 
the  charge,  which,  from  the  peculiar  nature  of  the  offense  and  the  lack 
of  physical  evidence  upon  the  victim,  would  require  strong  corroborative 
testimony  in  order  to  secure  a  conviction.  This  corroboration  would 
necessarily  be  lacking,  for  if  the  accused  is  in  full  possession  of  his  or 
her  senses,  a  third  party  would  not  likely  be  permitted  to  witness  the 
assault.  Authentic  instances  of  indecent  assault  of  adult  females  upon 
male  children  are  comparatively  rare  in  the  literature  upon  the  subject, 
because  their  actions  toward  the  child,  even  though  they  might  arouse 
the  suspicions  of  a  witness,  could  be  easily  and  satisfactorily  explained. 
Krafft-Ebing  {Psychopath) a  Sexualis,  p.  377)  mentions  the  case  of  a  mar- 
ried woman,  thirty  years  of  age,  who  enticed  a  boy  of  five,  by  means  of 
mone}r  and  sweetmeats,  committed  an  indecent  assault  upon  him  by 
lustfully  handling  his  genitals,  causing  him  to  handle  hers,  and  then  en- 
deavored to  cause  him  to  have  intercourse  with  her. 

Women  suffering  from  nymphomania  or  some  other  variety  of  sexual 
perversion,  or  merely  for  the  purpose  of  revenge,  have  been  known  to 
make  an  indecent  assault  upon  the  sexual  organs  of  a  male  or  female 
child  and  produce  such  an  amount  of  damage  that  the  cases  have  been 
brought  to  the  notice  of  the  criminal  authorities.  There  are  a  number 
of  recorded  cases  where  an  adult  female,  with  the  design  to  so  enlarge 
the  genital  organs  of  a  child  as  to  fit  her  for  sexual  intercourse  with 
men,  introduces  her  fingers,  candles,  round  pieces  of  wood  or  stone  into 
the  child's  vagina.  In  the  observance  of  the  Phallic  worship  of  ancient 
Egypt,  stones  shaped  like  the  adult  male  genital  organ  were  forced  into 
the  vaginre  of  children  in  order  to  prepare  them  for  sexual  intercourse. 
The  practice  of  thus  injuring  children  is  common  in  southern  countries, 
and  mothers  themselves  will  frequently  inflict  these  injuries  upon  their 
own  children  for  the  purpose  of  selling  them  into  prostitution,  very 
young  children  being  particularly  desirable  for  sexual  intercourse,  es- 
pecially by  old  men.  Casper  mentions  the  case  of  a  girl  ten  years  of 
age,  whose  vagina  had  been  dilated  in  this  way  by  her  mother,  who  first 
used  her  fingers  as  dilators  and  then  forced  a  long  smooth  stone  into 
the  vagina.  Ogston  refers  to  this  iniquitous  practice  in  Edinburgh,  and 
describes  the  peculiar  funnel-like  dilatation,  which  is  likened  to  the 
mechanical  enlargement  mentioned  by  Tardieu  and  other  writers,  and 
found  in  passive  peederasts. 

In  Taylor's  Medical  Jurisprudence  is  mentioned  the  case  of  a  man  who 
committed  a  rape  upon  a  child,  who  admitted  that  he  had  first  used  a 
stick  to  enlarge  the  vaginal  orifice.     Several  years  ago,  in  New  York 


INDECENT  ASSAULT   UPON  CHILDREN  651 

city,  two  boys  attempted  to  commit  a  rape  upon  a  girl  nine  years  of  age, 
and  finding  her  vagina  too  small,  forced  sticks  into  it  in  order  to  en- 
large it. 

Penalty. — In  this  country,  in  most  of  the  States  in  which  the  crime 
of  indecent  assault  is  recognized  as  a  separate  offense  it  is  considered  a 
misdemeanor.  In  New  York,  according  to  the  new  penal  code,  it  is 
classed  as  an  assault  in  the  third  degree.  In  some  States,  notably 
Louisiana  and  Mississippi,  no  such  offense  is  recognized  under  the  spe- 
cific term  of  "indecent  assault,"  such  an  assault  being  considered  an 
assault  with  the  intent  to  commit  rape.  In  the  States  where  the  crime 
is  classed  as  a  misdemeanor,  the  average  penalty  is  one  year  in  the  pen- 
itentiary. Sometimes  a  fine,  or  both  a  fine  and  imprisonment,  are  im- 
posed. In  New  York  the  penalty  is  one  year  in  prison  or  a  fine  of  five 
hundred  dollars,  or  both.  In  the  States  where  the  crime  is  considered 
a  felony,  the  penalty  is  greater  and  the  confinement  is  in  state-prison, 
notably :  California,  two  and  a  half  years  in  state-prison ;  Illinois,  one 
to  fourteen  years ;  Michigan,  not  more  than  ten  years,  or  a  fine  not  ex- 
ceeding one  thousand  dollars,  or  both.  No  difference  is  made  in  the 
penalty  whether  the  victim  of  the  assault  is  an  adult  or  a  child.  (See 
Rape,  etc.,  vol.  ii.) 

Age  of  Consent. — "While  the  age  of  consent  of  females  has  no  bear- 
ing upon  the  penalty  for  the  crime  of  indecent  assault,  and  according  to 
the  common  law  the  consent  of  a  child  of  tender  years  is  considered  a 
sufficient  defense  for  the  crime,  it  is  of  great  importance  in  determining 
the  age  under  which  a  child  must  be  in  order  that  the  person  accused  of 
the  crime  of  indecent  assault  may  be  prosecuted  for  endangering  the 
morals  of  the  victim.  In  the  majority  of  States  a  child  is  considered 
capable  of  giving  consent  at  the  age  of  fourteen  years.  In  Alabama 
and  Mississippi  the  age  of  consent  is  ten  years ;  in  Louisiana  and  Texas 
it  is  twelve ;  in  Iowa  it  is  thirteen ;  in  Nebraska  it  is  fifteen ;  in  New 
York  and  Pennsylvania  it  is  sixteen ;  and  in  Kansas  and  Wyoming  it  is 
eighteen. 

Undoubtedly  the  largest  proportion  of  cases  of  indecent  assault  upon 
children  occur  among  the  older  girls,  but  in  most  of  these  cases  the 
child's  consent  has  been  obtained,  and  the  assaults  are  but  seldom  re- 
ported to  the  criminal  authorities,  as  but  little  or  no  physical  injury  is 
done  these  girls  by  an  indecent  assault  alone,  and  there  has  been  no 
witness.  When  the  children  are  very  young,  the  perpetrators  of  the 
assault  are  either  insane  or  intoxicated,  and  the  physical  injury  is  much 
greater  than  in  the  first  class  of  cases,  and  they  are  consequently  more 
likely  to  be  brought  to  public  notice. 

Varieties  of  Indecent  Assault. — A  common  form  of  indecent  assault 
upon  children  is  where  an  adult  male  or  female  permits  or  compels  a 
child  of  either  sex  to  perform  an  act  of  manustupration  upon  him  or 
her.  Numerous  instances  of  this  variety  of  assault  have  been  brought 
to  my  notice  as  examining  physician  of  the  New  York  Society  for  the 
Prevention  of  Cruelty  to  Children,  but  as  there  is  usually  no  corrobora- 
tive testimony  and  no  physical  evidences  upon  the  child,  the  cases  seldom 
find  their  way  into  court.  No  injury  except  a  moral  one  has  been  done 
the  child,  and  unless  the  crime  has  been  witnessed  by  some  third  person, 
the  evidence  of  the  victim,  who  is  often  too  young  to  testify,  is  not 
sufficient  to  secure  a  conviction.     If  the  child  is  old  enough  to  give  com- 


(552  <*  SYSTEM   OF  LEGAL  MEDICINE. 

petent  testimony,  he  or  she  will  often  try  to  shield  the  accused,  especi- 
ally it  the  act  was  done  with  the  subject's  full  consent. 

*  "  The  annals  of  legal  medicine  distinguish  as  the  equivalents  of  the 
impossible  physiological  sexual  act,  exhibition  of  the  genital  organs, 
lustful  handling  of  the  genital  organs  of  children,  inducing  them  to 
perform  manustupration  of  the  seducer  and  performing  masturbation 
and  flagellation  of  the  victim.  In  this  stage  the  intellect  may  be  suffi- 
ciently intact  to  allow  avoidance  of  publicity  and  discovery,  while  the 
moral  sense  is  too  far  gone  to  consider  the  moral  significance  of  the  act 
and  resistance  of  the  impulse."     {Psychopathia  Sexual  is,  p.  40.) 

Another  variety  of  indecent  assault  which  has  frequently  been 
brought  to  my  notice  in  the  examination  of  children  is  where  a  man,  for 
the  gratification  of  a  perverted  sexual  appetite,  applies  his  mouth  and 
tongue  to  the  external  genital  organs  of  a  female  child.  This  act,  des- 
ignated by  the  term  "  cunnilingus,"  while  it  is,  strictly  speaking,  an  in- 
decent assault,  is  classed  under  the  "crimes  against  nature,"  and  is 
punished  by  a  longer  term  of  imprisonment.  A  remarkable  instance  of 
this  species  of  moral  depravity  was  the  case  of  Mamie  Prosser,  a  well- 
developed  child  of  eleven  years,  whom  I  examined  for  the  Children's 
Society  in  September,  1892.  She  was  a  typical  example  of  a  New  York 
street  urchin,  dirty  and  uncared  for.  Three  men  and  two  boys  attempted, 
with  her  consent  and  for  the  payment  of  five  cents,  to  have  sexual  inter- 
course with  her,  but  failed,  as  her  vagina  was  too  small.  The  child 
stated  that  two  of  the  men,  finding  they  were  unable  to  effect  sexual 
intercourse,  applied  their  mouths  to  her  vulva.  The  men  admitted  that 
they  had  done  so.  All  five  pleaded  guilty  to  the  charge  of  abduction 
and  were  sentenced  to  state-prison. 

Another  case  in  point  was  that  of  the  manager  of  a  "female  base- 
ball team,"  a  man  fifty  years  of  age,  who  was  convicted  after  a  long- 
trial  of  the  crime  of  abduction.  The  child,  the  so-called  "  mascot "  of 
his  base-ball  team,  an  extremely  pretty,  well-developed  girl  fifteen  years 
of  age,  was  examined  in  July,  1892.  She  admitted  that  numerous  acts 
of  sexual  intercourse  had  occurred  between  her  and  the  accused,  with 
her  full  consent,  however.  On  the  witness-stand  she  stated  that  the  ac- 
cused man,  before  he  was  able  to  have  sexual  intercourse  with  her,  had 
compelled  her  to  perform  masturbation  upon  him  upon  numerous  occa- 
sions, and  that  he  had  frequently  performed  the  act  upon  her.  He  was 
tried  upon  the  charges  of  rape  and  abduction,  and  convicted  upon  the 
latter.  The  charge  of  indecent  assault  was  not  pressed,  as  there  was  no 
evidence  to  corroborate  that  of  the  child. 

The  Accused. — In  my  experience,  criminal  assaults  upon  children 
are  usually  perpetrated  by  men  who  are  insane,  old  men  beyond  the  age 
of  virility,  men  under  the  influence  of  liquor,  and  those  suffering  from 
some  form  of  perversion  of  the  sexual  instinct  which  may  be  akin  to  in- 
sanity.  In  southern  countries,  where  children  are  frequently  employed 
for  sexual  intercourse  by  men,  the  indecent  assaults  upon  their  genitals 
are  made  for  the  purpose  of  first  enlarging  these  organs.  Other  vari- 
eties of  indecent  assaults,  including  cunnilingus  and  manustupration, 
are  usually  perpetrated  by  sexual  perverts.  Those  developing  senile 
dementia  due  to  brain  atrophy  and  psychical  degeneration  first  exhibit 
a  sexual  perversion  by  lascivious  speech  and  gestures  in  the  presence  of 
females;  then  they  devote  their  attention  to  children,  because  of  the 


INDECENT  ASSAULT   UPON  CHILDREN.  653 

better  facilities  for  secret  gratification,  but  more  especially  because  of 
their  knowledge  of  their  own  deficiency  in  sexual  power  which  would 
keep  them  from  approaching  adidts.  This  perversion  of  the  sexual  im- 
pulses in  very  old  men  may  be  explained  by  reason  of  their  defective 
sexual  powers  and  greatly  diminished  moral  sense.  Other  motives  im- 
pelling an  adult  to  make  an  indecent  assaidt  upon  a  child  may  be  jealousy 
or  a  desire  on  the  part  of  the  perpetrator  to  obtain  revenge  upon  the 
parents  or  friends  of  the  child  for  some  real  or  supposed  injury. 

The  usual  defense  advanced  by  the  accused  perpetrator  of  an  indecent 
assault  is  an  alibi,  which,  if  sustained,  is  necessarily  a  complete  defense. 
He  may  also  attempt  to  prove  that  the  offense  was  committed  with 
the  child's  full  consent  by  showing  that  the  assault  occurred  in  a  place 
where  the  child  had  but  to  make  an  outcry  to  have  obtained  assistance. 
The  accused  frequently  claims  that  the  child  solicited  the  assault,  but 
even  had  she  done  so,  he  can  be  held  and  prosecuted  (in  the  State  of 
New  York)  under  Section  289  of  the  penal  code.  Another  line  of  de- 
fense offered  by  the  defendant  is  that  he  placed  his  hands  under  the 
girl's  clothes  at  her  request  in  order  to  arrange  some  article  of  her  dress 
that  had  become  loosened,  and  that  it  was  not  his  intention  to  violate 
chastity.  The  absence  of  any  corroborative  testimony  or  marks  of  vio- 
lence upon  the  child,  especially  if  the  accused  can  prove  a  uniformly 
good  character,  would  undoubtedly  cause  him  to  be  given  the  benefit  of 
a  reasonable  doubt  if  tried. 

False  Accusations. — False  accusations  of  indecent  assaidt  upon 
children  have  been  brought  against  men,  sometimes  intentionally  and 
at  times  unintentionally.  Intentional  false  accusations  are  usually 
brought  for  the  purpose  of  revenge,  and  in  such  cases  the  child  will 
have  been  taught  the  story  she  repeats.  Cases  are  recorded  where  the 
parties  interested  in  procuring  the  accusation  have  so  irritated  the  geni- 
tals of  the  child  as  to  make  them  appear  as  if  an  assault  had  actually 
taken  place.  Such  cases  rarely  go  so  far  as  a  trial  in  a  criminal  court, 
as  their  real  merits  are  easily  discovered  if  the  child  is  made  to  tell  her 
story  while  apart  from  her  friends  or  those  particularly  interested  in 
making  the  accusation. 

What  was  apparently  an  instance  of  an  unintentional  false  accusa- 
tion of  indecent  assault  was  brought  to  my  notice  in  a  case  where  a  man 
was  accused  of  placing  his  hands  under  the  clothes  and  upon  the  person 
of  a  child  three  years  of  age.  The  complainant  was  an  old  woman  who 
Jived  in  a  house  adjoining  that  of  the  accused,  her  windows  being  on  a 
level  with  his,  but  situated  on  the  opposite  side  of  a  fifteen-foot  court- 
yard. She  testified  that  she  had  seen  the  accused  place  his  hands  under 
the  child's  clothing  on  several  occasions  as  he  and  the  child  were  stand- 
ing at  the  window  of  his  apartment.  The  offense  appeared  so  plain  to 
her  that  she  made  complaint,  and  the  man  was  arrested.  I  examined 
the  child,  but  could  find  no  evidences  of  injury.  On  the  trial  the  ac- 
cused man  stated  that  he  had  merely  buttoned  the  child's  drawers, 
which  had  become  loosened.  There  was  no  corroboration  of  the  com- 
plainant's testimony,  and  the  child  was  too  young  to  testify.  The  man 
produced  witnesses  to  vouch  for  his  good  character,  and  he  was  acquitted. 

Severity  of  the  Assaults. — Indecent  assault  upon  children  varies  in 
the  severity  of  its  effects  from  the  merest  physical  contact  of  the  hands 
of  the  assailant  upon  the  genital  organs  or  breasts  of  the  child,  leaving 


654  A    SYSTEM  OF  LEGAL  MEDICINE. 

no  evidences  upon  the  child  which  can  be  detected  by  the  medical  exam- 
iner, to  injuries  so  severe  and  extensive,  involving  not  only  the  genitals 
but  any  other  portion  of  the  body,  as  to  produce  a  fatal  result.  In  the 
absence  of  any  marks  of  external  violence  upon  the  child,  either  because 
no  physical  injury  has  been  done  or  because  all  traces  of  such  injuries 
have  disappeared  in  the  lapse  of  time  between  the  assault  and  the  ex- 
amination, the  testimony  of  the  medical  examiner  is  of  little  or  no  im- 
portance except  upon  questions  as  to  the  possibility  and  probability  of 
such  injuries  and  their  results. 

The  child  usually  states  that  "  he  put  his  hands  under  my  clothes  " ; 
sometimes  that  "  he  took  off  my  drawers  and  placed  his  hands  upon  me  "  ; 
or  again,  "he  put  something  into  me  that  scratched  and  hurt  me." 
(Taylor's  Medical  Jurisprudence.)  It  is  these  latter  cases  which  are 
brought  to  the  attention  of  the  medical  examiner,  and  the  extent  of  in- 
jury found  will  depend  entirely  upon  the  violence  of  the  assault,  the  in- 
strument used  in  its  commission,  and  the  time  elapsed  since  it  was 
committed.  The  victim's  body  will  present  evidences  of  injuries  in  pro- 
portion to  the  violence  used  and  the  resistance  on  the  part  of  the  child. 
The  body  and  limbs  may  present  ecchymoses  from  pressure  of  the 
assailant's  grasp,  contusions,  scratches,  and  cuts  from  blows  and  falls, 
but  the  genital  regions  are  usually  the  more  extensively  involved  in  the 
injury.  These  injuries  may  consist  of  an  irritation  of  the  external 
genitals  from  friction,  contusions,  burns,  scratches,  tears ;  especially 
from  the  introduction  of  the  finger  or  other  foreign  bodies,  as  pencils, 
meat-skewers,  sticks,  and  stones,  into  the  vagina ;  and  at  times  complete 
rupture  of  the  recto-vaginal  or  vagino-peritoneal  septa.  Injuries  other 
than  those  upon  the  genitals  cannot  be  called  direct  evidences  of  an  in- 
decent assault,  but  form  additional  proof  when  there  are  injuries  in  the 
genital  regions  or  corroborating  testimony  to  the  assault. 

The  mere  presence  of  evidences  of  characteristic  injuries  upon  the 
child's  genitals  should  not  be  taken  as  conclusive  proof  of  an  indecent 
assault,  for  such  injuries  may  frequently  be  the  result  of  masturbation 
with  the  finger  or  any  other  object  which  may  suit  the  child's  fancy,  or 
any  accidental  injury  may  account  for  the  condition  found.  Sometimes 
the  presence  of  filth  or  disease  may  be  responsible  for  the  irritated  or 
excoriated  condition  of  the  child's  genital  region  when  brought  for  ex- 
amination. In  all  cases  of  doubt  the  medical  examiner  should  state 
exactly  the  condition  he  finds  present,  leaving  the  proof  of  the  cause  of 
the  condition  to  the  general  testimony  m  the  case. 

A  vaginal  or  vulval  discharge  frequently  follows  an  indecent  assault, 
and  is  usually  due  to  the  injury  of  t?.e  mucous  membrane  and  the  deeper 
structures,  or  to  the  communication  of  some  disease  from  the  assailant's 
hands.  This  indirect  communication  of  a  venereal  disease  would  be 
easily  accomplished  should  a  man,  suffering  from  gonorrhoea  or  other 
venereal  disease,  first  handle  his  own  genital  organs  and  soon  afterward 
make  an  indecent  assault  upon  the  genitals  of  a  child.  The  discharge 
from  the  victim's  privates  may  be  mucous,  mueo-purulent,  or  purulent, 
according  to  the  character  and  severity  of  the  indecent  assault,  and  in 
doubtful  cases  cultures  and  microscopical  examination  should  be  made 
for  the  determination  of  the  gonococcus  which  will  make  the  character 
of  the  discharge  plain.  Investigation  of  the  genitalia  of  the  prisoner 
should  also  be  made. 


INDECENT  ASSAULT   UPON  CHILDREN.  (,55 

Evidences  of  a  recent  violent  indecent  assault  consist  in  severe  in- 
flammation and  tumefaction  of  the  vulva,  abrasions  of  the  mucous  mem- 
brane and  skin  about  the  genital  regions,  bleeding,  more  or  less  tearing 
of  the  deeper  structures,  hymen  completely  or  partially  lacerated,  vaginal 
mucous  membrane  torn  and  ecchymotic.  Severer  injuries,  such  as  com- 
plete rupture  of  the  recto- vaginal  or  vaginoperitoneal  septa,  are  recorded, 
but  fortunately  are  not  commonly  met  with. 

In  one  case  which  I  examined  for  the  Society  for  the  Prevention  of 
Cruelty  to  Children  in  August,  1893,  the  child,  eight  months  of  age,  had 
been  raped  by  her  father,  a  robust  Italian  about  thirty  years  old.  The 
child  had  been  very  severely  injured,  and  when  I  examined  her  I  found 
a  complete  rupture  of  the  perina?um,  extending  into  the  anus  and  in- 
volving a  portion  of  the  recto-vaginal  septum.  I  also  examined  the 
father,  and  found  a  large  abrasion  upon  the  dorsum  of  his  glans  penis. 
His  actions  plainly  indicated  that  he  was  insane.  The  child's  injuries 
were  of  such  a  nature  that  I  do  not  believe  they  could  have  been  pro- 
duced by  the  forcible  introduction  of  the  father's  penis  alone  without 
causing  greater  injury  to  that  organ.  It  is  my  opinion  that  the  man, 
suddenly  seized  with  an  insane  desire  for  sexual  intercourse,  attempted 
to  rape  his  own  baby,  but  finding  her  parts  too  small,  tore  out  with  his 
finger  the  perinaeum  and  recto-vaginal  septum,  and  then  was  able  to  in- 
sert his  penis.  The  man  was  subsequently  examined  and  pronounced 
insane. 

Another  case  of  this  kind  brought  to  me  for  examination  from  the 
same  society  was  a  girl,  seven  years  of  age,  who  stated  that  several  hours 
previously  a  Chinaman  had  removed  her  drawers  and  then  inserted  his 
finger  into  her  vulva.  On  examination  I  found  blood  oozing  from  her 
genitals,  the  parts  were  congested  and  irritated,  and  on  separating  the 
labia  I  detected  a  tear  through  the  base  of  the  hymen  upon  the  right 
side,  separating  it  from  the  lateral  vaginal  wall  for  a  distance  of  three 
eighths  of  an  inch,  extending  entirely  through  the  hymen  like  a  button- 
hole, but  leaving  its  free  margin  intact.  The  tear  was  undoubtedly 
produced  by  the  finger-nail. 

A  very  aggravated  case  of  what  was  undoubtedly  indecent  assault 
was  that  upon  a  child  five  years  of  age  by  her  father.  She  claimed  that 
the  prisoner  had  on  several  occasions  introduced  a  pencil  and  a  wooden 
meat-skewer  into  her  vagina.  On  examination  I  found  her  genitals  in- 
flamed and  irritated,  and  the  hymen  completely  and  recently  ruptured, 
the  edges  being  ragged  and  bieeding.  At  the  trial  the  child  was  con- 
sidered too  young  to  give  competent  testimony,  and  as  there  were  no 
other  witnesses  to  the  assault,  the  accused  was  given  the  benefit  of  a 
reasonable  doubt  and  discharged. 

Examination. — In  making  an  examination  of  a  child  upon  whom  it 
is  suspected  that  an  assault  has  been  perpetrated,  it  is  always  advisable 
to  strip  it  entirely,  so  that  a  thorough  examination  of  the  entire  surface 
of  the  bod}r  can  be  made  in  order  to  detect  any  contusions  or  abrasions 
which  might  form  additional  evidences  of  violence.  I  recently  examined 
two  children,  sisters,  aged  nine  and  seven  years  respectively,  whom  an 
Italian  tied  to  a  tree  and  outraged.  He  succeeded  in  committing  rape 
upon  the  older  child,  and  in  the  violence  of  his  attack  she  was  very 
seriously  injured.  Upon  the  younger  child  he  only  succeeded  in  com- 
mitting an  indecent  assault,  and  upon  stripping  her  I  found  numerous 


656  A   SYSTEM  OF  LEGAL  MEDLCLNE. 

contusions  upon  the  arms  and  body,  but  the  most  characteristic  injuries 
were  upon  her  thighs,  where  I  found  contusions  corresponding  to  the 
exact  imprints  of  his  thumbs  upon  the  inner  aspect,  and  of  his  four 
fingers  upon  the  outer  aspect  of  each  thigh,  showing  how  he  had  grasped 
the  child  in  order  to  force  her  thighs  apart.  There  were  no  injuries 
upon  the  genitals.  The  accused  man  was  tried  and  convicted  upon  the 
charge  of  rape  committed  upon  the  elder  girl,  the  child  upon  whom  he 
had  committed  the  indecent  assault  being  used  as  a  witness  against 
him. 

In  examining  the  genitals  care  should  be  taken  to  note  every  abnor- 
mal condition,  for  in  these  cases  the  injury  produced  by  the  assailant 
may  be  so  exceedingly  small  that  the  scratch  of  a  finger-nail,  the  rupture 
of  the  hymen  from  the  introduction  of  some  foreign  body,  or  the  con- 
tused imprint  of  a  finger  may  be  all  the  examining  physician  is  able  to 
detect.  The  exact  time  and  date  of  the  alleged  assault  and  of  the  ex- 
amination should  be  noted  carefully  in  order  that  the  physician  may 
determine  whether  the  condition  of  the  injuries  would  indicate  that  they 
had  existed  for  a  longer  or  a  shorter  period  than  that  which  has  elapsed 
since  the  assault. 

The  examination  of  the  child's  injuries  should  be  made  as  soon  as 
possible  after  the  alleged  assault,  for  the  evidences  of  physical  injuries, 
unless  they  have  been  extremely  serious,  will  disappear  within  a  very 
few  days.  The  condition  of  the  genitals  as  to  cleanliness  and  disease 
should  be  carefully  noted,  for  it  is  frequently  found  that  the  irritation 
and  discharge  from  which  she  is  suffering,  and  which  are  thought  by 
her  friends  to  be  the  result  of  an  indecent  assaidt,  are  merelv  the  natural 
consequences  of  filth  and  neglect,  or  sometimes  to  ascarides  that  find 
their  way  from  the  rectum  to  the  vulva  and  vagina. 

The  largest  majority  of  the  cases  of  indecent  assault  upon  children 
occur  among  the  poorest  and  most  depraved  classes  of  people,  and  if 
the  child  has  escaped  serious  physical  injury  no  notice  may  be  taken  of 
the  occurrence.  In  fact,  unless  the  child  is  very  young  or  the  assault 
has  been  witnessed  by  a  third  person,  the  knowledge  of  it  may  not 
reach  the  child's  parents  at  all.  If,  however,  the  child  has  received  a 
serious  injury,  she  is  usually  taken  to  a  dispensary  or  some  free  medical 
institution  for  treatment,  where  for  lack  of  time  too  often  little  attention 
is  paid  to  the  cause  of  the  condition  from  which  the  child  is  suffering, 
the  physicians'  entire  efforts  being  directed  to  the  appropriate  treatment. 
Even  if  a  history  of  an  indecent  assault  is  given,  the  physician  is  some- 
times loath,  especially  if  the  injury  is  slight,  to  report  it  to  the  proper 
authorities,  fearing,  if  he  does  so,  that  he  may  be  brought  to  court  as  a 
witness.  In  many  of  these  cases  a  careful  examination  by  the  attend- 
ing physician  into  the  character  and  cause  of  the  vaginal  irritation  and 
discharge  from  which  a  child  is  suffering  might  reveal  cases  of  rape 
and  indecent  assault  which  otherwise  would  remain  unknown,  and  when 
such  cases  are  known  it  is  the  duty  of  any  physician  to  report  them  to 
the  proper  authorities.  Many  of  the  vaginal  discharges  for  which  chil- 
dren of  this  class  are  brought  for  treatment  are  gonorrhoea!  in  their 
origin,  and  due  to  an  indecent  assault  or  attempted  rape,  but  which 
are  considered  by  their  physicians,  for  lack  of  proper  inquiry,  to  be 
cases  of  simple  vulvitis  or  vaginitis  due  to  filth  or  some  constitutional 
disease. 


INDECENT  ASSAULT   UPON  CHILDREN.  657 

As  far  as  practicable  the  medical  examination  of  the  child  should  be 
made  without  giving  her  or  her  friends  warning,  for  in  cases  of  false 
accusation  the  friends,  or  the  child  herself,  desiring  to  have  the  charge 
substantiated  by  the  corroborating  testimony  of  the  examining  physician, 
might  easily  so  irritate  the  genitals  as  to  make  it  appear  as  if  the  assault 
had  really  taken  place.  Any  refusal  on  the  part  of  the  friends  to  allow 
an  examination  of  the  child's  genitals  by  a  properly  authorized  disinter- 
ested physician  would  form  a  strong  point  in  circumstantial  evidence 
against  the  accusation. 


• 


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